Strongyloides stercoralis in Immunosuppressed Patients

Abstract

Context: Strongyloides stercoralis is a nematode parasite, which is endemic in tropical and subtropical regions. Infection usually remains asymptomatic, but in immunocompromised hosts, hyperinfection syndrome (HS) and disseminated disease (DD) can occur and can be related to a high mortality rate. Evidence Acquisition: An exhaustive bibliographic research was performed in the main biomedical databases, including PubMed, Scopus, Index Copernicus, DOAJ, EBSCO, Iranmedex, Scielo, and Google Scholar. Articles written in English, Spanish, and Portuguese were considered. Narrative and systematical reviews, case-control studies, observational studies, and remarkable case reports (due to atypical presentation) were included in the revision. Duplicated articles, abstracts only, and grey literature were not considered for revision. A narrative review of the included article was done. The databases were searched to identify review articles, original manuscripts, and case reports about strongyloidiasis in immunocompromised patients. Terms used in the search were the following: Strongyloides stercoralis, hyperinfection syndrome, immunosuppressed patients, AIDS, HIV, HTLV-1, transplant recipients, corticosteroid therapy, immunosuppressive drugs, sindrome de hiperinfestacion, pacientes inmunocomprometidos, SIDA, VIH, receptors de trasplantes, tratamiento con corticoides, e inmunosupresores. Results: S. stercoralis is an intestinal nematode that can survive in asymptomatic form in its human host for decades after the initial infection. However, this geohelmintic parasite can lead to a disseminated and fulminant hyperinfection syndrome in severely immunocompromised patients, or patients with HIV or HTLV-1 retroviral infections, especially those treated with high doses of corticosteroid therapy. Conclusions: Clinical features of strongyloidiasis are nonspecific, and a high index of suspicion is necessary for early diagnosis and to improve the poor prognosis of patients with hyperinfection syndrome due to S. stercoralis.