Strongyloides stercoralis larvae in the urine of a patient with transitional cell carcinoma of the bladder: a case report

  • Okokon I. Ita
  • Idorenyin C. Akpayak
  • Kenneth I. Onyedibe
  • Akaninyene A. OtuEmail author
Short Communication


Disseminated infection with Strongyloides stercoralis refers to the massive migration of infective larvae from the gastrointestinal tract to other organs that are not involved in the normal life cycle of the parasite. We describe the case of a Nigerian male with transitional cell carcinoma of the bladder in whom larvae of S. stercoralis was identified in the urine. This report involves a 60-year old male Nigerian presenting to the Urology clinic of the Jos University teaching hospital, Nigeria with disseminated S. stercoralis. The index patient presented with a 5 month history of total haematuria, urinary frequency, urgency, nocturia, straining to pass urine, feeling of incomplete voiding and terminal dribbling. He also had episodes of suprapubic pain. Physical examination revealed a cachexic patient who had mild suprapubic tenderness. Urinary examination showed numerous red blood cells and rhabditiform larvae of S. stercoralis. Abdominal ultrasound revealed a heterogeneous mass in the urinary bladder measuring 4.0 × 3.3 cm. Abdominal computed tomography also showed an irregular mass measuring 4.2 × 3.8 cm with HU of 41 projecting into the bladder from the posterior wall towards the dome. Histology of the biopsy specimen revealed transitional cell carcinoma. The patient was treated with a single dose of oral ivermectin but died 1 week later. Physicians working in areas that are endemic for S. stercoralis should consider investigating immunocompromised patients for S. stercoralis infection given the poor prognosis of disseminated infection in this group of patients.


Strongyloides stercoralis Jos Disseminated Transitional cell cancer Ivermectin 


Authors’ contribution

IOI conceived the case report; ICA was directly involved in treating the patient; IOI and KIO ran the laboratory tests; IOI, AAO and ICA made the first draft; all authors read and edited the first draft for intellectual content.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from the next of kin of this patient to proceed with this report.


  1. Altintop L, Cakar B, Hokelek M et al (2010) Strongyloides stercoralis hyperinfection in a patient with rheumatoid arthritis and bronchial asthma: a case report. Ann Clin Microbiol Antimicrob 9:12CrossRefGoogle Scholar
  2. Azira NM, Zeehaida M (2010) Strongyloides stercoralis hyperinfection in a diabetic patient: case report. Trop Biomed 27(1):115–119PubMedGoogle Scholar
  3. Brooker S, Bundy D (2009) Soil-transmitted Helminths. In: Cook G, Zumla A (eds) Manson’s tropical diseases, 22nd edn. WB Saunders, Philadelphia, PA, p 1532Google Scholar
  4. Buonfrate D, Requena-Mendez A, Angheben A et al (2013) Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 13:78CrossRefGoogle Scholar
  5. Fowler CF, Lindsay I, Lewin J et al (1982) Recurrent hyperinfestation with Strongyloides stercoralis in a renal allograft recipient. BMJ 285:1394CrossRefGoogle Scholar
  6. Gotuzzo E, Terashima A, Alvarez H et al (1999) Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru. Am J Trop Med Hyg 60(1):146–149CrossRefGoogle Scholar
  7. Keiser PB, Nutman TB (2004) Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17:208–217CrossRefGoogle Scholar
  8. Maguire J (2015) Intestinal Nematodes (Roundworms). In: Bennet J, Dolin R, Blaser M (eds) Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, 8th edn. Elsevier Inc, Philadelphia, PA, pp 3204–3206Google Scholar
  9. Mahmoud AAF (1996) Strongyloidiasis. Clin Infect Dis 23:949–953CrossRefGoogle Scholar
  10. Malakoutian T, Mohammadi R, Asgari M et al (2015) Disseminated strongyloidiasis in a patient with membranoproliferative glomerulonephritis—case report. Iran J Parasitol. 1:141–145Google Scholar
  11. Morgan J, Schaffner W, Stone W (1986) Opportunistic strongyloidiasis in renal transplant recipients. Transplantation 42(5):518–524CrossRefGoogle Scholar
  12. Mori S, Konishi T, Matsuoka K et al (1998). Strongyloidiasis associated with nephrotic syndrome. Accessed 12 Sept 2018
  13. Pasqualotto AC, Zborowski MF, dos Anjos M et al (2009) Strongyloides stercoralis in the urine. Trans R Soc Trop Med Hyg 103(1):106–107CrossRefGoogle Scholar
  14. Pocaterra L, Pérez G, Rojas E et al (2016) Urinary rhabditiform larvae of Strongyloides stercoralis in disseminated disease affecting a kidney-transplanted patient TT—Larvas rabditoides de Strongyloides stercoralis en orina en paciente conriñón trasplantado y estrongiloidiasis diseminada. Rev Medica Hered 27(1):35–40. Accessed 20 Sept 2018CrossRefGoogle Scholar
  15. Purvis RS, Ueichtler EL, Diven DC et al (1992) Strongyloides hyperinfection presenting with petechiae and purpura. Int J Dermatol. 31(3):169–171. Accessed 27 Sept 2018CrossRefGoogle Scholar
  16. Puthiyakunnon S, Boddu S, Li Y et al (2014) Strongyloidiasis—an insight into its global prevalence and management. PLoS Negl Trop Dis 8(8):e3018CrossRefGoogle Scholar
  17. Roxby AC, Gottlieb GS, Limaye AP (2009) Immunocompromised hosts: Strongyloidiasis in transplant patients. Clin Infect Dis 49(9):1411–1423. Accessed 19 Sept 2018CrossRefGoogle Scholar
  18. Safdar A, Malathum K, Rodriguez SJ et al (2014) Strongyloidiasis in patients at a comprehensive cancer center in the United States: a retrospective study covering the years 1971–2003. Cancer 100(7):1531–1536CrossRefGoogle Scholar
  19. Stewart DM, Ramanathan R, Mahanty S et al (2011) Disseminated Strongyloides stercoralis infection in HTLV-1-associated adult T-cell leukemia/lymphoma. Acta Haematol 126(2):63–67CrossRefGoogle Scholar
  20. Whitehill R, Miller MH (1944) Infestation of the genito-urinary tract by Strongyloides stercoralis: a case report. Bull Johns Hopkins Hosp 75(3):169–174Google Scholar

Copyright information

© Indian Society for Parasitology 2018

Authors and Affiliations

  • Okokon I. Ita
    • 1
  • Idorenyin C. Akpayak
    • 2
  • Kenneth I. Onyedibe
    • 3
  • Akaninyene A. Otu
    • 4
    • 5
    Email author
  1. 1.Department of Medical Microbiology and ParasitologyUniversity of CalabarCalabarNigeria
  2. 2.Division of Urology, Surgery DepartmentJos University Teaching HospitalJosNigeria
  3. 3.Department of Medical MicrobiologyUniversity of JosJosNigeria
  4. 4.Department of Internal MedicineUniversity of CalabarCalabarNigeria
  5. 5.Wythenshawe HospitalManchester University Foundation NHS TrustManchesterUK

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