Resumo

• An infection with the intestinal nematode Strongyloides stercoralis. Should be considered in all migrants or residents from endemic areas regardless of time since immigration.
• Infection persists lifelong owing to its unique auto-infective cycle, but is often asymptomatic.
• Clinical clues include wheezing, abdominal distress and eosinophilia >0.4 x 10^9 eosinophils/L (>400 eosinophils/microlitre) or eosinophilia >5% of the WBC differential count.
• Stool ova and parasite tests are relatively insensitive for detection of strongyloides larvae. Strongyloides IgG serology has >95% sensitivity and is useful in people with unexplained eosinophilia with negative stool examinations.
• If people with strongyloides infection are given corticosteroids for a comorbid condition, they can develop life-threatening hyperinfection.
• Empirical treatment with oral ivermectin should be considered when urgently initiating corticosteroid therapy in any high-risk patient (migrants or residents from endemic areas, particularly agricultural workers and others with history of soil exposure).