DOI: 10.12890/2026_006028
Symptomatic chronic Strongyloides stercoralis infection after Roux-en-Y gastric bypass in an immunocompetent patient
Authors
jarastevens@gmail.com
Keywords
Strongyloidiasis, infectious diseases, Roux-en-Y gastric bypassAbstract
Introduction: Strongyloides stercoralis is a parasitic nematode with a unique auto infective life cycle, enabling persistent infection. While infection can remain asymptomatic for decades, factors such as malnutrition may facilitate the transition to symptomatic strongyloides infection. Roux-en-Y gastric bypass (RYGB) induce malnutrition due to reduced intake and impaired nutrient absorption.
Case description: A 31-year-old male presented with nausea, diarrhoea, and general malaise following RYGB six months earlier. Jejunal biopsy and faecal polymerase chain reaction (PCR) confirmed chronic S. stercoralis infection, likely acquired during travel to Bali in 2016. Treatment with ivermectin led to rapid clinical improvement, normalization of eosinophil counts, and negative faecal PCR within four weeks.
Conclusion: Chronic S. stercoralis infection may become symptomatic following RYGB, likely due to postoperative physiological changes, such as malnutrition. Malabsorption, particularly zinc deficiency, may impair mucosal immunity and facilitate parasite persistence. Additionally, reduced colonic motility and gastric acid secretion post-RYGB may compromise host defence mechanisms, increasing the risk of transformation to symptomatic infection. These findings suggest that preoperative screening for S. stercoralis might be considered in bariatric candidates with prior exposure to endemic regions. Further research is warranted to clarify the pathophysiological mechanisms linking bariatric surgery to reactivation of chronic strongyloidiasis.
References
- Yeh MY, Aggarwal S, Carrig M, Azeem A, Nguyen A, Devries S, et al. Strongyloides stercoralis Infection in Humans: A Narrative Review of the Most Neglected Parasitic Disease. Cureus 2023;15:e46908. doi: 10.7759/cureus.46908
- Barroso M, Salvador F, Sánchez-Montalvá A, Bosch-Nicolau P, Molina I. Strongyloides stercoralis infection: A systematic review of endemic cases in Spain. PLoS Negl Trop Dis 2019;13:e0007230. doi: 10.1371/journal.pntd.0007230
- Page W, Judd JA, Bradbury RS. The Unique Life Cycle of Strongyloides stercoralis and Implications for Public Health Action. Trop Med Infect Dis 2018;3:53. doi: 10.3390/tropicalmed3020053
- Puthiyakunnon S, Boddu S, Li Y, Zhou X, Wang C, Li J, et al. Strongyloidiasis--an insight into its global prevalence and management. PLoS Negl Trop Dis 2014;8:e3018. doi: 10.1371/journal.pntd.0003018
- Sánchez PR, Guzman AP, Guillen SM, Adell RI, Estruch AM, Gonzalo IN, et al. Endemic strongyloidiasis on the Spanish Mediterranean coast. QJM 2001;94:357-363. doi: 10.1093/qjmed/94.7.357
- Gala K, Ghusn W, Abu Dayyeh BK. Gut motility and hormone changes after bariatric procedures. Curr Opin Endocrinol Diabetes Obes 2024;31:131-137. doi: 10.1097/MED.0000000000000860
- Ruz M, Carrasco F, Rojas P, Codoceo J, Inostroza J, Basfi-fer K, et al. Zinc absorption and zinc status are reduced after Roux-en-Y gastric bypass: a randomized study using 2 supplements. Am J Clin Nutr 2011;94:1004-1011. doi: 10.3945/ajcn.111.018143
- Scott ME, Koski KG. Zinc deficiency impairs immune responses against parasitic nematode infections at intestinal and systemic sites. J Nutr 2000;130:1412S-1420S. doi: 10.1093/jn/130.5.1412S
- Khan WI, Collins SM. Immune-mediated alteration in gut physiology and its role in host defence in nematode infection. Parasite Immunol 2004;26:319-326. doi: 10.1111/j.0141-9838.2004.00715.x. Erratum in: Parasite Immunol 2004;26:423.
- Giannella RA, Broitman SA, Zamcheck N. Influence of gastric acidity on bacterial and parasitic enteric infections. A perspective. Ann Intern Med 1973;78:271-276. doi: 10.7326/0003-4819-78-2-271
