- 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