Repeated Autoinfection within the Gastrointestinal Tract Increases the Parasite Burden, Resulting in the Hyperinfection Syndrome
Rhabditiform Larvae Transform into Filariform Larvae, Which Then Penetrate the Intestinal Wall to Enter the Bloodstream
Massive Dissemination of Filariform Larvae Occurs to the Lungs, Liver, Heart, Central Nervous System, and Endocrine Glands
Risk Factors
General Comments
Retrospective Case Review of Strongyloides Hyperinfection Syndrome Cases (Infection, 2015) [MEDLINE]
Immunosuppression was Present in Most Cases of Hyperinfection Syndrome (with Chronic Long-Term Corticosteroids Being the Most Common Immunosuppressive)
Even Short Corticosteroid Courses Can Lead to Severe (and Potentially Fatal) Hyperinfection Syndrome (Trans R Soc Trop Med Hyg, 2007) [MEDLINE]
Cytotoxic Agents
However, in Contrast to Other Immunosuppressives, Cyclosporine A Has Activity Against Strongyloides (see Cyclosporine A, [[Cyclosporine A]]): it is unclear if this activity is sufficient to inhibit the development of the hyperinfection syndrome
Mortality Rate with the Strongyloides Hyperinfection Syndrome: 10-80%
ICU Mortality Rate
Retrospective Case Review of Strongyloides Hyperinfection Syndrome Cases (Infection, 2015) [MEDLINE]: ICU mortality rate was 60.3%
Poor Prognostic Factors
Need for Mechanical Ventilation
Presence of Shock
References
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Case records of the Massachusetts General Hospital. Case 28-2014. A 39-year-old man with a rash, headache, fever, nausea, and photophobia. N Engl J Med. 2014 Sep 11;371(11):1051-60. doi: 10.1056/NEJMcpc1405886 [MEDLINE]
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Strongyloides stercoralis hyperinfection syndrome: a case series and a review of the literature. Infection. 2015 Dec;43(6):691-8. doi: 10.1007/s15010-015-0799-1. Epub 2015 May 26 [MEDLINE]