Volume 95, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



is well known to cause hyperinfection syndrome during the period of immunosuppression; but dissemination, worsening hyperinfection, and development of multiorgan dysfunction syndrome after initiation of ivermectin has not been reported in the past. Herein, we describe the case of a 62-year-old man with chronic strongyloidiasis and human T-cell lymphotropic virus-1 coinfection, who developed significant clinical worsening after 24–48 hours of initiation of treatment with ivermectin (200 μg/kg daily). Oral albendazole (600 mg every 12 hours) was added to the regimen due to clinical deterioration. Notably, after a protracted clinical course with multiple complications, which included respiratory failure from gram-negative pneumonia and pulmonary alveolar hemorrhage, meningitis, colitis, and herpes labialis, the patient eventually recovered. Health-care providers should be aware that during the early days of antihelminthic treatment initiation, significant dissemination of and worsening of the clinical scenario can occur.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Keiser PB, Nutman TB, , 2004. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17: 208217.[Crossref] [Google Scholar]
  2. Gotuzzo E, Terashima A, Alvarez H, Tello R, Infante R, Watts DM, Freedman DO, , 1999. Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru. Am J Trop Med Hyg 60: 146149. [Google Scholar]
  3. Neva FA, Neva FA, , 1994. Intestinal nematodes of human beings. In: , ed. Basic Clinical Parasitology, 6th edition. Norwalk, CT: Appleton & Lange, 123128. [Google Scholar]
  4. Grove DI, Grove DI, , 1989. Clinical manifestations. In: , ed. Strongyloidiasis: A Major Roundworm Infection of Man. London: Taylor & Francis, 155173. [Google Scholar]
  5. Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, Ende JVD, Bisoffi Z, , 2013. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 13: 78.[Crossref] [Google Scholar]
  6. Olsen A, Van Lieshout L, Marti H, Polderman T, Polman K, Steinmann P, Stothard R, Thybo S, Verweij JJ, Magnussen P, , 2009. Strongyloidiasis: the most neglected of the neglected tropical diseases? Trans R Soc Trop Med Hyg 103: 967972.[Crossref] [Google Scholar]
  7. Boulware DR, Stauffer WM, Hendel-Paterson BR, Rocha JL, Seet RC, Summer AP, Nield LS, Supparatpinyo K, Chaiwarith R, Walker PF, , 2007. Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey. Am J Med 120: 541548.[Crossref] [Google Scholar]
  8. Berk SL, Verghese A, Alvarez S, Hall K, Smith B, , 1987. Clinical and epidemiologic features of strongyloidiasis: a prospective study in rural Tennessee. Arch Intern Med 147: 12571261.[Crossref] [Google Scholar]
  9. Walzer PD, Milder JE, Banwell JG, Kilgore G, Klein M, Parker R, , 1982. Epidemiologic features of Strongyloides stercoralis infection in an endemic area of the United States. Am J Trop Med Hyg 31: 313319. [Google Scholar]
  10. Dixon AC, Yanagihara ET, Kwock DW, Nakamura JM, , 1989. Strongyloidiasis associated with human T-cell lymphotropic virus type-I infection in a nonendemic area. West J Med 151: 410413. [Google Scholar]
  11. Milder JE, Walzer PD, Kilgore G, Rutherford I, Klein M, , 1981. Clinical features of Strongyloides stercoralis infection in an endemic area of the United States. Gastroenterology 80: 14811488. [Google Scholar]
  12. Mahmoud AAF, Mandell GL, Douglas RG, Bennett JE, , 1979. Intestinal nematodes (roundworms). , eds. Principles and Practice of Infectious Diseases. New York, NY: John Wiley and Sons, 21572164. [Google Scholar]
  13. Gill GV, Bell DR, , 1979. Strongyloides stercoralis infection in former Far East prisoners of war. Br Med J 2: 572574.[Crossref] [Google Scholar]
  14. Weller PF, Nutman TB, Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, , 2005: Intestinal nematodes. , eds. Harrison's Principles of Internal Medicine, 16th edition. New York, NY: McGraw-Hill, 12561260. [Google Scholar]
  15. Vadlamudi RS, Chi DS, Krishnaswamy G, , 2006. Intestinal strongyloidiasis and hyperinfection syndrome. Clin Mol Allergy 4: 8.[Crossref] [Google Scholar]
  16. Concha R, Harrington WJ, Rogers AI, , 2005. Intestinal strongyloidiasis: recognition, management, and determinants of outcome. J Clin Gastroenterol 39: 203211.[Crossref] [Google Scholar]
  17. Siddiqui AA, Genta RM, Berk SL, , 2002. Strongyloides stercoralis. Infect Gastrointestinal Tract 70: 11131126. [Google Scholar]
  18. Lim S, Katz K, Krajden S, Fuksa M, Keystone JS, Kain KC, , 2004. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. CMAJ 171: 479484.[Crossref] [Google Scholar]
  19. Link K, Orenstein R, , 1999. Bacterial complications of strongyloidiasis: Streptococcus bovis meningitis. South Med J 92: 728731.[Crossref] [Google Scholar]
  20. Siddiqui AA, Berk SL, , 2003. Strongyloidiasis. Curr Treat Options Infect Dis 5: 283289. [Google Scholar]
  21. Cremades Romero MJ, Igual AR, Ricart OC, Estelles PF, Pastor-Guzman A, Menendez VR, , 1997. Infection by Strongyloides stercoralis in the county of Safor, Spain. Med Clin (Barc) 109: 212215. [Google Scholar]
  22. Furuya N, Shimozi K, Nakamura H, Owan T, Tateyama M, Tamaki K, Fukuhara H, Kusano N, Shikiya T, Kaneshima H, , 1989. A case report of meningitis and sepsis due to Enterococcus faecium complicated with strongyloidiasis. Kansenshogaku Zasshi 63: 13441349.[Crossref] [Google Scholar]
  23. Chiu HH, Lai SL, , 2005. Fatal meningoencephalitis caused by disseminated strongyloidiasis. Acta Neurol Taiwan 14: 2427. [Google Scholar]
  24. Hovette P, Tuan JF, Camara P, Lejean Y, Lo N, Colbacchini P, , 2002. Pulmonary strongyloidiasis complicated by E. coli meningitis in a HIV-1 and HTLV-1 positive patient. Presse Med 31: 10211023. [Google Scholar]
  25. Troncoso GE, Munoz ML, Callejas Rubio JL, Lopez Ruz MA, , 2000. Klebsiella pneumoniae meningitis, Strongyloides stercoralis infection and HTLV-1. Med Clin (Barc) 115: 158.[Crossref] [Google Scholar]
  26. Jain AK, Agarwal SK, el Sadr W, , 1994. Streptococcus bovis bacteremia and meningitis associated with Strongyloides stercoralis colitis in a patient infected with human immunodeficiency virus. Clin Infect Dis 18: 253254.[Crossref] [Google Scholar]
  27. Genta RM, Douce RW, Walzer PD, , 1986. Diagnostic implications of parasite-specific immune responses in immunocompromised patients with strongyloidiasis. J Clin Microbiol 23: 10991103. [Google Scholar]
  28. Nandy A, Addy M, Patra P, Bandyopashyay AK, , 1995. Fulminating strongyloidiasis complicating Indian kala-azar. Trop Geogr Med 47: 139141. [Google Scholar]
  29. Siddiqui AA, Berk SL, , 2001. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 33: 10401047.[Crossref] [Google Scholar]
  30. Singh S, , 2002. Human strongyloidiasis in AIDS era: its zoonotic importance. J Assoc Physicians India 50: 415422. [Google Scholar]
  31. Newton RC, Limpuangthip P, Greenberg S, Gam A, Neva FA, , 1992. Strongyloides stercoralis hyperinfection in a carrier of HTLV-I virus with evidence of selective immunosuppression. Am J Med 92: 202208.[Crossref] [Google Scholar]
  32. Sauca SG, Barrufet BP, Besa BA, Rodriguez RE, , 2005. Strongyloides stercoralis hyperinfection in a patient with acquired immunodeficiency syndrome. Med Interna 22: 139141. [Google Scholar]
  33. Olmos M, Gracia S, Villoria F, Salesa R, Gonzalez-Macias J, , 2004. Disseminated strongyloidiasis in a patient with acquired immunodeficiency syndrome. Eur J Intern Med 15: 529530.[Crossref] [Google Scholar]
  34. Orem J, Mayanja B, Okongo M, Morgan D, , 2003. Strongyloides stercoralis hyperinfection in a patient with AIDS in Uganda successfully treated with ivermectin. Clin Infect Dis 37: 152153.[Crossref] [Google Scholar]
  35. Takayanagui OM, Lofrano MM, Araugo MB, Chimelli L, , 1995. Detection of Strongyloides stercoralis in the cerebrospinal fluid of a patient with acquired immunodeficiency syndrome. Neurology 45: 193194.[Crossref] [Google Scholar]
  36. Morgello S, Soifer FM, Lin CS, Wolfe DE, , 1993. Central nervous system Strongyloides stercoralis in acquired immunodeficiency syndrome: a report of two cases and review of the literature. Acta Neuropathol 86: 285288.[Crossref] [Google Scholar]
  37. Maayan S, Wormser GP, Widerhorn J, Sy ER, Kim YH, Ernst JA, , 1987. Strongyloides stercoralis hyperinfection in a patient with the acquired immune deficiency syndrome. Am J Med 83: 945948.[Crossref] [Google Scholar]
  38. Feely NM, Waghorn DJ, Dexter T, Gallen I, Chiodini P, , 2010. Strongyloides stercoralis hyperinfection: difficulties in diagnosis and treatment. Anaesthesia 65: 298301.[Crossref] [Google Scholar]
  39. Scowden EB, Schaffner W, Stone WJ, , 1978. Overwhelming strongyloidiasis: an unappreciated opportunistic infection. Medicine (Baltimore) 57: 527544.[Crossref] [Google Scholar]
  40. Purtilo DT, Meyers WM, Connor DH, , 1974. Fatal strongyloidiasis in immunosuppressed patients. Am J Med 56: 488493.[Crossref] [Google Scholar]
  41. Kaye D, , 1988. The spectrum of strongyloidiasis. Hosp Pract 23: 111126.[Crossref] [Google Scholar]
  42. Stewart DM, Ramanathan R, Mahanty S, Fedorko DP, Janik JE, Morris JC, , 2011. Disseminated Strongyloides stercoralis in HTLV-1-associated adult T-cell leukemia/lymphoma. Acta Haematol 126: 6367.[Crossref] [Google Scholar]
  43. Carvalho EM, Da Fonseca PA, , 2004. Epidemiological and clinical interaction between HTLV-1 and Strongyloides stercoralis . Parasite Immunol 26: 487497.[Crossref] [Google Scholar]
  44. Olson BG, Domachowske JB, , 2006. Mazzotti reaction after presumptive treatment for schistosomiasis and strongyloidiasis in a Liberian refugee. Pediatr Infect Dis J 25: 466468.[Crossref] [Google Scholar]
  45. Hunter CJ, Petrosyan M, Asch M, , 2008. Dissemination of Strongyloides stercoralis in a patient with systemic lupus erythematosus after initiation of albendazole: a case report. J Med Case Reports 2: 156.[Crossref] [Google Scholar]
  46. Thompson JR, Berger R, , 1991. Fatal adult respiratory distress syndrome following successful treatment of pulmonary strongyloidiasis. Chest 99: 772774.[Crossref] [Google Scholar]
  47. Vigg A, Mantri S, Anand V, Reddy P, Biyani V, , 2006. Acute respiratory distress syndrome due to Strongyloides stercoralis in non-Hodgkin's lymphoma. Indian J Chest Dis Allied Sci 48: 6769. [Google Scholar]
  48. Genta RM, , 1989. Global prevalence of strongyloidiasis: critical review with epidemiologic insights into the prevention of disseminated disease. Rev Infect Dis 11: 755767.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 04 Apr 2016
  • Accepted : 25 Jun 2016
  • Published online : 05 Oct 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error