Fatal Outcome of a Hyperinfection Syndrome despite Successful Eradication of Strongyloides with Subcutaneous Ivermectin

Byline: H. P. Hauber (1), J. Galle (2), P. L. Chiodini (3), J. Rupp (4), R. Birke (1), E. Vollmer (2), P. Zabel (1), C. Lange (1) Abstract: Abstract We report the case of a 77--year--old man who developed a Strongyloides hyperinfection syndrome following immunosuppressive therapy more than 60 years after he moved away from an area endemic for Strongyloides stercoralis. Successful eradication of the nematode was achieved with an off label subcutaneous formulation of ivermectin. However, the patient subsequently died from acute respiratory distress syndrome (ARDS). Despite a high wormload in the stool and sputum of the patient and delayed infection control measures in the hospital, testing of the medical staff revealed a very low risk of Strongyloides transmission among healthcare workers. Author Affiliation: (1) Medical Clinic, Research Center Borstel, Parkallee 35, 23845, Borstel, Germany (2) Clinical and Experimental Pathology, Research Center Borstel, Borstel, Germany (3) Hospital for Tropical Diseases and London School of Hygiene and Tropical Medicine, London, UK (4) Dept. of Microbiology, University Hospital Luebeck, Luebeck, Germany Article History: Registration Date: 01/01/2005 Received Date: 26/04/2005 Accepted Date: 09/08/2005 Article note: This paper is dedicated to the founders of the Walter Marget Foundation, D. Adam and F. Daschner, in gratitude for their support of the training in infectious diseases.