Case Report

Investigation of Strongyloidiasis Transmission from Infected Mother to Newborn Postpartum: A Case Report

Abstract

Strongyloidiasis is a disease caused by the soil-transmitted nematode Strongyloides stercoralis. It is considered a neglected disease that can lead to long-term disability, growth retardation in children, complications during pregnancy, and adverse effects on the fetus. In the present case report, we examined a case of strongyloidiasis in a newborn born to a mother with confirmed strongyloidiasis during pregnancy, diagnosed by serological, parasitological, and molecular methods. A 38-year-old woman at 35 weeks of gestation from a rural area in Rasht, Guilan Province, Iran, presented with gastrointestinal symptoms (diarrhea, abdominal pain) and severe dyspnea since the fourth month of pregnancy. Her medical history included hypothyroidism and a pituitary microadenoma.  Laboratory findings revealed a peripheral blood eosinophil count of 2%. Stool examination (direct smear, formalin-ethyl acetate concentration, and agar plate culture) and serological testing (ELISA for S. stercoralis antibodies) confirmed strongyloidiasis, further validated by molecular methods. Due to potential risks of anti-helminthic drugs during pregnancy, treatment was deferred until one month post-delivery, after breastfeeding cessation. The newborn’s stool and breast milk were tested parasitologically and molecularly one month after birth, with negative results, indicating no infection. Although mother-to-fetus transmission has not been definitively established, the fetus is considered a high-risk group. Pregnant women, due to their immunocompromised state, are also classified as a high-risk population and may develop disseminated strongyloidiasis or hyperinfection syndrome. Given the adverse effects of antiparasitic treatment during pregnancy, routine serological screening for S. stercoralis in women before pregnancy in endemic areas is recommended to enable early intervention and mitigate complications, safeguarding maternal and fetal health.

1. Olsen A, van Lieshout L, Marti H, et al. Strongyloidiasis–the most neglected of the neglected tropical diseases? Trans R Soc Trop Med Hyg. 2009;103(10):967-72.
2. World Health Organization. Ending the neglect to attain the sustainable develop-ment goals: a road map for neglected tropical diseases 2021–2030. Geneva: World Health Organization; 2022.
3. Sharifdini M, Kia EB, Ashrafi K, Hosseini M, Mirhendi H, Mohebali M, Kamranrashani B. An Analysis of Clinical Characteristics of Strongyloides stercoralis in 70 indigenous patients in Iran. Iran J Parasitol. 2014 Apr-Jun;9(2):155-62. PMID: 25848380; PMCID: PMC4386034.
4. Sharifdini M, Kia EB, Ashrafi K, et al. Molecular diagnosis of strongyloidiasis in a population of an endemic area through nested-PCR. Gastroenterol Hepatol Bed Bench. 2018;11(1):68-74.
5. Grove DI. Human strongyloidiasis. Adv Parasitol. 1996;38:251-309.
6. Keiser PB, Nutman TB. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev. 2004;17(1):208-17.
7. Milner PF, Irvine WJ, Milner PF. Intestinal malabsorption in Strongyloides stercoralis infestation. Gut. 1965;6(6):574-581.
8. Robinson DP, Klein SL. Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Horm Behav. 2012;62(3):263-71.
9. Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010;63(6):425-33.
10. Aderoba AK, Iribhogbe OI, Olagbuji BN, et al. Prevalence of helminth infestation during pregnancy and its association with maternal anemia and low birth weight. Int J Gynaecol Obstet. 2015;129(3):199-202.
11. Fairley JK, Bisanzio D, Ondigo BN, et al. Birthweight in offspring of mothers with high prevalence of helminth and malaria infection in coastal Kenya. Am J Trop Med Hyg. 2013;88(1):48-53.
12. De Liberato C, Iatta R, Scarito MA, et al. Strongyloides stercoralis in a dog litter: evidence suggesting a transmammary transmission. Acta Trop. 2022;231:106465.
13. Shoop WL, Michael BF, Eary CH, Haines HW. Transmammary transmission of Strongyloides stercoralis in dogs. J Parasitol. 2002 Jun;88(3):608-9.
14. Mota-Ferreira DM, Gonçalves-Pires Mdo R, Júnior AF, et al. Specific IgA and IgG antibodies in paired serum and breast milk samples in human strongyloidiasis. Acta Trop. 2009;109(2):103-7.
15. Akers AN, Mohan S, Oke V, et al. Strongyloides stercoralis Hyperinfection Syndrome in Pregnancy. Cureus. 2023; 15(8):e43977.
16. Westlake CS, Aronoff DM. Evaluating the risks of systemic maternal ivermectin exposure during pregnancy in human and vertebrate animals: a scoping review. Curr Drug Saf. 2021;16(3):299-308.
17. Montresor A, Mupfasoni D, Mikhailov A, et al. The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030. PLoS Negl Trop Dis. 2020;14(8):e0008505.
18. Kalantari N, Ghaffari S, Bayani M, et al. Prevalence and associated risk factors of Strongyloides sp. infection in diabetic patients in the central part of Mazandaran, northern Iran. Arch Clin Infect Dis. 2019; 14(4):e94158.
19. Verweij JJ, Canales M, Polman K, et al. Molecular diagnosis of Strongyloides stercoralis in faecal samples using real-time PCR. Trans R Soc Trop Med Hyg. 2009; 103(4):342-6.
20. Jaleta TG, Zhou S, Bemm FM, et al. Different but overlapping populations of Strongyloides stercoralis in dogs and humans—Dogs as a possible source for zoonotic strongyloidiasis. PLoS Negl Trop Dis. 2017;11(8):e0005752.
21. Puthiyakunnon S, Boddu S, Li Y, et al. Strongyloidiasis—an insight into its global prevalence and management. PLoS Negl Trop Dis. 2014;8(8):e3018.
22. Wikman-Jorgensen P, Requena-Méndez A, Llenas-García J. A review on strongyloidiasis in pregnant women. Res Rep Trop Med. 2021;12:219-225.
23. Ashford RW, Barnish G, Viney ME. Strongyloides fuelleborni kellyi: infection and disease in Papua New Guinea. Parasitol Today. 1992;8(9):314-8.
24. Brown RC, Girardeau HF. Transmammary passage of Strongyloides sp. larvae in the human host. Am J Trop Med Hyg. 1977;26(2):215-9.
25. Nwosu AB. Human neonatal infections with hookworms in an endemic area of Southern Nigeria: a possible transmammary route. Trop Geogr Med. 1981;33(2):105-11.
26. Ericsson CD, Steffen R, Siddiqui AA, et al. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis. 2001;33(7):1040-7.
27. Chan AHE, Thaenkham U. From past to present: opportunities and trends in the molecular detection and diagnosis of Strongyloides stercoralis. Parasit Vectors. 2023;16(1):123.
Files
IssueVol 20 No 4 (2025) QRcode
SectionCase Report(s)
Keywords
Strongyloides stercoralis Pregnant women Neonate Iran
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sorouri Majd M, Kia EB, Mousavi Mobarakeh S, Sharami SH, Jafari A, Fakhrieh Kashan Z. Investigation of Strongyloidiasis Transmission from Infected Mother to Newborn Postpartum: A Case Report. Iran J Parasitol. 2025;20(4):602-607.