Strongyloidiasis in immunosuppressed hosts. Presentation as massive lower gastrointestinal bleeding

Area of Science:

• Medical Parasitology
• Immunocompromised Host Research
• Gastroenterology

Background:

• Strongyloides stercoralis is a nematode with a complex life cycle, posing diagnostic and therapeutic challenges.
• Disseminated strongyloidiasis in immunosuppressed individuals carries a high mortality rate.
• Gastrointestinal hemorrhage can be a severe manifestation of complicated strongyloidiasis.

Observation:

• Two cases of massive lower gastrointestinal hemorrhage in immunosuppressed patients were identified.
• The hemorrhage was attributed to complicated Strongyloides stercoralis infestation.
• Patients presented with severe clinical manifestations requiring intensive management.

Findings:

• Successful treatment involved reducing corticosteroid dosage and administering high-dose thiabendazole.
• Parenteral nutrition and multiple blood product transfusions were essential supportive measures.
• Vigorous supportive management was critical for patient recovery.

Implications:

• Early recognition and prompt, aggressive treatment are vital for improving outcomes in disseminated strongyloidiasis.
• Proactive strategies for preventing, detecting, and treating hyperinfection are necessary in immunosuppressed patients.
• Understanding the complex life cycle of Strongyloides stercoralis is key to effective clinical management.