Hyperinfection Syndrome with Strongyloides stercoralis

Infection with the parasitic nematode, Strongyloides stercoralis, can lead to death in patients with various clinical disorders. Alteration of the parasite—host relationship may lead to hyperinfection characterized by profound malabsorption, diarrhea, electrolyte imbalance, gram-negative or opportunistic fungal sepsis, coma, and death. During the last 3 years nine such patients were studied in the hematology section of a 300-bed university hospital. Eight patients died, four in spite of energetic treatment with thiabendazole. Since diagnosis of hyperinfection is often made only at autopsy, its presence should be suspected in hematologic patients and patients with diseases of altered immunity, such as leprosy and systemic lupus erythematosus. Since early diagnosis is essential to avoid fatalities, laboratory technicians and physicians dealing with such patients as well as with large population groups that harbor this parasite (for example, Puerto Ricans) should be alerted.