Address correspondence to: Dr. This article has been cited by other articles in PMC. Strongyloides is a parasite that is very prevalent in the tropical and subtropical regions of the world and is endemic in the Southeastern United States. In hyperinfection syndrome, this classic life cycle is exaggerated ie, the parasite burden and turnaround increase and accelerate.
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Raja S Vadlamudi: moc. This article has been cited by other articles in PMC. Abstract In spite of recent advances with experiments on animal models, strongyloidiasis, an infection caused by the nematode parasite Strongyloides stercoralis, has still been an elusive disease.
Though endemic in some developing countries, strongyloidiasis still poses a threat to the developed world. Due to the peculiar but characteristic features of autoinfection, hyperinfection syndrome involving only pulmonary and gastrointestinal systems, and disseminated infection with involvement of other organs, strongyloidiasis needs special attention by the physician, especially one serving patients in areas endemic for strongyloidiasis.
Strongyloidiasis can occur without any symptoms, or as a potentially fatal hyperinfection or disseminated infection. Th2 cell-mediated immunity, humoral immunity and mucosal immunity have been shown to have protective effects against this parasitic infection especially in animal models.
Any factors that suppress these mechanisms such as intercurrent immune suppression or glucocorticoid therapy could potentially trigger hyperinfection or disseminated infection which could be fatal. Even with the recent advances in laboratory tests, strongyloidiasis is still difficult to diagnose. But once diagnosed, the disease can be treated effectively with antihelminthic drugs like Ivermectin.
This review article summarizes a case of strongyloidiasis and various aspects of strongyloidiasis, with emphasis on epidemiology, life cycle of Strongyloides stercoralis, clinical manifestations of the disease, corticosteroids and strongyloidiasis, diagnostic aspects of the disease, various host defense pathways against strongyloidiasis, and available treatment options.
Background In United States, strongyloidiasis is the most important nematode infection in humans with a tendency towards chronic persistent infection and with special characteristic features of autoinfection, hyperinfection involving pulmonary and gastrointestinal systems, and disseminated infection involving other organs [ 1 - 4 ]. Strongyloidiasis is caused by a soil dwelling nematode helminth, Strongyloides stercoralis. This helminth resides in the small intestine of the human host.
There is another species of same genus, Strongyloides fuelleborni that can also cause human infection but is mostly seen in African countries [ 4 ]. Infection with Strongyloides stercoralis was first reported in the year in French soldiers working in Vietnam [ 4 ].
It took nearly 50 years for the complete elucidation of the complex life cycle after the discovery of the parasite [ 4 ] because of the rare and characteristic feature of autoinfection that occurs in the life cycle.
Strongyloidiasis was first described by Fulleborn in [ 5 ]. First reports of disseminated infection or hyperinfection date back to when Cruz et al. Though many advances have been made in the diagnosis and treatment of strongyloidiasis, it still prevails as one of the elusive diseases to tackle in the present day world.
Strongyloidiasis may have a spectrum of manifestations ranging from the most common asymptomatic disease to potentially life threatening hyperinfection syndrome and disseminated disease.
The patients, if symptomatic, present with pulmonary and gastrointestinal symptoms. Most of them are found to have strongyloidiasis after a laboratory work up reveals an incidental finding of eosinophilia. This review article documents a case report with symptoms along with review of the epidemiology, biology of strongyloidiasis, clinical manifestations of the disease including hyperinfection syndrome, effect of systemic corticosteroids on strongyloidiasis, diagnostic aspects of the disease, various pathophysiological mechanisms and host defense pathways regulating strongyloidiasis, and different options available to treat the infection.
Case report A 77 year old male veteran with past medical history significant for chronic obstructive pulmonary disease, coronary artery disease status post coronary artery bypass graft, dyslipidemia, hypertension, and gastro esophageal reflux disease was found to have an incidental eosinophilia with He reported morning cough with small amounts of thick mucus.
He denied any epistaxis, difficulty in breathing, abdominal pain, diarrhea and constipation. He had lived in North East Tennessee for almost 30 yrs. He was an ex-smoker but had ceased to smoke almost 30 years ago.
On examination, he was an obese male with periorbital edema. Auscultation demonstrated a bruit just above the left sternoclavicular joint, but his chest was clear to auscultation.
A midline scar consistent with previous coronary bypass grafting was seen. The rest of the examination was essentially benign. Due to eosinophilia, a complete evaluation was carried out. Serological tests for strongyloidiasis were strongly positive with antibody titer of Repeat labs, 4 months after the second treatment with ivermectin, showed decreased strongyloid antibody titer to 5.
Strongyloides hyperinfection syndrome: an emerging global infectious disease.
Received Jun 23; Accepted Nov Published by Wolters Kluwer Health, Inc. The work cannot be changed in any way or used commercially without permission from the journal. We present a year-old man from Colombia who was undergoing corticosteroid therapy for a meningioma who presented after neurosurgery with abdominal pain and a profound gastrointestinal GI bleed. The patient underwent an esophagogastroduodenoscopy EGD , an attempted embolization, and an exploratory laparotomy to remove the necrosed duodenum.
Intestinal strongyloidiasis and hyperinfection syndrome