Strongyloides hyper infection in a steroid dependent leprosy patient.

Background: Immunosuppresion caused by corticosteroids predisposes leprosy patients to Strongyloides stercoralis infection which if untreated can be fatal. Patients acquire infection by walking barefoot in infested soils and can be infected for life because of the auto infective cycle of the parasite. Corticosteroids have precipitated death in more than 60% of disseminated strongyloidiasis cases. Objective: The aim of this article is to report a successfully treated case of SS infection in a low resourceleprosy hospital in rural India and increase awareness of the unique features of S. stercoralis and also to outline the important role that dermatologists and leprologists have in diagnosing and treating chronic strongyloidiasis, thus preventing cases of fatal hyperinfection. Discussion: Leprosy patients live in tropics and subtropics which are also endemic for SS infestation and hence are prone to develop this infection. Chronic strongyloidiasis does not have typical symptoms and clinical features. Those who have unexplained eosinophilia must be checked for the presence of the parasite before initiation of steroid therapy for reactions and neuritis. Leprosy heath workers must have the awareness and a high index of suspicion to diagnose disseminated SS infection. Otherwise these patients, if infected, may develop hyperinfection syndrome, which has a high fatality rate.

Recurrence of strongyloides stercoralis infection in a patient with Hansen's disease: a case report.

In patients with immunosuppressive disorders, S. stercoralis infection may develop into a hyperinfection syndrome which, on rare occasions, may be a life-threatening condition. Therapy of S. stercoralis infection with thiabendazole has been limited, due to its numerous side effects, and has been replaced by albendazole and ivermectin. The present case report describes a case of Strongyloides Hyperinfection Syndrome (SHS) in a patient with Hansen's disease and lack of response to first-line anthelmintic treatment. A 38 year-old man was diagnosed as having borderline lepromatous leprosy. He developed Erythema Nodosum Leprosum and was treated with thalidomide and prednisone. In May 2010 he was diagnosed with S. stercoralis infection and was treated with albendazole. One year later, the stool examination showed continued presence of S. stercoralis larvae. He was treated with ivermectin (6 mg) in a double dose (given 1 month apart) which resulted in larvae excretion clearance. The absence of infection was confirmed three times during a 1 year followup period by stool examination and non-detection of anti-S. stercoralis IgG levels.

A fatal case of systemic strongyloidiasis and review of the literature.

Systemic strongyloidiasis is a rare but serious complication of intestinal strongyloidiasis. The condition occurs mainly in immunosuppressed patients and has a significant mortality rate. A case of systemic strongyloidiasis is described in a patient who received systemic steroid treatment, and a short review of the literature is given. The increased use of immunosuppressive and cytotoxic treatment necessitates increased awareness of this infection. HIV-infection, however, does not appear to increase the risk of developing systemic strongyloidiasis. Patients from endemic areas and travellers to such areas, even in the remote past, should be examined for strongyloidiasis before being given immunosuppressive treatment. Awareness of the possibility of systemic strongyloidiasis is essential if such a patient develops gastrointestinal or pulmonary symptoms or has repeated episodes of unexplained gram-negative infections while undergoing immunosuppressive treatment.