Review Article

Not Your Typical Strongyloides Infection: A Literature Review and Case Study

Authors: Elizabeth B. Foreman, MD, Philip J. Abraham, MD, Jeffrey L. Garland, MD

Abstract

Strongyloides hyperinfection syndrome is one of several clinical manifestations of strongyloidiasis and has a mortality rate exceeding 85%. The syndrome is characterized by a high organism burden owing to autoinfection and is most common in immunocompromised hosts. The recovery of multiple pathogens is likely due to a piggyback phenomenon that occurs when enteric pathogens are transferred to the bloodstream attached to Strongyloideslarvae. Herein, we describe a case of Strongyloides hyperinfection syndrome with a novel feature in a 69-year-old Venezuelan man. To our knowledge, this is the first case ofStrongyloides hyperinfection syndrome and Pneumocystis jiroveci pneumonia occurring simultaneously. Owing to its extremely high mortality rate, Strongyloides hyperinfection syndrome must be considered early in the differential diagnosis for respiratory failure when multiple pathogens are recovered in patients from endemic areas.


Key Points


* Strongyloides stercoralis is endemic to several regions of the United States as well as tropical and subtropical climates worldwide.


* Strongyloidiasis should be considered when patients' respiratory symptoms worsen after the start of therapy with corticosteroids or other immunosuppressants.


* Strongyloides hyperinfection syndrome has a mortality rate exceeding 85%.

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