Unsuspected Strongyloides stercoralis infection in hospital patients with comorbidity in need of proper management

Investigate the role of latent strongyloidiasis infection in patients at the University Hospital, Honduras.

Thirty five (5 %) of 712 patients had S. stercoralis larvae in one stool sample; 62.8 % came from rural areas and 91.7 % were poor; 68.5 % (24/35) were 21 years old or older. Eight patients (22.8 %) had no predisposing illness; 3 (8.6 %) received steroid treatment, 29/35 (82.8 %) presented with persistent diarrhea and 24/35 (68.5 %) presented following comorbidities: HIV/AIDS (31.4 %), alcoholism alone (11.4 %) or with other associated illness (8.6 %), malignancy (8.6 %), renal failure (5.7 %) and hyperthyroidism (2.8 %). A combination of symptoms suggestive of strongyloidiasis but indistinguishable from those potentially associated to their comorbid condition included severe epigastric pain, diarrhea of weeks duration, peripheral eosinophilia, astenia, adynamia, fever, anemia and weight loss in 85.7 % of the cases, 3 of whom described skin lesions compatible with larva currens. None of the diagnostic clinical impressions mentioned Strongyloides infection. Ten strongyloidiasis patients received partial treatment with albendazole or ivermectin. Incomplete data, underestimation of the parasitic infection and no laboratory follow-up of the patients limited our observations.