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 due to its unique autoinfective cycle, but is often asymptomatic.
Clinical clues include wheezing, abdominal distress, and eosinophilia >400 cells/microliter 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.
Empiric 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).
Infection by the intestinal nematode Strongyloides stercoralis causes strongyloidiasis. The primary mode of infection is through larvae penetrating the skin. Strongyloides larvae migrate from subcutaneous tissues into the venous circulation, then to the lungs. Larvae migrate up the airways, are swallowed, and establish chronic infection in the intestinal tract as adults. New larvae continue this cycle within the human host creating indefinite autoinfection; meaning that, without treatment, infection is lifelong. Subtropical and tropical regions worldwide are endemic.
Lois & Richard King Distinguished Associate Professor
Associate Director of Global Health
Department of Medicine
University of Minnesota
DRB is an author of a number of references cited in this monograph.
Department of Pediatrics
Boston Medical Center
EB declares that she is on a speaker's bureau for Merck. She is an author of a reference cited in this monograph.
Associate Professor of Pediatrics
West Virginia University School of Medicine
LN is an author of a reference cited in this monograph.
Professor of International Medicine and Honorary Consultant Physician
Liverpool School of Tropical Medicine
GG declares he has no competing interests.
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