11.24 SFGH pearls – strongyloidiasis hyperinfection

  • Hyperinfection with strongy occurs when the cycle of autoinfection (see graphic below!) leads to greatly increased parasite burden and the infection becomes detectable in extraintestinal regions.
    • Bacteremia is a common complication, as the larvae bring intestinal bacteria into the bloodstream (usually E. coli, klebsiella, or Enterobacter)
    • Estimates vary widely, but most suggest that mortality from hyperinfection exceed 80%
  • Likelihood of developing hyperinfection increases with cell-mediated immunity impairment, specifically TH-2 helper cell dysfunction
    • The classes of immunosuppression most associated with strongyloidiasis are hypogammaglobulinemia, anti-TNF therapy, and immunosuppressive regimens used for organ transplantation
  • For reasons not yet understood, eosinophilia may be absent in patients with GNR bacteremia
  • The most common toxicities associated with lenalidomide include neutropenia (30-40% of patients), anemia (~10%), thrombocytopenia (~10%) and VTE (~12%).

o   Other side effects include infection, fatigue, insomnia, diarrhea and constipation, though these are usually not severe

Evernote link: https://www.evernote.com/shard/s300/sh/6ce83565-2e34-444e-8257-0b13768922c9/a341032f2cebed4aacdad7b1d9ab601f

Chen C, Reece DE, Siegel D, et al. Expanded safety experience with lenalidomide plus dexamethasone in relapsed or refractory multiple myeloma. Br J Haematol 2009; 146:164.

Lam CS, Tong MK, Chan KM, Siu YP. Disseminated strongyloidiasis: a retrospective study of clinical course and outcome. Eur J Clin Microbiol Infect Dis 2006; 25:14.

Concha R, Harrington W Jr, Rogers AI. Intestinal strongyloidiasis: recognition, management, and determinants of outcome. J Clin Gastroenterol 2005; 39:203.

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