Multifaceted clinical presentations and predisposing factors of Strongyloides stercoralis and its treatment outcome: A case series

Abstract

Strongyloides stercoralis, a soil-transmitted intestinal nematode is often undiagnosed owing to its non-specific clinical manifestations, laboratory findings and radiological features. Corticosteroids, HIV and Human T-cell lymphotrophic virus type-1 are some of the many immunocompromised conditions where strongyloidiasis infection might lead to a hyper-infection syndrome of disseminated strongyloidiasis. Albendazole, ivermectin and, recently, moxidectin are anti-helminthic drugs with excellent activity against this neglected tropical parasite. In our case series, we report five cases, each with different clinical features, immunity status, predisposing conditions and different treatment outcomes. Stool microscopy was positive for S. stercoralis larva in all cases. Either albendazole or ivermectin was administered, its duration being adjusted according to the patient's response. Although its incidence is relatively low in India, Strongyloides should be considered as one of the differential diagnoses in any patient with the afore-mentioned immunosuppression states.