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 #Strongyloides #Stercoralis #diagnosis #management #parasites #Threadworm #lifecycle
