Hyperinfection syndrome should be considered a potential medical emergency. Thus, treatment should be started immediately if this is being considered. Strongyloides stercoralis Hyperinfection remain quiescent indefinitely, immunosuppression can lead to the hyperinfection syndrome, which is. Whereas in chronic strongyloidiasis and in hyperinfection syndrome the larvae are limited to the GI tract and the lungs, in disseminated.

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Strongyloides is a parasite that is very prevalent in the tropical and subtropical regions of the world and is endemic in the Southeastern United States.

In hyperinfection syndrome, this classic life cycle is exaggerated ie, the parasite burden and turnaround increase and accelerate. The life cycle of Strongyloides is basically comprised of 2 parts: The cough reflex helps to push the larvae out of the bronchial tree and trachea. However, once the syndrrome reach the larynx, they are swallowed and travel to the stomach and small bowel.

A Fatal Strongyloides Stercoralis Hyperinfection Syndrome in a Patient With Chronic kidney Disease

Within the intestinal lumen, the eggs hatch into noninfective rhabditiform larvae, which are excreted, along with stool, into the environment ie, soil.

A unique feature of some nematodes, including Strongyloides, is their ability to cause autoinfection. This means that the parasite never reaches the soil; instead, it re-enters the host via enteral circulation endoautoinfection or perianal skin exoautoinfection. Thus, parasites can remain in the human body for the remainder of the host’s life.

One study found strongyloidiasis in a patient who had syjdrome undergone colectomy for suspected ulcerative colitis 10 ; this finding is important, as it demonstrates the occurrence of disease in a patient who no longer lived in an endemic area. Hyperinfection syndrome and disseminated strongyloidiasis can ensue in patients with impaired cell-mediated immunity such as transplant patients, patients receiving steroids or immunosuppressants, or patients infected dyndrome human T-cell lymphotrophic virus type 1.


Syndrime clinical presentation of hyperinfection syndrome symdrome similar to that of classic strongyloidiasis, which includes nausea, vomiting, diarrhea, weight loss, abdominal pain, GI hemorrhage, cough, fever, and dyspnea.

Some experts argue that the mere presence of eosinophilia is enough reason to search for this parasite. Biopsies obtained from the patient’s duodenum and gastric antrum suggested active chronic duodenitis and chronic sndrome, with nematodes most suggestive of Strongyloides stercoralis visualized within the crypts. Multiple biopsy specimens should be taken to increase the histopathologic yield, even if the duodenal mucosa does not manifest any major abnormalities.

Endoscopic view of the duodenal hyperinffction in a patient with Strongyloides hyperinfection syndrome. Note the diffuse mucosal swelling, erythema, and massive mucopurulent secretion on top of the mucosa. Resolution of eosinophilia does not always indicate clearance of Strongyloides. Because of the often gyperinfection course of disseminated strongyloidiasis, a strong case can be made that clinicians should search for this parasite in patients hhyperinfection transplantation.

Strongyloidiasis can involve many organs and, therefore, can have unspecific and unusual clinical manifestations, making the infection difficult to diagnose. Furthermore, lack of familiarity with this condition can have catastrophic consequences.

Due to its unique life cycle, Strongyloides is capable of infecting a host until death of the host. Strongyloidiasis can be a severe disease, causing both hyperinfection syndrome and disseminated disease, particularly in transplantation patients.


Clinicians should search for strongyloidiasis synxrome any patient awaiting transplantation who has epidemiologic risk factors or clinical or laboratory signs of the condition. National Center for Biotechnology InformationU. Gastroenterol Hepatol N Y. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Open in a separate window. Summary Strongyloidiasis can involve many organs and, therefore, can have unspecific and unusual clinical manifestations, making the infection difficult to diagnose.

Strongyloidiasis and other intestinal nematode infections.

Infect Dis Clin North Am. Strongyloidiasis in transplant patients. The spectrum of GI strongyloidiasis: Ganesh S, Cruz RJ. Gastroenterol Hepatol N Y ; 7: Severe strongyloidiasis in corticosteroid-treated patients: HTLV-1 decreases Th2 type of immune response in patients with strongyloidiasis.

Intestinal strongyloidiasis and hyperinfection syndrome

Risk factors for strongyloidiasis hyperinfection and clinical outcomes. Strongyloides hyperinfection syndrome after heart transplantation: J Heart Lung Transplant.

Chronic relapsing colitis due to Strongyloides stercoralis. Am J Trop Med Hyg. Global prevalence of strongyloidiasis: Unsuspected strongyloidiasis in hospitalised elderly patients with and without eosinophilia. Strongyloides infection in a cardiac transplant recipient: Streptococcus bovis bacteremia associated with Strongyloides stercoralis colitis.

Strongyloides stercoralis hyperinfestation syndrome with Escherichia coli meningitis: Strongyloides stercoralis eosinophilic granulomatous enterocolitis.

Am J Surg Pathol. Drugs for Parasitic Infections. The Medical Letter, Inc; Byperinfection for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Support Center Support Center. Please review our privacy policy.