Strongyloidiasis is an infection caused by an intestinal nematode, Strongyloides stercoralis, which has a cosmopolitan distribution in tropical and subtropical regions. Infection is via trans-cutaneous by filariform larvae. This usually leads to cutaneous, gastrointestinal, or pulmonary symptoms depending on the host immune status [31]. It is endemic world-wide, yet more prevalent in hot and humid climates as well as resource poor countries with inadequate sanitary conditions [32].
S. stercoralis is unique among intestinal nematodes in its ability to complete its life cycle within the host through an asexual auto-infective cycle, allowing the infection to persist in the host indefinitely. Under some conditions associated with immunocompromised, this autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome, characterized by gastrointestinal bleeding and respiratory distress [33]. It makes S. stercoralis opportunistic parasite, which occurs frequently in immunocompromised patients, especially in those with a defect in cell-mediated immunity [34].
A variety of underlying conditions appear to predispose to severe infections. Including immunodeficiency due to defective T-lymphocyte function, therapeutic regimens consisting of corticosteroids or other immunosuppressive medication, and chronic illness or malnutrition, predispose to systemic strongyloidiasis. Studies suggested that this infection incorporate unexplained gram-negative bacillary bacteremia in a compromised host [32].
Measurement like screening for Strongyloides infection before the initiation of immunosuppressive therapy should be considered in patients with unexplained eosinophilia, serpiginous skin lesions, or pulmonary or gastrointestinal symptoms [31,35]. Furthermore, transplantation centers drawing patients from areas with endemic Strongyloides should evaluate potential recipients closely for occult strongyloides infection prior to initiating immunosuppressive therapy [34]. To conclude, after immunocompromised patients develop hyperinfection syndrome, diagnosis is often delayed and mortality is high, as a result emphasis should be placed on testing and treatment prior to transplantation.