Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding

SummaryStrongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.

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Immunosuppression with Antitumour Necrosis Factor Therapy Leading to Strongyloides Hyperinfection Syndrome

Case Reports in Infectious Diseases ◽

10.1155/2018/6341680 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Muhammad Farhan Khaliq ◽

Rayan E. Ihle ◽

James Perry

Keyword(s):

Respiratory Failure ◽

Multidisciplinary Approach ◽

Parasitic Infection ◽

Strongyloides Stercoralis ◽

Diagnostic Challenge ◽

Travel History ◽

Hyperinfection Syndrome ◽

Factor Therapy ◽

Low Prevalence ◽

Necrosis Factor

Strongyloides stercoralis is an endemic parasitic infection that can remain asymptomatic for years, but it can cause death in immunosuppressed individuals. Here, we present a case of Strongyloides hyperinfection in a 75-year-old male secondary to sepsis and chronic immunosuppression due to TNF-α inhibitors. Despite aggressive treatment including broad-spectrum antibiotics and antihelminths, his respiratory failure worsened and he died after palliative extubation. S. stercoralis infection remains a diagnostic challenge. Presentation with Strongyloides is often nonspecific, and eosinophilia is absent in hyperinfection. Diagnosis can be delayed, especially in low-prevalence areas where suspicion is low. Strongyloides should be considered in the differential diagnosis in the presence of risk factors including immunosuppressive therapy, and a travel history should be carefully obtained. Patients with recurrent enterobacterial sepsis or respiratory failure with diffuse infiltrates in the setting of eosinophilia should undergo testing for Strongyloides. A multidisciplinary approach can result in earlier diagnosis and favorable outcomes.

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Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.15-0355 ◽

2015 ◽

Vol 93 (4) ◽

pp. 822-827 ◽

Cited By ~ 3

Author(s):

Brittany Yee ◽

Thomas J. Savides ◽

Joseph M. Vinetz ◽

Nai-Wen Chi ◽

Lawrence A. Hansen ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Strongyloides Stercoralis ◽

Cushing Disease ◽

Hyperinfection Syndrome

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Strongyloides stercoralis in the Immunocompromised Population

Clinical Microbiology Reviews ◽

10.1128/cmr.17.1.208-217.2004 ◽

2004 ◽

Vol 17 (1) ◽

pp. 208-217 ◽

Cited By ~ 538

Author(s):

Paul B. Keiser ◽

Thomas B. Nutman

Keyword(s):

Hematologic Malignancy ◽

Clinical Manifestations ◽

Parasite Burden ◽

Strongyloides Stercoralis ◽

Glucocorticoid Treatment ◽

T Lymphotropic Virus ◽

Intestinal Nematode ◽

Increased Risk ◽

Hyperinfection Syndrome ◽

And Migration

SUMMARY Strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. S. stercoralis is unique among intestinal nematodes in its ability to complete its life cycle within the host through an asexual autoinfective cycle, allowing the infection to persist in the host indefinitely. Under some conditions associated with immunocompromise, this autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome, characterized by increased numbers of infective filariform larvae in stool and sputum and clinical manifestations of the increased parasite burden and migration, such as gastrointestinal bleeding and respiratory distress. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid treatment and human T-lymphotropic virus type 1 infection are the two conditions most specifically associated with triggering hyperinfection, but cases have been reported in association with hematologic malignancy, malnutrition, and AIDS. Anthelmintic agents such as ivermectin have been used successfully in treating the hyperinfection syndrome as well as for primary and secondary prevention of hyperinfection in patients whose exposure history and underlying condition put them at increased risk.

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Strongyloidiasis in the gastrointestinal biopsy

Pulse ◽

10.3329/pulse.v3i1.6551 ◽

1970 ◽

Vol 3 (1) ◽

pp. 27-28

Author(s):

A Khaled ◽

N Ara ◽

LL Chawdhury ◽

TA Nasir

Keyword(s):

Strongyloides Stercoralis ◽

Precise Estimate ◽

Stool Examination ◽

Disseminated Infection ◽

Human Host ◽

Infective Larvae ◽

Intestinal Nematode ◽

Hyperinfection Syndrome ◽

Detection And Diagnosis

Strongyloides stercoralis is an intestinal nematode of humans. It is estimated that tens of millions of persons are infected worldwide, although no precise estimate is available [1].S. stercoralis is distinguished by its ability-unusual among helminths-to replicate in the human host. This capacity permits ongoing cycles of autoinfection as infective larvae are internally produced. Strongyloides can thus persist for decades without further exposure of the host to exogenous infective larvae [2]. Most infected individuals are asymptomatic, but under some conditions associated with immunocompromise, this autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome and disseminated infection [3]. Diagnosis of Strongyloides stercoralis is usually made by stool examination. Detection and diagnosis of strongyloidiasis in the gastrointestinal biopsy is relatively rare [4].DOI: 10.3329/pulse.v3i1.6551Pulse Vol.3(1) July 2009 p27-28

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Löeffler síndrome caused by hyperinfection syndrome due to strongyloides stercoralis in a non-endemic area.

10.26226/morressier.5afac50ad0241f0023ccbc61 ◽

2018 ◽

Author(s):

Alba García-Moral

Keyword(s):

Endemic Area ◽

Strongyloides Stercoralis ◽

Hyperinfection Syndrome

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Strongyloides stercoralis Infestation in a Child: How a Nematode Can Affect Gut Microbiota

International Journal of Molecular Sciences ◽

10.3390/ijms22042131 ◽

2021 ◽

Vol 22 (4) ◽

pp. 2131

Author(s):

Stefania Pane ◽

Anna Sacco ◽

Andrea Iorio ◽

Lorenza Romani ◽

Lorenza Putignani

Keyword(s):

Gut Microbiota ◽

Bacterial Species ◽

Alpha Diversity ◽

Strongyloides Stercoralis ◽

Pulmonary Involvement ◽

Diversity Indices ◽

Parasite Infection ◽

Intestinal Nematode ◽

Immune Mediated ◽

Stool Samples

Background: Strongyloidiasis is a neglected tropical disease caused by the intestinal nematode Strongyloides stercoralis and characterized by gastrointestinal and pulmonary involvement. We report a pediatric case of strongyloidiasis to underline the response of the host microbiota to the perturbation induced by the nematode. Methods: We performed a 16S rRNA-metagenomic analysis of the gut microbiota of a 7-year-old female during and after S. stercolaris infection, investigating three time-point of stool samples’ ecology: T0- during parasite infection, T1- a month after parasite infection, and T2- two months after parasite infection. Targeted-metagenomics were used to investigate ecology and to predict the functional pathways of the gut microbiota. Results: an increase in the alpha-diversity indices in T0-T1 samples was observed compared to T2 and healthy controls (CTRLs). Beta-diversity analysis showed a shift in the relative abundance of specific gut bacterial species from T0 to T2 samples. Moreover, the functional prediction of the targeted-metagenomics profiles suggested an enrichment of microbial glycan and carbohydrate metabolisms in the T0 sample compared with CTRLs. Conclusions: The herein report reinforces the literature suggestion of a putative direct or immune-mediated ability of S. stercolaris to promote the increase in bacterial diversity.

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cGMP and NHR Signaling Co-regulate Expression of Insulin-Like Peptides and Developmental Activation of Infective Larvae in Strongyloides stercoralis

PLoS Pathogens ◽

10.1371/journal.ppat.1004235 ◽

2014 ◽

Vol 10 (7) ◽

pp. e1004235 ◽

Cited By ~ 24

Author(s):

Jonathan D. Stoltzfus ◽

Stephen M. Bart ◽

James B. Lok

Keyword(s):

Strongyloides Stercoralis ◽

Infective Larvae

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Strongyloidosis Hyperinfection Syndrome in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

Case Reports in Infectious Diseases ◽

10.1155/2018/6870768 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Kartik Natrajan ◽

Mahenderkumar Medisetty ◽

Raviraj Gawali ◽

Ajit Tambolkar ◽

Divya Patel ◽

...

Keyword(s):

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Immunocompromised Host ◽

Strongyloides Stercoralis ◽

Parasitic Infections ◽

Infected Female ◽

Resource Limited ◽

Hyperinfection Syndrome ◽

Advanced Hiv Disease ◽

Inflammatory Syndrome

Parasitic infections such as Strongyloides stercoralis and HIV have been reported to coexist, particularly in resource-limited settings such as India. In an immunocompromised host, S. stercoralis can progress to strongyloidiasis hyperinfection syndrome (SHS). However, SHS is not common in patients with advanced HIV disease. Immune reconstitution inflammatory syndrome (IRIS) developing after initiation of antiretroviral therapy (ART) can target multiple pathogens including S. stercoralis. The authors present here a 46-year-old HIV-infected female who was recently diagnosed with HIV-1 infection, started ART, and developed SHS. Her upper GI endoscopy revealed severe gastroduodenitis, and X-ray chest showed extensive bilateral pneumonitis. We could identify S. stercoralis in induced sputum and duodenal biopsy. We could also identify gut inflammation to restrict invading parasites. After receiving antihelminthic therapy, she showed improvement, a course of events that fit the diagnosis of unmasking S. stercoralis IRIS.

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