Advertisement

Current Infectious Disease Reports

, Volume 10, Issue 2, pp 105–110 | Cite as

Strongyloides stercoralis infection in the immunocompromised host

  • Roshan Ramanathan
  • Thomas B. Nutman
Article

Abstract

Strongyloides stercoralis is an intestinal nematode acquired in the tropics or subtropics. Most often, it causes chronic, asymptomatic infection, but a change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use is most commonly associated with hyperinfection syndrome. Diagnosis of Strongyloides infection is based on serology and serial stool examinations for larvae. The treatment of choice for chronic, asymptomatic infection is oral ivermectin. Alternative pharmacologic agents include albendazole and thiabendazole. For hyperinfection syndrome, ivermectin remains the drug of choice, though therapy duration must be individualized with the end point being complete parasite eradication. Recurrent strongyloidiasis should prompt an evaluation for human T-cell lymphotropic virus type 1 coinfection. No test of cure is currently available, although immunoglobulin G antibody levels have been shown to decline within 6 months of successful treatment.

Keywords

Ivermectin Albendazole Thiabendazole Duodenal Obstruction Protein Losing Enteropathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Genta RM: Strongyloidiasis. In Tropical Infectious Diseases. Edited by Guerrant RL. Philadelphia: Elsevier; 2005:1274–1282.Google Scholar
  2. 2.
    Al-Hasan MN, McCormick M, Ribes JA: Invasive enteric infections in hospitalized patients with underlying strongyloidiasis. Am J Clin Pathol 2007, 128:622–627.PubMedCrossRefGoogle Scholar
  3. 3.
    Posey DL, Blackburn BG, Weinberg M, et al.: High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis 2007, 45:1310–1315.PubMedCrossRefGoogle Scholar
  4. 4.
    Hirata T, Nakamura H, Kinjo N, et al.: Prevalence of Blastocystis hominis and Strongyloides stercoralis infection in Okinawa, Japan. Parasitol Res 2007, 101:1717–1719.PubMedCrossRefGoogle Scholar
  5. 5.
    Czachor JS, Jonas AP: Transmission of Strongyloides stercoralis person to person. J Travel Med 2000, 7:211–212.PubMedGoogle Scholar
  6. 6.
    Sugiyama K, Hasegawa Y, Nagasawa T, Hitomi S: Exposure of medical staff to Strongyloides stercolaris from a patient with disseminated strongyloidiasis. J Infect Chemother 2006, 12:217–219.PubMedCrossRefGoogle Scholar
  7. 7.
    Patel G, Arvelakis A, Sauter BV, et al.: Strongyloides hyperinfection syndrome after intestinal transplantation. Transpl Infect Dis 2007, [Epub ahead of print].Google Scholar
  8. 8.
    Ben-Youssef R, Baron P, Edson F, et al.: Stronglyoides stercoralis infection from pancreas allograft: case report. Transplantation 2005, 80:997–998.PubMedCrossRefGoogle Scholar
  9. 9.
    Said T, Nampoory MR, Nair MP, et al.: Hyperinfection strongyloidiasis: an anticipated outbreak in kidney transplant recipients in Kuwait. Transplant Proc 2007, 39:1014–1015.PubMedCrossRefGoogle Scholar
  10. 10.
    Keiser PB, Nutman TB: Strongyloides stercoralis in the Immunocompromised Population. Clin Microbiol Rev 2004, 17:208–217.PubMedCrossRefGoogle Scholar
  11. 11.
    Nutman TB: Evaluation and differential diagnosis of marked, persistent eosinophilia. Immunol Allergy Clin North Am 2007, 27:529–549.PubMedCrossRefGoogle Scholar
  12. 12.
    Leighton PM, MacSween HM: Strongyloides stercoralis. The cause of an urticarial-like eruption of 65 years’ duration. Arch Intern Med 1990, 150:1747–1748.PubMedCrossRefGoogle Scholar
  13. 13.
    Richter J, Muller-Stover I, Strothmeyer H, et al.: Arthritis associated with Strongyloides stercoralis infection in HLA B-27-positive African. Parasitol Res 2006, 99:706–707.PubMedCrossRefGoogle Scholar
  14. 14.
    Hsieh YP, Wen YK, Chen ML: Minimal change nephrotic syndrome in association with strongyloidiasis. Clin Nephrol 2006, 66:459–463.PubMedGoogle Scholar
  15. 15.
    Atul S, Ajay D, Ritambhara N, Harsh M, et al.: An unusual cause of malabsorption in an immunocompetent host. J Ayub Med Coll Abbottabad 2005, 17:85–86.PubMedGoogle Scholar
  16. 16.
    Suvarna D, Mehta R, Sadasivan S, et al.: Infiltrating Strongyloides stercoralis presenting as duodenal obstruction. Indian J Gastroenterol 2005, 24:173–174.PubMedGoogle Scholar
  17. 17.
    Harish K, Sunilkumar R, Varghese T, et al.: Strongyloidiasis presenting as duodenal obstruction. Trop Gastroenterol 2005, 26:201–202.PubMedGoogle Scholar
  18. 18.
    Gulbas Z, Kebapci M, Pasaoglu O, Vardareli E: Successful ivermectin treatment of hepatic strongyloidiasis presenting with severe eosinophilia. South Med J 2004, 97:907–910.PubMedCrossRefGoogle Scholar
  19. 19.
    Tullis DC: Bronchial asthma associated with intestinal parasites. N Engl J Med 1970, 282:370–372.PubMedGoogle Scholar
  20. 20.
    Hauber HP, Galle J, Chiodini PL, et al.: Fatal outcome of a hyperinfection syndrome despite successful eradication of Strongyloides with subcutaneous ivermectin. Infection 2005, 33:383–386.PubMedCrossRefGoogle Scholar
  21. 21.
    Yoshida H, Endo H, Tanaka S, et al.: Recurrent paralytic ileus associated with strongyloidiasis in a patient with systemic lupus erythematosus. Mod Rheumatol 2006, 16:44–47.PubMedCrossRefGoogle Scholar
  22. 22.
    Ramdial PK, Hlatshwayo NH, Singh B: Strongyloides stercoralis mesenteric lymphadenopathy: clue to the etiopathogenesis of intestinal pseudo-obstruction in HIV-infected patients. Ann Diagn Pathol 2006, 10:209–214.PubMedCrossRefGoogle Scholar
  23. 23.
    Csermely L, Jaafar H, Kristensen J, et al.: Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding. World J Gastroenterol 2006, 12:6401–6404.PubMedGoogle Scholar
  24. 24.
    Salluh JI, Bozza FA, Pinto TS, et al.: Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease? Braz J Infect Dis 2005, 9:419–424.PubMedCrossRefGoogle Scholar
  25. 25.
    Seet RC, Gong LL, Tambyath PA: Image of the month. Strongyloides stercoralis hyperinfection and syndrome of inappropriate secretion of antidiuretic hormone. Gastroenterology 2005, 128:8, 252.PubMedCrossRefGoogle Scholar
  26. 26.
    Ghosh K, Ghosh K: Strongyloides stercoralis septicaemia following steroid therapy for eosinophilia: report of three cases. Trans R Soc Trop Med Hyg 2007, 101:1163–1165.PubMedCrossRefGoogle Scholar
  27. 27.
    Hirata T, Uchima N, Kishimoto K, et al.: Impairment of host immune response against Strongyloides stercoralis by human T cell lymphotropic virus type 1 infection. Am J Trop Med Hyg 2006, 74:246–249.PubMedGoogle Scholar
  28. 28.
    Satoh M, Toma H, Sato Y, et al.: Reduced efficacy of treatment of strongyloidiasis in HTLV-I carriers related to enhanced expression of IFN-gamma and TGF-beta1. Clin Exp Immunol 2002, 127:354–359.PubMedCrossRefGoogle Scholar
  29. 29.
    Ratner L, Grant C, Zimmerman B, et al.: Effect of treatment of Strongyloides infection on HTLV-1 expression in a patient with adult T-cell leukemia. Am J Hematol 2007, 82:929–931.PubMedCrossRefGoogle Scholar
  30. 30.
    Gabet AS, Mortreux F, Talarmin A, et al.: High circulating proviral load with oligoclonal expansion of HTLV-1 bearing T cells in HTLV-1 carriers with strongyloidiasis. Oncogene 2000, 19:4954–4960.PubMedCrossRefGoogle Scholar
  31. 31.
    Viney ME, Brown M, Omoding NE, et al.: Why does HIV infection not lead to disseminated strongyloidiasis? J Infect Dis 2004, 190:2175–2180.PubMedCrossRefGoogle Scholar
  32. 32.
    Currie BJ, McCarthy JS: Strongyloides stercoralis infection as a manifestation of immune restoration syndrome? Clin Infect Dis 2005, 40:635.PubMedCrossRefGoogle Scholar
  33. 33.
    Seet RC, Lau LG, Tambyah PA: Strongyloides hyperinfection and hypogammaglobulinemia. Clin Diagn Lab Immunol 2005, 2:680–682.CrossRefGoogle Scholar
  34. 34.
    Siddiqui AA, Berk SL: Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 2001, 33:1040–1047.PubMedCrossRefGoogle Scholar
  35. 35.
    Sato Y, Kobayashi J, Toma H, Shiroma Y: Efficacy of stool examination for detection of Strongyloides infection. Am J Trop Med Hyg 1995, 53:248–250.PubMedGoogle Scholar
  36. 36.
    Rivasi F, Pampiglione S, Boldorini R, Cardinale L: Histopathology of gastric and duodenal Strongyloides stercoralis locations in fifteen immunocompromised subjects. Arch Pathol Lab Med 2006, 130:1792–1798.PubMedGoogle Scholar
  37. 37.
    Ravi V, Ramachandran S, Thompson RW, et al.: Characterization of a recombinant immunodiagnostic antigen (NIE) from Strongyloides stercoralis L3-stage larvae. Mol Biochem Parasitol 2002, 125:73–81.PubMedCrossRefGoogle Scholar
  38. 38.
    van Doorn HR, Koelewijn R, Hofwegen H, et al.: Use of enzyme-linked immunosorbent assay and dipstick assay for detection of Strongyloides stercoralis infection in humans. J Clin Microbiol 2007, 45:438–442.PubMedCrossRefGoogle Scholar
  39. 39.
    Sithithaworn J, Sithithaworn P, Janrungsopa T, et al.: Comparative assessment of the gelatin particle agglutination test and an enzyme-linked immunosorbent assay for diagnosis of strongyloidiasis. J Clin Microbiol 2005, 43:3278–3282.PubMedCrossRefGoogle Scholar
  40. 40.
    Neva FA, Gam AA, Maxwell C, Pelletier LL: Skin test antigens for immediate hypersensitivity prepared from infective larvae of Strongyloides stercoralis. Am J Trop Med Hyg 2001, 65:567–572.PubMedGoogle Scholar
  41. 41.
    Igual-Adell R, Oltra-Alcaraz C, Soler-Company E, et al.: Efficacy and safety of ivermectin and thiabendazole in the treatment of strongyloidiasis. Expert Opin Pharmacother 2004, 5:2615–2619.PubMedCrossRefGoogle Scholar
  42. 42.
    Toma H, Sato Y, Shiroma Y, et al.: Comparative studies on the efficacy of three anthelminthics on treatment of human strongyloidiasis in Okinawa, Japan. Southeast Asian J Trop Med Public Health 2000, 31:147–151.PubMedGoogle Scholar
  43. 43.
    Gann PH, Neva FA, Gam AA: A randomized trial of single-and two-dose ivermectin versus thiabendazole for treatment of strongyloidiasis. J Infect Dis 1994, 169:1076–1079.PubMedGoogle Scholar
  44. 44.
    Marti H, Haji HJ, Savioli L, et al.: A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop Med Hyg 1996, 55:477–481.PubMedGoogle Scholar
  45. 45.
    Boken DJ, Leoni PA, Preheim LC: Treatment of Strongyloides stercoralis hyperinfection syndrome with thiabendazole administered per rectum. Clin Infect Dis 1993, 16:123–126.PubMedGoogle Scholar
  46. 46.
    Turner SA, Maclean JD, Fleckenstein L, Greenaway C: Parenteral administration of ivermectin in a patient with disseminated strongyloidiasis. Am J Trop Med Hyg 2005, 73:911–914.PubMedGoogle Scholar
  47. 47.
    Karunajeewa H, Kelly H, Leslie D, et al.: Parasite-specific IgG response and peripheral blood eosinophil count following albendazole treatment for presumed chronic strongyloidiasis. J Travel Med 2006, 13:84–91.PubMedCrossRefGoogle Scholar
  48. 48.
    Kerepesi LA, Keiser PB, Nolan TJ, et al.: DNA immunization with Na+-K+ ATPase (Sseat-6) induces protective immunity to larval Strongyloides stercoralis in mice. Infect Immun 2005, 73:2298–2305.PubMedCrossRefGoogle Scholar
  49. 49.
    Heukelbach J, Winter B, Wilcke T, et al.: Selective mass treatment with ivermectin to control intestinal helminthiases and parasitic skin diseases in a severely affected population. Bull World Health Organ 2004, 82:563–571.PubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Clinical Parasitology Unit and Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaUSA

Personalised recommendations