Skip to main content
Download PDF

Strongyloides stercoralis infection in the immunocompromised host

Current Infectious Disease Reports volume 10, pages 105–110 (2008)Cite this 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.

References and Recommended Reading

  1. Genta RM: Strongyloidiasis. In Tropical Infectious Diseases. Edited by Guerrant RL. Philadelphia: Elsevier; 2005:1274–1282.

    Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  5. Czachor JS, Jonas AP: Transmission of Strongyloides stercoralis person to person. J Travel Med 2000, 7:211–212.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  7. Patel G, Arvelakis A, Sauter BV, et al.: Strongyloides hyperinfection syndrome after intestinal transplantation. Transpl Infect Dis 2007, [Epub ahead of print].

  8. Ben-Youssef R, Baron P, Edson F, et al.: Stronglyoides stercoralis infection from pancreas allograft: case report. Transplantation 2005, 80:997–998.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  10. Keiser PB, Nutman TB: Strongyloides stercoralis in the Immunocompromised Population. Clin Microbiol Rev 2004, 17:208–217.

    PubMed  Article  Google Scholar 

  11. Nutman TB: Evaluation and differential diagnosis of marked, persistent eosinophilia. Immunol Allergy Clin North Am 2007, 27:529–549.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  14. Hsieh YP, Wen YK, Chen ML: Minimal change nephrotic syndrome in association with strongyloidiasis. Clin Nephrol 2006, 66:459–463.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  16. Suvarna D, Mehta R, Sadasivan S, et al.: Infiltrating Strongyloides stercoralis presenting as duodenal obstruction. Indian J Gastroenterol 2005, 24:173–174.

    PubMed  Google Scholar 

  17. Harish K, Sunilkumar R, Varghese T, et al.: Strongyloidiasis presenting as duodenal obstruction. Trop Gastroenterol 2005, 26:201–202.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  19. Tullis DC: Bronchial asthma associated with intestinal parasites. N Engl J Med 1970, 282:370–372.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  23. Csermely L, Jaafar H, Kristensen J, et al.: Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding. World J Gastroenterol 2006, 12:6401–6404.

    PubMed  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  32. Currie BJ, McCarthy JS: Strongyloides stercoralis infection as a manifestation of immune restoration syndrome? Clin Infect Dis 2005, 40:635.

    PubMed  Article  Google Scholar 

  33. Seet RC, Lau LG, Tambyah PA: Strongyloides hyperinfection and hypogammaglobulinemia. Clin Diagn Lab Immunol 2005, 2:680–682.

    Article  Google Scholar 

  34. Siddiqui AA, Berk SL: Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 2001, 33:1040–1047.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Clinical Parasitology Unit and Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Center Drive, Building 4, Room B1-05, Bethesda, MD, 20892, USA

    Roshan Ramanathan

Authors
  1. Roshan Ramanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas B. Nutman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roshan Ramanathan.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ramanathan, R., Nutman, T.B. Strongyloides stercoralis infection in the immunocompromised host. Curr Infect Dis Rep 10, 105–110 (2008). https://doi.org/10.1007/s11908-008-0019-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-008-0019-6

Keywords

  • Ivermectin
  • Albendazole
  • Thiabendazole
  • Duodenal Obstruction
  • Protein Losing Enteropathy