Risk factors for hyperinfection or disseminated infection:
(1) immunosuppression with steroids or other agents for the treatment of organ transplants, autoimmune disease, or hematologic malignancy
(2) leukemia or malignant lymphoma
(3) malnutrition
(4) chronic alcohol abuse
(5) tuberculosis or other chronic systemic infections
(6) chronic debilitating disease
(7) infection with HTLV-1 or HIV
(8) therapy with etanercept or other targeted therapy against tumor necrosis factor alpha (TNF)
Hyperinfections in patients with HIV infection is uncommon. It tends to occur when the CD4 count is < 200 per µL and the patient is being treated with corticosteroids.
Renal transplant patients are at increased risk. Therapy with cyclosporine reduced the risk of hyperinfection. Hyperinfection in other transplant patients is uncommon.
A patient with one or more risk factors should be evaluated for hyperinfection or disseminated infection if:
(1) they have a history of travel or residence in a high risk location for strongyloides infection (South America, Southeast Asia, sub-Saharan Africa, Southern United States, Southern and Eastern Europe)
(2) they develop postprandial abdominal pain or increased stool frequency
(3) they develop a diffuse pulmonary infiltrate
(4) they develop asthmatic symptoms
(5) they develop pneumonia, bacteremia or meningitis due to an enteric bacteria
(6) they develop multiorgan dysfunction.
