What is the pathophysiology of stage 4 of the Strongyloides stercoralis life cycle in strongyloidiasis?

Updated: Jun 20, 2019
  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The pathophysiology that results from the hyperinfection cycle, which leads to dissemination in a compromised host, is not well understood. Patients receiving high-dose corticosteroids [5] or patients with human T-cell lymphotrophic virus type I (HTLV-I) are at particularly increased risk.

Hyperinfection syndrome represents an acceleration of the normal life cycle of S stercoralis, leading to excessive worm burden without the spread of larvae outside the usual migration pattern (eg, gastrointestinal tract, lungs) (see the following image). The larvae do not exit the host in feces and instead molt into the infective filariform larva within the intestinal lumen. These larvae are then capable of penetrating the bowel wall and traveling throughout the body.

Fourth stage, life cycle of Strongyloides stercora Fourth stage, life cycle of Strongyloides stercoralis. Illustration by Tessa Kalman.

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