Journal of Parasitic Diseases

, Volume 43, Issue 2, pp 167–175 | Cite as

Strongyloides stercoralis hyperinfection syndrome: a deeper understanding of a neglected disease

  • George Vasquez-RiosEmail author
  • Roberto Pineda-Reyes
  • Juan Pineda-Reyes
  • Ricardo Marin
  • Eloy F. Ruiz
  • Angélica Terashima
Review Article


Strongyloides stercoralis hyperinfection syndrome (SHS) is a life-threatening condition that warrants early detection and management. We describe the pathogenesis, organ-specific clinical manifestations, and risk factors associated to this condition. A comprehensive review of the literature was conducted in PubMed, LILACS, EBSCO and SciELO by using the keywords: “hyperinfection syndrome”; “Strongyloides stercoralis”; “disseminated strongyloidiasis”; “systemic strongyloidiasis”, “pathogenesis” and “pathophysiology”. Relevant articles on this topic were evaluated and included by consensus. Also, a secondary search of the literature was performed. Articles in English and Spanish language were included. SHS has been described in tropical and sub-tropical regions. However, there is growing evidence of cases detected in developed countries favored by increasing migration and the advance in immunosuppressive therapies for oncologic and inflammatory diseases. SHS is characterized by massive multiplication of larvae, typically in immunocompromised hosts. Clinical manifestations vary according to the organ involved and include diarrhea, intestinal bleeding, alveolar hemorrhages, heart failure, jaundice, bacteremia among others. Despite advances in the understanding of this condition, fatality rates are near 90%. Clinicians should consider SHS in the differential diagnosis of acutely ill patients with multiple organ damage and epidemiological risk factors. Adverse outcomes are common, especially with delayed anti-parasitic treatment.


Strongyloidiasis Autoinfection Massive infection Soil-transmitted helminths Clinical manifestations 



The authors would like to express their gratitude to the Laboratory of Parasitology at the Alexander von Humboldt Tropical Medicine Institute for their support to the elaboration of this manuscript.

Author’s contribution

GVR and RPR drafted the manuscript. GVR, RPR, JPR, RM, EFR and AT critically reviewed the literature, designed the study and made significant contributions to it. AT provided expert consultation for this topic. All the authors reviewed the manuscript and approved the final version.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Indian Society for Parasitology 2019

Authors and Affiliations

  • George Vasquez-Rios
    • 1
    Email author
  • Roberto Pineda-Reyes
    • 1
  • Juan Pineda-Reyes
    • 2
  • Ricardo Marin
    • 2
  • Eloy F. Ruiz
    • 1
  • Angélica Terashima
    • 1
    • 2
  1. 1.Laboratory of ParasitologyInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano HerediaLimaPeru
  2. 2.Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano HerediaLimaPeru

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