Management of Strongyloides Hyperinfection Syndrome

  • Shijing JiaEmail author
  • Hedwig S. Murphy
  • Melissa A. Miller


Strongyloides stercoralis is an infectious helminth endemic to the tropics and subtropics, and can be seen in immigrants and returning travelers. Symptoms of acute infection involve organs of the typical life cycle of the nematode. In milder forms of chronic infections, strongyloides is capable of persisting in a host for years to decades. Severe strongyloidiasis includes the hyperinfection syndrome and disseminated infection, and occurs most frequently in the immunocompromised and immunosuppressed populations. We illustrate a case of severe strongyloidiasis, discuss clinical manifestations and diagnosis of infection, and present the evidence for treatment options. The key to successful therapy is early recognition of disease, and prompt diagnosis in high risk patients.


Strongyloides Strongyloides stercoralis Severe strongyloidiasis Strongyloides hyperinfection Disseminated strongyloides infection Strongyloides treatment Ileus Helminthic infections 



Disclosure: The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality (AHRQ). No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.


  1. 1.
    Schar F, Trostdorf U, Giardina F, Khieu V, Muth S, Marti H, et al. Strongyloides stercoralis: global distribution and risk factors. PLoS Negl Trop Dis. 2013;7(7):e2288.CrossRefGoogle Scholar
  2. 2.
    Starr MC, Montgomery SP. Soil-transmitted helminthiasis in the United States: a systematic review – 1940–2010. Am J Trop Med Hyg. 2011;85(4):680–4.CrossRefGoogle Scholar
  3. 3.
    Roxby AC, Gottlieb GS, Limaye AP. Strongyloidiasis in transplant patients. Clin Infect Dis. 2009;49(9):1411–23.CrossRefGoogle Scholar
  4. 4.
    Maguire JH. Intestinal nematodes (roundworms). In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Elsevier/Saunders; 2015. p. 3199–207.Google Scholar
  5. 5.
    Greaves D, Coggle S, Pollard C, Aliyu SH, Moore EM. Strongyloides stercoralis infection. BMJ (Clin Res Ed). 2013;f4610:347.Google Scholar
  6. 6.
    Buonfrate D, Requena-Mendez A, Angheben A, Munoz J, Gobbi F, Van Den Ende J, et al. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis. 2013;13:78.CrossRefGoogle Scholar
  7. 7.
    Woodring JH, Halfhill H 2nd, Reed JC. Pulmonary strongyloidiasis: clinical and imaging features. AJR Am J Roentgenol. 1994;162(3):537–42.CrossRefGoogle Scholar
  8. 8.
    Siddiqui AA, Berk SL. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis. 2001;33(7):1040–7.CrossRefGoogle Scholar
  9. 9.
    Requena-Mendez A, Chiodini P, Bisoffi Z, Buonfrate D, Gotuzzo E, Munoz J. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoS Negl Trop Dis. 2013;7(1):e2002.CrossRefGoogle Scholar
  10. 10.
    Levenhagen MA, Costa-Cruz JM. Update on immunologic and molecular diagnosis of human strongyloidiasis. Acta Trop. 2014;135:33–43.CrossRefGoogle Scholar
  11. 11.
    Bisoffi Z, Buonfrate D, Angheben A, Boscolo M, Anselmi M, Marocco S, et al. Randomized clinical trial on ivermectin versus thiabendazole for the treatment of strongyloidiasis. PLoS Negl Trop Dis. 2011;5(7):e1254.CrossRefGoogle Scholar
  12. 12.
    Suputtamongkol Y, Premasathian N, Bhumimuang K, Waywa D, Nilganuwong S, Karuphong E, et al. Efficacy and safety of single and double doses of ivermectin versus 7-day high dose albendazole for chronic strongyloidiasis. PLoS Negl Trop Dis. 2011;5(5):e1044.CrossRefGoogle Scholar
  13. 13.
    Mejia R, Nutman TB. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis. 2012;25(4):458–63.CrossRefGoogle Scholar
  14. 14.
    Tarr PE, Miele PS, Peregoy KS, Smith MA, Neva FA, Lucey DR. Case report: rectal adminstration of ivermectin to a patient with Strongyloides hyperinfection syndrome. Am J Trop Med Hyg. 2003;68(4):453–5.CrossRefGoogle Scholar
  15. 15.
    Grein JD, Mathisen GE, Donovan S, Fleckenstein L. Serum ivermectin levels after enteral and subcutaneous administration for Strongyloides hyperinfection: a case report. Scand J Infect Dis. 2010;42(3):234–6.CrossRefGoogle Scholar
  16. 16.
    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(5):911–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Shijing Jia
    • 1
    Email author
  • Hedwig S. Murphy
    • 2
  • Melissa A. Miller
    • 3
  1. 1.Internal Medicine, Pulmonary and Critical CareUniversity of MichiganAnn ArborUSA
  2. 2.Department of PathologyUniversity of Michigan and Veterans Affairs Ann Arbor Health SystemAnn ArborUSA
  3. 3.Division of Healthcare-Associated InfectionsCenter for Quality Improvement and Patient Safety, Agency for Healthcare Research and QualityRockvilleUSA

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