Lethal strongyloidiasis - Diagnostic and forensic issues

J Forensic Leg Med. 2019 Feb:62:103-106. doi: 10.1016/j.jflm.2019.01.014. Epub 2019 Feb 2.

Abstract

Strongyloidiasis is an infectious disease affecting approximately 30-100 million people globally. The main human pathogen is Strongyloides stercoralis which may cause a brief period of acute symptoms and signs after the initial infection, and then lapse into a chronic asymptomatic carrier state for decades due to the nematode's unique ability to autoinfect hosts. Immunosuppression from steroid therapy, T-lymphocytic viral (HTLV-1) infections, or a variety of underlying medical conditions may then result in dissemination and the highly lethal and infectious hyperinfection syndrome. Clinical suspicions for the condition are often not high in non-endemic areas, the diagnosis is difficult, and the incidence is increasing, particularly given recent mass population movements. Indications of infection at autopsy include gastrointestinal ulceration and haemorrhage, with pulmonary oedema, congestion, haemorrhage and diffuse alveolar damage.

Keywords: Death; Dissemination; Forensic; Hyperinfection; Steroid therapy; Strongyloides stercoralis; Strongyloidiasis.

Publication types

  • Review

MeSH terms

  • Animals
  • Carrier State
  • Feces / parasitology
  • Forensic Pathology
  • Hemorrhage / parasitology
  • Hemorrhage / pathology
  • Humans
  • Immunocompromised Host
  • Intestinal Diseases, Parasitic / parasitology
  • Intestinal Diseases, Parasitic / pathology
  • Larva
  • Opportunistic Infections / parasitology
  • Pulmonary Edema / parasitology
  • Pulmonary Edema / pathology
  • Sputum / parasitology
  • Strongyloides stercoralis / pathogenicity
  • Strongyloides stercoralis / physiology
  • Strongyloidiasis / diagnosis*
  • Ulcer / parasitology
  • Ulcer / pathology