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.
PuthiyakunnonS, BodduS, LiY, et al. Strongyloidiasis: an insight into its global prevalence and management. Plos Neg Trp Dis. 2014;6:e3018. [https://doi.org/10.1371/journal.pntd.0003018].
BannonJP, FaterM, SolitR. Intestinal ileus secondary to Strongyloides stercoralis infection: case report and review of the literature. Am Surg. 1995;61(4):377-80. [PMID:7893110]
SudréAP, MacedoHW, PeraltaRHS, PaeraltaJM. Diagnóstico da estrongiloidíase humana: importância e técnicas. Revista de Patologia Tropical. 2006;35:173-84.
MillerA, SmithML, JuddJA, SpeareR. Strongyloides stercoralis: systematic review of barriers to controlling strongyloidiasis for Australian indigenous communities. PLoS Negl Trop Dis. 2014;8(9):e3141. [https://doi.org/10.1371/journal.pntd.0003141]. [PMID:25254655]
SuputtamongkolY, PremasathianN, BhumimuangK, 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. [https://doi.org/10.1371/journal.pntd.0001044]. [PMID:21572981]
Giavina-BianchiP, SilvaFS, Toledo-BarrosM, BiroliniD, KalilJ, RizzoLV. A rare intestinal manifestation in a patient with common variable immunodeficiency and strongyloidiasis. Int Arch Allergy Immunol. 2006;140(3):199-204. [https://doi.org/10.1159/000093205]. [PMID:16682801]
RodriguesMAM, FróesRC, AnefalosA, KobayasiS. 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. [https://doi.org/10.1590/S0041-87812001000400002]. [PMID:11717716]
FerreiraCM, BarbosaNS, FerreiraWA, et al. Infecção pulmonar por Strongyloides stercoralis em paciente tratado com imunossupressores. Rev. Patol. Trop. 2008;37:275-80.
GiannellaRA, BroitmanSA, ZamcheckN. Influence of gastric acidity on bacterial and parasitic enteric infections. A perspective. Ann Intern Med. 1973;78(2):271-6. [https://doi.org/10.7326/0003-4819-78-2-271]. [PMID:4567180]
GotuzzoE, TerashimaA, AlvarezH, 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]
LessnauKD, CanS, TalaveraW. Disseminated Strongyloides stercoralis in human immunodeficiency virus-infected patients. Treatment failure and a review of the literature. Chest. 1993;104(1):119-22. [https://doi.org/10.1378/chest.104.1.119]. [PMID:8325052]
FerreiraMS, NishiokaSA, BorgesAS, 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. [https://doi.org/10.1086/517188]. [PMID:10028097]
BrandãoRM, BrandãoRPM, GonçalvesACMA, LabordaLS, LimaPP, CamposFPF. Strongyloides stercoralis disseminated infection and schistosomiasis in an AIDS patient. Autopsy Case Rep. 2012;2(4):35-44. [https://doi.org/10.4322/acr.2012.035].
DeVaultGAJr, KingJW, RohrMS, LandreneauMD, BrownST3rd, McDonaldJC. Opportunistic infections with Strongyloides stercoralis in renal transplantation. Rev Infect Dis. 1990;12(4):653-71. [https://doi.org/10.1093/clinids/12.4.653]. [PMID:2201067]
FriedenbergF, WongpraparutN, FischerRA, et al. Duodenal obstruction caused by Strongyloides stercoralis enteritis in an HTLV-1-infected host. Dig Dis Sci. 1999;44(6):1184-8. [https://doi.org/10.1023/A:1026636509713]. [PMID:10389694]
NonakaD, TakakiK, TanakaM, 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]
SenP, GilC, EstrellasB, MiddletonJR. Corticosteroid-induced asthma: a manifestation of limited hyperinfection syndrome due to Strongyloides stercoralis. South Med J. 1995;88(9):923-7. [https://doi.org/10.1097/00007611-199509000-00007]. [PMID:7660209]
SwansonSJ, PharesCR, MamoB, SmithKE, CetronMS, StaufferWM. Albendazole Therapy and Enteric Parasites. in United States–Bound Refugees. N Engl J Med. 2012; 366:1498-507.
PortoMA, MunizA, OliveiraJJr, CarvalhoEM. Clinical and immunological consequences of the association between HTLV-1 and strongyloidiasis. Rev Soc Bras Med Trop. 2002;35(6):641-9.
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