eMedicine Specialties > Dermatology > Parasitic Infections

Strongyloidiasis: Follow-up

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Mordechai M Tarlow, MD, Physician, Department of Medicine, Section of Dermatology, Kimball Medical Center
Contributor Information and Disclosures

Updated: May 29, 2009

Follow-up

Further Outpatient Care

  • Continue serial sampling of the stool or duodenal aspirates at intervals of 2-3 months to ensure complete eradication of the parasite.
  • Serologic studies can be used to monitor the response to therapy.
    • Perform these tests 4-8 months after anthelmintic therapy is completed.
    • Strongyloides titers should decrease to low or undetectable levels 6-18 months after treatment. If titer has not decreased sufficiently, additional therapy may be necessary.

Deterrence/Prevention

  • Infection is prevented by avoiding direct skin contact with soil containing infective larvae. Instruct travelers to endemic areas to wear footwear when walking on the beach and other areas with soil.
  • Identify patients at risk and perform appropriate diagnostic tests before they begin immunosuppressive therapy.
  • No accepted prophylactic regimens exist, and no vaccines are available.
  • A wise practice is to search for S stercoralis larvae before initiating immunosuppression in anyone who has traveled to an endemic area, even if it was decades earlier.10

Complications

  • Cutaneous complications of strongyloidiasis include larva currens and chronic urticaria. Cutaneous complications in immunocompromised patients with severe infection include purpura and petechia.
  • Many systemic complications are possible; these can be divided by system.
    • GI complications include intestinal obstruction, perforation or infarction, malabsorption, hemorrhage, ileus, jaundice, and peritonitis.
    • Respiratory complications include pneumonitis, alveolar hemorrhage, pleural effusion, exacerbation of preexisting pulmonary disease, granulomatous lung disease, and adult respiratory distress syndrome (ARDS).
    • Neurologic complications include meningitis and cerebral abscess.
    • Renal and musculoskeletal complications are rare.

Prognosis

  • Acute and chronic strongyloidiasis have a good prognosis. However, untreated infection can persist for the remainder of the patient's life because of autoinfection. A patient's prolonged absence from an endemic area is no guarantee of freedom from infection.
  • Severe infection or dissemination is commonly a fatal event, and it is often unresponsive to therapy.22

Miscellaneous

Medicolegal Pitfalls

  • Infected immunocompromised patients are at high risk of developing severe disseminated disease.8 Strongyloides infection should be excluded prior to commencing immunosuppressive therapies in patients from endemic areas. Appropriate diagnostic procedures must be performed.
  • Imported strongyloidosis should be considered in travelers to and immigrants from endemic areas.23
 


More on Strongyloidiasis

Overview: Strongyloidiasis
Differential Diagnoses & Workup: Strongyloidiasis
Treatment & Medication: Strongyloidiasis
Follow-up: Strongyloidiasis
References
Further Reading
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References

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  2. Chandrasekar PH, Bharadwaj RA, Polenakovik H, Polenakovik S. Strongyloidiasis. eMedicine from WebMD [serial online]. April 3, 2009;Available at http://emedicine.medscape.com/article/229312-overview.

  3. Milder JE, Walzer PD, Kilgore G, Rutherford I, Klein M. Clinical features of Strongyloides stercoralis infection in an endemic area of the United States. Gastroenterology. Jun 1981;80(6):1481-8. [Medline].

  4. Pelletier LL Jr. Chronic strongyloidiasis in World War II Far East ex-prisoners of war. Am J Trop Med Hyg. Jan 1984;33(1):55-61. [Medline].

  5. Pelletier LL Jr, Gabre-Kidan T. Chronic strongyloidiasis in Vietnam veterans. Am J Med. Jan 1985;78(1):139-40. [Medline].

  6. Pattison DA, Speare R. Strongyloidiasis in personnel of the Regional Assistance Mission to Solomon Islands (RAMSI). Med J Aust. Aug 18 2008;189(4):203-6. [Medline].

  7. Yori PP, Kosek M, Gilman RH, et al. Seroepidemiology of strongyloidiasis in the Peruvian Amazon. Am J Trop Med Hyg. Jan 2006;74(1):97-102. [Medline].

  8. Johnston FH, Morris PS, Speare R, et al. Strongyloidiasis: a review of the evidence for Australian practitioners. Aust J Rural Health. Aug 2005;13(4):247-54. [Medline].

  9. Fardet L, Genereau T, Poirot JL, Guidet B, Kettaneh A, Cabane J. Severe strongyloidiasis in corticosteroid-treated patients: case series and literature review. J Infect. Jan 2007;54(1):18-27. [Medline].

  10. Guyomard JL, Chevrier S, Bertholom JL, Guigen C, Charlin JF. [Finding of Strongyloides stercoralis infection, 25 years after leaving the endemic area, upon corticotherapy for ocular trauma]. J Fr Ophtalmol. Feb 2007;30(2):e4. [Medline].

  11. Salluh JI, Bozza FA, Pinto TS, Toscano L, Weller PF, Soares M. Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?. Braz J Infect Dis. Oct 2005;9(5):419-24. [Medline].

  12. Goncalves AL, Machado GA, Goncalves-Pires MR, Ferreira-Junior A, Silva DA, Costa-Cruz JM. Evaluation of strongyloidiasis in kennel dogs and keepers by parasitological and serological assays. Vet Parasitol. Jun 20 2007;147(1-2):132-9. [Medline].

  13. Meamar AR, Rezaian M, Mohraz M, Hadighi R, Kia EB. Strongyloides stercoralis hyper-infection syndrome in HIV+/AIDS patients in Iran. Parasitol Res. Aug 2007;101(3):663-5. [Medline].

  14. Qu Z, Kundu UR, Abadeer RA, Wanger A. Strongyloides colitis is a lethal mimic of ulcerative colitis: the key morphologic differential diagnosis. Hum Pathol. Apr 2009;40(4):572-7. [Medline].

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  16. Sithithaworn J, Sithithaworn P, Janrungsopa T, Suvatanadecha K, Ando K, Haswell-Elkins MR. Comparative assessment of the gelatin particle agglutination test and an enzyme-linked immunosorbent assay for diagnosis of strongyloidiasis. J Clin Microbiol. Jul 2005;43(7):3278-82. [Medline].

  17. Page WA, Dempsey K, McCarthy JS. Utility of serological follow-up of chronic strongyloidiasis after anthelminthic chemotherapy. Trans R Soc Trop Med Hyg. Nov 2006;100(11):1056-62. [Medline].

  18. Kishimoto K, Hokama A, Hirata T, et al. Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection. World J Gastroenterol. Mar 21 2008;14(11):1768-73. [Medline].

  19. Mittal S, Sagi SV, Hawari R. Strongyloidiasis: endoscopic diagnosis. Clin Gastroenterol Hepatol. Feb 2009;7(2):e8. [Medline].

  20. Pacanowski J, Santos MD, Roux A, et al. Subcutaneous ivermectin as a safe salvage therapy in Strongyloides stercoralis hyperinfection syndrome: a case report. Am J Trop Med Hyg. Jul 2005;73(1):122-4. [Medline].

  21. Robson D, Beeching NJ, Gill GV. Strongyloides hyperinfection syndrome in British veterans. Ann Trop Med Parasitol. Mar 2009;103(2):145-8. [Medline].

  22. Fasih N, Irfan S, Sheikh U, Beg MS. A fatal case of gram negative bacterial sepsis associated with disseminated strongyloidiasis in an immunocompromised patient. J Pak Med Assoc. Feb 2008;58(2):91-2. [Medline].

  23. Nuesch R, Zimmerli L, Stockli R, Gyr N, Christoph Hatz FR. Imported strongyloidosis: a longitudinal analysis of 31 cases. J Travel Med. Mar-Apr 2005;12(2):80-4. [Medline].

  24. Amer M, Attia M, Ramadan AS, Matout K. Larva currens and systemic disease. Int J Dermatol. Jul-Aug 1984;23(6):402-3. [Medline].

  25. Markell EK, John DT, Krotoski WA. Markell and Voge's Medical Parasitology. 8th ed. Philadelphia, Pa: WB Saunders; 1999:287-93.

  26. Ouimet MJ, Munoz M, Narasiah L, Rambure V, Correa JA. [Current pathologies among asylum seekers in Montreal: prevalence and associated risk factors]. Can J Public Health. Nov-Dec 2008;99(6):499-504. [Medline].

  27. Roeckel IE, Lyons ET. Cutaneous larva migrans, an occupational disease. Ann Clin Lab Sci. Sep-Oct 1977;7(5):405-10. [Medline].

  28. Smith JD, Goette DK, Odom RB. Larva currens. Cutaneous strongyloidiasis. Arch Dermatol. Aug 1976;112(8):1161-3. [Medline].

  29. Stone OJ, Newell GB, Mullins JF. Cutaneous strongyloidiasis: larva currens. Arch Dermatol. Nov 1972;106(5):734-6. [Medline].

  30. von Kuster LC, Genta RM. Cutaneous manifestations of strongyloidiasis. Arch Dermatol. Dec 1988;124(12):1826-30. [Medline].

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Keywords

strongyloidiasis, cutaneous strongyloidiasis, cutaneous larva migrans, larva currens, racing larva, creeping eruption, creeping infection, threadworm infection, disseminated strongyloidiasis, Strongyloides stercoralis, S stercoralis

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Mordechai M Tarlow, MD, Physician, Department of Medicine, Section of Dermatology, Kimball Medical Center
Mordechai M Tarlow, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for MOHS Surgery, American Society of Cosmetic Dermatology and Aesthetic Surgery, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

James J Nordlund, MD, Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine
James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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