Management of severe strongyloidiasis attended at reference centers in Spain

Abstract

Strongyloides stercoralis is a globally distributed worm. It has a free living cycle in wet moist soils, and an autoinfecting cycle affecting humans in their lungs, bowels and skin. Strongyloidiasis is the name of the infection caused by S.stercoralis and it can vary from an indolent state, with no symptoms at all, to a severe clinical condition if the adult worms reproduce and disseminate into the body tissues. This second clinical picture usually presents when the immune system of the host is altered for any reason, most likely other immunosuppressive infections or treatments. Severe clinical conditions are usually confirmed when an increased number of S.stercoralis larvae are found in body tissues, which leads to a broad spectrum of clinical symptoms that are usually fatal without treatment. These conditions are both uncommon and not well defined. We present the experience of eight referral centers in Spain regarding the management of severe strongyloidiasis. We found 18 cases diagnosed over 15 years, the second largest series outside endemic areas, and compiled their epidemiological, clinical and outcome data.