Strongyloides Stercoralis

EPIDEMIOLOGY - ASSOCIATED WITH SOUTHEASTERN U.S.:

 • 0-6% US Prevalence of those:

 • ~30% Asymptomatic

 • Contracted through soil (walking with bare feet), human waste/sewage contact, farming

CLINICAL FEATURES - 3 PHASES:

 - Invasion: larva currens (pruritus serpiginous urticarial tracks) primarily on lower abdominal wall, buttocks, thighs

 - Migration to Pulmonary System: cough, wheezing, shortness of breath, pulmonary infiltrates

 - Intestinal Manifestations & Autoinfection: Indigestion, abdominal pain, vomiting, diarrhea, steatorrhea, enteropathy, protein-calorie malnutrition, weight loss

DIAGNOSIS

 • Identification of larvae in stool or duodenal fluid.

 • Hyperinfection: sputum, gastric aspirates

 • IgG ELISA

TREATMENT

 • Ivermectin: 200mcg/kg/day for 2 days or

 • Albendazole: 400mg PO BID for 7 days

PEARLS:

 • Can take several weeks after infection to be detected in the stool; intermittent egg excretion can lower diagnostic yield. ELISA and other assays approach 100% sensitivity and specificity

 • Look for Eosinophilia

HYPERINFECTION SYNDROME:

 • Translocation through bowel wall can carry flora + Strongyloides into systemic circulation

 • GNR Bacteremia + Multiple Organ Involvement

 • Sudden generalized abdominal pain and distension, fever, petechia/purpura, cough, wheezing, hemoptysis



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