Autopsy and Case Reports
Autopsy and Case Reports
Article / Clinical Case Report

Strongyloides stercoralis hyperinfection associated with impaired intestinal motility disorder

Cláudia Frangioia Figueira; Márcio Teodoro da Costa Gaspar; Lynda Dorene Cos; Edson Yassushi Ussami; José Pinhata Otoch; Aloisio Felipe-Silva

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Infection by Strongyloides stercoralis is a highly prevalent helminthiasis, which is mostly distributed in the tropical and subtropical regions of the world. Although a substantial number of cases are asymptomatic or paucisymtomatic, severe and life-threatening forms of this infection still occur and not infrequently is lately diagnosed. Gram-negative bacteria septicemia, which frequently accompanies the severe helminthiasis, contributes to the high mortality rate. Severe infection is invariably triggered by any imbalance in the host's immunity, favoring the auto-infective cycle, which increases the intraluminal parasite burden enormously. Clinical presentation of severe cases is varied, and diagnosis requires a high suspicion index. Acute abdomen has been reported in association with S. stercoralis infection, but intestinal necrosis is rarely found during the surgical approach.

The authors report the case of a man who sought the emergency unit with recent onset abdominal pain. Clinical and imaging features were consistent with obstructive acute abdomen. Scattered adhesions and a necrotic ileal segment with a tiny perforation represented the surgical findings. The patient outcome was unfavorable and respiratory distress required an open lung biopsy. Both surgical specimens showed S. stercoralis infection. Unfortunately the patient underwent multiple organ failure and septicemia, and subsequently died.

The authors call attention to the finding of intestinal necrosis and impaired intestinal motility disorder as possibilities for the diagnosis and risk factor, respectively, for a severe infection of S. stercoralis.



Strongyloidiasis, , Intestinal Diseases, Parasitic


Concha R, Harrington W Jr, Rogers AI. Intestinal strongyloidiasis: recognition, management, and determinants of outcome. J Clin Gastroenterol. 2005;39(3):203-11. []. [PMID:15718861]

Benincasa CC, Azevedo FO, Canabarro MS, et al. [Strongyloides Stercoralis hyperinfection syndrome: case report]. Rev Bras Ter Intensiva. 2007;19(1):128-31. []. [PMID:25310671]

Puthiyakunnon S, Boddu S, Li Y, et al. Strongyloidiasis: an insight into its global prevalence and management. Plos Neg Trp Dis. 2014;6:e3018. [].

Bannon JP, Fater M, Solit R. Intestinal ileus secondary to Strongyloides stercoralis infection: case report and review of the literature. Am Surg. 1995;61(4):377-80. [PMID:7893110]

Sudré AP, Macedo HW, Peralta RHS, Paeralta JM. Diagnóstico da estrongiloidíase humana: importância e técnicas. Revista de Patologia Tropical. 2006;35:173-84.

Miller A, Smith ML, Judd JA, Speare R. Strongyloides stercoralis: systematic review of barriers to controlling strongyloidiasis for Australian indigenous communities. PLoS Negl Trop Dis. 2014;8(9):e3141. []. [PMID:25254655]

Suputtamongkol Y, Premasathian N, Bhumimuang K, 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. []. [PMID:21572981]

Giavina-Bianchi P, Silva FS, Toledo-Barros M, Birolini D, Kalil J, Rizzo LV. A rare intestinal manifestation in a patient with common variable immunodeficiency and strongyloidiasis. Int Arch Allergy Immunol. 2006;140(3):199-204. []. [PMID:16682801]

Rodrigues MAM, Fróes RC, Anefalos A, Kobayasi S. Invasive enteritis by Strongyloides stercoralis presenting as acute abdominal distress under corticosteroid therapy. Rev Hosp Clin Fac Med Sao Paulo. 2001;56(4):103-6. []. [PMID:11717716]

Ferreira CM, Barbosa NS, Ferreira WA, et al. Infecção pulmonar por Strongyloides stercoralis em paciente tratado com imunossupressores. Rev. Patol. Trop. 2008;37:275-80.

Igra-Siegman Y, Kapila R, Sen P, Kaminski ZC, Louria DB. Syndrome of hyperinfection with Strongyloides stercoralis. Rev Infect Dis. 1981;3(3):397-407. []. [PMID:7025145]

Shelhamer JH, Neva FA, Finn DR. Persistent strongyloidiasis in an immunodeficient patient. Am J Trop Med Hyg. 1982;31(4):746-51. [PMID:7102907]

Purtilo DT, Meyers WM, Connor DH. Fatal strongyloidiasis in immunosuppressed patients. Am J Med. 1974;56(4):488-93. []. [PMID:4818417]

Coovadia YM, Rajput MC, Bhana RH. Disseminated strongyloidiasis in a diabetic patient. Trop Geogr Med. 1993;45(4):179-80. [PMID:8236470]

Scowden EB, Schaffner W, Stone WJ. Overwhelming strongyloidiasis: an unappreciated opportunistic infection. Medicine. 1978;57(6):527-44. []. [PMID:362122]

Giannella RA, Broitman SA, Zamcheck N. Influence of gastric acidity on bacterial and parasitic enteric infections. A perspective. Ann Intern Med. 1973;78(2):271-6. []. [PMID:4567180]

Genta RM, Miles P, Fields K. Opportunistic Strongyloides stercoralis infection in lymphoma patients. Report of a case and review of the literature. Cancer. 1989;63(7):1407-11. [<1407::AID-CNCR2820630729>3.0.CO;2-I]. [PMID:2646009]

Morgan JS, Schaffner W, Stone WJ. Opportunistic strongyloidiasis in renal transplant recipients. Transplantation. 1986;42(5):518-23. []. [PMID:3097891]

Gotuzzo E, Terashima A, Alvarez H, et al. Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru. Am J Trop Med Hyg. 1999;60(1):146-9. [PMID:9988339]

Lessnau KD, Can S, Talavera W. Disseminated Strongyloides stercoralis in human immunodeficiency virus-infected patients. Treatment failure and a review of the literature. Chest. 1993;104(1):119-22. []. [PMID:8325052]

Ferreira MS, Nishioka SA, Borges AS, et al. Strongyloidiasis and infection due to human immunodeficiency virus: 25 cases at a Brazilian teaching hospital, including seven cases of hyperinfection syndrome. Clin Infect Dis. 1999;28(1):154-5. []. [PMID:10028097]

Brandão RM, Brandão RPM, Gonçalves ACMA, Laborda LS, Lima PP, Campos FPF. Strongyloides stercoralis disseminated infection and schistosomiasis in an AIDS patient. Autopsy Case Rep. 2012;2(4):35-44. [].

DeVault GA Jr, King JW, Rohr MS, Landreneau MD, Brown ST 3rd, McDonald JC. Opportunistic infections with Strongyloides stercoralis in renal transplantation. Rev Infect Dis. 1990;12(4):653-71. []. [PMID:2201067]

al-Bahrani ZR, al-Saleem T, al-Gailani MA. Sub-acute intestinal obstruction by Strongyloides stercolaris. J Infect. 1995;30(1):47-50. []. [PMID:7751666]

Friedenberg F, Wongpraparut N, Fischer RA, et al. Duodenal obstruction caused by Strongyloides stercoralis enteritis in an HTLV-1-infected host. Dig Dis Sci. 1999;44(6):1184-8. []. [PMID:10389694]

Nonaka D, Takaki K, Tanaka M, et al. Paralytic ileus due to strongyloidiasis: case report and review of the literature. Am J Trop Med Hyg. 1998;59(4):535-8. [PMID:9790425]

Ali-Khan Z, Seemayer TA. Fatal bowel infarction and sepsis: an unusual complication of systemic strongyloidiasis. Trans R Soc Trop Med Hyg. 1975;69(5-6):473-6. []. [PMID:1228984]

Gutierrez Y, Bhatia P, Garbadawala ST, Dobson JR, Wallace TM, Carey TE. Strongyloides stercoralis eosinophilic granulomatous enterocolitis. Am J Surg Pathol. 1996;20(5):603-12. []. [PMID:8619425]

Sen P, Gil C, Estrellas B, Middleton JR. Corticosteroid-induced asthma: a manifestation of limited hyperinfection syndrome due to Strongyloides stercoralis. South Med J. 1995;88(9):923-7. []. [PMID:7660209]

Luvira V, Watthanakulpanich D, Pittisuttithum P. Management of Strongyloides stercoralis: a puzzling parasite. Int Health. 2014;6(4):273-81. []. [PMID:25173343]

Swanson SJ, Phares CR, Mamo B, Smith KE, Cetron MS, Stauffer WM. Albendazole Therapy and Enteric Parasites. in United States–Bound Refugees. N Engl J Med. 2012; 366:1498-507.

Porto MA, Muniz A, Oliveira J Jr, Carvalho EM. Clinical and immunological consequences of the association between HTLV-1 and strongyloidiasis. Rev Soc Bras Med Trop. 2002;35(6):641-9.

Gokhale VA, Pillai R, Al-Mammari S. Al- Layla D. Hyperinfection by Strongyloides stercoralis. OMJ. 2010;25. [].

Luna B, Grasselli R, Ananias M, et al. Estrongiloidíase disseminada: diagnóstico e tratamento. Rer. Bras. Terapia Intensiva. 2007; 19:463-68.

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. []. [PMID:22691685]


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