Strongyloidiasis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

If strongyloidiasis is left untreated, the infection can disseminate and transform into hyperinfection syndrome, which has a mortality rate of 90%. Complications that can develop as a result of strongyloidiasis are disseminated strongyloidiasis (especially in patients with HIV or who are otherwise immunocompromised), eosinophilic pneumonia, malnutrition, and malabsorption. With appropriate treatment, people should make a full recovery. Treatment needs to be repeated often. Infections that are severe or widespread often have a poor outcome, especially in patients with a suppressed immune system.

Natural history

If left untreated, the subclinical strongyloidiasis can disseminate and transform into hyperinfection syndrome, which has a mortality rate of 90%.^[1]

Complications

Complications that can develop as a result of strongyloidiasis are:^[2]^[3]

Disseminated strongyloidiasis(especially in patients with HIV and other immunocompromised conditions)
Polymicrobial sepsis including polymicrobial gram-negative meningitis
Eosinophilic pneumonia
Malnutrition
Malabsorption
Intestinal perforation

Prognosis

With appropriate treatment people should make a full recovery.
Sometimes, treatment needs to be repeated due to autoinfection.
Infections that are severe or widespread often have a poor outcome, especially in patients with a suppressed immune system.
Strongyloidiasis could be severe and life-threatening in specific groups including:
- Those who use oral or intravenous steroids, for example, in patients with asthma, chronic obstructive pulmonary disease (COPD) exacerbations, lupus, gout, or in persons using steroids for immunosuppression or symptomatic relief
- Those with HTLV-1 infection
- Those with hematologic malignancies such as leukemia or lymphoma
- Transplant recipients
Even with treatment, disseminated strongyloidiasis and hyperinfection syndrome have a mortality rate of 90%.

References

↑ Beknazarova M, Whiley H, Ross K (2016). “Strongyloidiasis: A Disease of Socioeconomic Disadvantage”. Int J Environ Res Public Health. 13 (5). doi:10.3390/ijerph13050517. PMC 4881142. PMID 27213420.
↑ Newberry AM, Williams DN, Stauffer WM, Boulware DR, Hendel-Paterson BR, Walker PF (2005). “Strongyloides hyperinfection presenting as acute respiratory failure and gram-negative sepsis”. Chest. 128 (5): 3681–4. doi:10.1378/chest.128.5.3681. PMC 1941746. PMID 16304332.
↑ Gomez, Juliana B.; Maque, Yvan; Moquillaza, Manuel A.; Anicama, William E. (2013). “E. coliMeningitis Presenting in a Patient with DisseminatedStrongyloides stercoralis”. Case Reports in Infectious Diseases. 2013: 1–4. doi:10.1155/2013/424362. ISSN 2090-6625.

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[pmid27213420-1] Beknazarova M, Whiley H, Ross K (2016). “Strongyloidiasis: A Disease of Socioeconomic Disadvantage”. Int J Environ Res Public Health. 13 (5). doi:10.3390/ijerph13050517. PMC 4881142. PMID 27213420.

[pmid16304332-2] Newberry AM, Williams DN, Stauffer WM, Boulware DR, Hendel-Paterson BR, Walker PF (2005). “Strongyloides hyperinfection presenting as acute respiratory failure and gram-negative sepsis”. Chest. 128 (5): 3681–4. doi:10.1378/chest.128.5.3681. PMC 1941746. PMID 16304332.

[GomezMaque2013-3] Gomez, Juliana B.; Maque, Yvan; Moquillaza, Manuel A.; Anicama, William E. (2013). “E. coliMeningitis Presenting in a Patient with DisseminatedStrongyloides stercoralis”. Case Reports in Infectious Diseases. 2013: 1–4. doi:10.1155/2013/424362. ISSN 2090-6625.

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