Strongyloides infection

Strongyloides infection should be considered in residents of endemic areas, or people who have migrated from an endemic area (regardless of time since immigration).

Clinical clues can include wheezing, abdominal distress, and eosinophilia.

Stool ova and parasite tests are relatively insensitive for detection of strongyloides larvae but are currently the tests of choice.

Treatment with ivermectin is recommended, regardless of resource setting.

Rapid spread of infection can lead to hyperinfection syndrome and disseminated disease, both of which are associated with a high mortality rate in immunosuppressed patients.

Empiric treatment should be considered when initiating corticosteroids in any high-risk patient due to risk of life-threatening hyperinfection.

An infection caused by the intestinal nematode Strongyloides stercoralis. Transmission occurs widely in tropical and subtropical areas, but also in countries with temperate climates.[1]World Gastroenterology Organisation. WGO practice guideline: management of strongyloidiasis. February 2018 [internet publication]. http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/15_management_strongyloidiasis_en.pdf The primary mode of infection is through filariform larvae penetrating the skin. Strongyloides larvae are found in soil that has been contaminated by human feces. 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 can continue this cycle within the human host creating indefinite autoinfection; meaning that, without treatment, infection can persist for prolonged periods of time. Strongyloidiasis is also known as threadworm.