Strongyloides infection

Last reviewed: 21 Apr 2022
Last updated: 27 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • infection with other parasites
More key diagnostic factors

Other diagnostic factors

  • abdominal pain
  • altered bowel habit
  • weight loss
  • fever (hyperinfection)
  • signs of sepsis (hyperinfection)
  • chronic cough
  • wheezing
  • pruritus or dermatitis
  • larva currens
  • urticaria
  • cutaneous larva migrans
  • apparent drug reaction rash (hyperinfection)
  • other skin complaints
  • symptoms and signs of inflammatory bowel disease
Other diagnostic factors

Risk factors

  • soil exposure in or migrants from an endemic area of the world
  • international travellers
  • corticosteroids (risk of hyperinfection)
  • human T-cell lymphotropic virus type-1 (HTLV-1) infection (risk of hyperinfection)
  • impaired immunity
  • solid-organ transplant recipient
More risk factors

Diagnostic investigations

1st investigations to order

  • stool ova and parasites (O&P) examination
  • FBC with differential
  • therapeutic trial with ivermectin (in specific situations)
More 1st investigations to order

Investigations to consider

  • sputum O&P examination
  • clinical sample (non-stool or sputum) O&P examination
  • strongyloides IgG serology
  • tissue biopsy
More investigations to consider

Emerging tests

  • polymerase chain reaction (PCR)

Treatment algorithm

INITIAL

immigrant from endemic area

ACUTE

able to tolerate oral therapy: not critically ill (nonpregnant)

unable to tolerate oral therapy or critically ill (nonpregnant)

pregnant

ONGOING

poor clinical response or initial treatment not completed

Contributors

Authors

David R. Boulware, MD, MPH, CTropMed
David R. Boulware

Professor of Medicine

Department of Medicine

University of Minnesota

Minneapolis

MN

Disclosures

DRB is an author of a number of references cited in this topic.

Peer reviewers

Elizabeth Barnett, MD

Professor

Department of Pediatrics

Boston Medical Center

Boston University

Boston

MA

Disclosures

EB declares that she is on a speaker's bureau for Merck. She is an author of a reference cited in this topic.

Linda Nield, MD, FAAP

Professor of Pediatrics

West Virginia University School of Medicine

Morgantown

WV

Disclosures

LN is an author of a reference cited in this topic.

Geoff Gill, MA, MSc, MD, FRCP, DTMH

Professor of International Medicine and Honorary Consultant Physician

Liverpool School of Tropical Medicine

Liverpool

UK

Disclosures

GG declares that he has no competing interests.

  • Strongyloides infection images
  • Differentials

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  • Guidelines

    • CDC health information for international travel (the Yellow Book). Chapter 4: travel-related infectious diseases (strongyloidiasis)
    • CDC parasites - strongyloides: resources for health professionals
    More Guidelines
  • Patient leaflets

    Threadworm

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