Strongyloidiasis Clinical Presentation

  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jun 29, 2011
 

History and Physical Examination

The clinical manifestations of Strongyloides infections vary, depending on the acuity of infection and the underlying host response. The vast majority of patients with strongyloidiasis have uncomplicated disease. As many as 50% of patients remain asymptomatic and can survive decades undiagnosed.

Symptomatic infections typically manifest in gastrointestinal, pulmonary, and dermatologic systems. Patients who become symptomatic do so shortly after exposure, or they develop late symptoms. Severe symptoms may develop and death may ensue, especially in individuals who are immunocompromised.

Acute infection is generally characterized by gastrointestinal (GI) and pulmonary symptoms, whereas chronic infection is characterized by skin involvement.

Severe strongyloidiasis (hyperinfection, disseminated disease) may be insidious; occasionally, symptoms may have an abrupt onset. Fever is almost always present in disseminated disease.[34] Invasion of larvae into tissue is potentially massive. As a result, patients present with an exaggeration of the symptoms of established infection found in patients who are immunocompetent. In addition, as larvae penetrate the intestinal wall, they may allow enteric flora to escape, causing bacteremia, sepsis, meningitis, and endocarditis. Thus, a diagnosis of severe strongyloidiasis should be suspected with unusual GI or pulmonary symptoms or an unexplained Gram-negative bacilli sepsis.

Gastrointestinal manifestations

Gastrointestinal symptoms are vague, including epigastric abdominal cramping, indigestion, anorexia, weight loss, nausea, vomiting, chronic diarrhea, constipation, pruritus ani, bloating and, rarely, small bowel obstruction. Strongyloides is an important cause of failure to thrive and cachexia in immunocompetent children.

In classic cases, diarrhea is profuse, watery, and mucoid. Periods of alternation between diarrhea and constipation may occur. Malabsorption of fat and vitamin B-12 has been reported in chronic infections and has been successfully treated by deworming.

Prolonged malabsorption of both fat and protein can lead to a celiac-like syndrome, characterized by steatorrhea, hypoalbuminemia, and peripheral edema, such as a syndrome of infantile infection caused by S fulleborni described in western Papua New Guinea. These children have diarrhea that becomes protracted in the first months of life, respiratory distress, failure to thrive, protein-losing enteropathy, and a kwashiorkor-like appearance (with ascites and pleural effusions) due to hypoalbuminemia ("swollen baby" sickness).

In severe hyperinfection syndrome or disseminated disease, abdominal symptoms are similar to those of chronic infection, but they are more severe. Gut flora invade host tissues either through penetration of infective larvae from bowel lumen or through damaged intestinal epithelium. Escherichia coli and Klebsiella species are the most common organisms involved. Bloody stools and/or blood diarrhea may occur along with severe abdominal pains. Massive GI tract bleeding has also been reported.[35]

Pulmonary manifestations

Symptomatic pulmonary strongyloidiasis that results from migrating larvae is observed in 10% of patients. Initial infection may trigger wheezing[36] and mild cough.

Migration of the larvae through the lungs produces a pneumonitis that resembles Loeffler syndrome. Symptoms include a productive cough, at times with blood-streaked sputum, dyspnea, and fever. Strongyloidiasis can also produce a clinical syndrome that mimics either asthma or pneumonia.

In severe (disseminated) disease, pneumonitis may cause hemoptysis and difficulty in breathing. In addition, cough, hemoptysis, dyspnea, wheezing, pleuric pain, tachypnea can occur, and acute respiratory distress syndrome (ARDS) may require mechanical ventilation.

Dermatologic manifestations

Skin penetration by infective larvae can elicit ground itch, a cutaneous eruption of pruritic papulovesicular lesions. Typically, skin penetration is on the feet but may be at any site that contacted infected soil (eg, around the anus [within 12 cm] or anywhere on the trunk and thighs).

Larva currens (racing larvae), the pathognomonic rash of Strongyloides infection, is an intensely pruritic linear or serpiginous urticarial rash that may consist of 1 or more such bands and creeps 5-15 cm/h up the body. The rash, likely an allergic response to the migrating filariform larvae, often manifests as a pruritic wheal or linear urticaria. This dermatologic manifestation may last hours to days but in autoinfection cycles can recur over weeks, months, and years. In an individual who has already been sensitized, a second, creeping, urticarial rash may appear, which is caused by an allergic reaction to the larvae penetrating the skin. Excoriation and impetigo are common.

Rarely, in disseminated strongyloidiasis, a rapidly progressive, diffuse, petechial purpuric eruption may be present secondary to vessel injury during larval migration.[37] Characteristic purpuric periumbilical skin lesions should raise the suspicion for its diagnosis; it often portends a fatal outcome in cancer patients.[38] There have also been case reports of multiple atypical dermatologic presentations in hyperinfection cases.[39]

Neurologic and other manifestations (severe strongyloidiasis)

An altered mental status, focal seizures, meningitis, brain abscess or nuchal rigidity may indicate central nervous (CNS) involvement. Symptoms of meningitis may include headache, nausea, vomiting, and, in extreme cases, coma.

Granulomatous hepatitis and parasitic invasion of the heart, kidney, peritoneum, lymph nodes, pancreas, prostate, ovaries, thyroid, or parathyroid may be present in disseminated disease.

A case report demonstrated infertility as a presentation for disseminated strongyloidiasis with larvae found in ejaculate and conception occurring after treatment. Another patient experienced years of recurrent abdominal pain and fever with recurrent eosinophilic oophoritis who had positive strongyloides serology and clinical response to treatment.[40]

Next

Complications

Strongyloidiasis can lead to gastrointestinal (GI), pulmonary, dermatologic, neurologic, and other complications, as well as death.

GI complications include the following:

GI hemorrhage: Life-threatening GI bleeding has been described in a patient with hyperinfection syndrome; the bleeding was found to be from microaneurysms ("berry aneurysms") in the superior and inferior mesenteric arteries

  • Malabsorption
  • Intestinal obstruction,[41] perforation, and infarction
  • Eosinophilic oophoritis[40]
  • Appendicitis[42]
  • Peritonitis
  • Obstructive jaundice
  • Ileus
  • Pneumatosis intestinalis

Pulmonary complications include the following:

  • Asthma or exacerbation of preexisting obstructive pulmonary disease
  • Pneumonitis
  • Respiratory failure,[33] acute respiratory distress syndrome (ASDS)
  • Alveolar hemorrhage
  • Pleural effusion
  • Granulomatous lung disease

Dermatologic complications include larva currens, purpura of the trunk and proximal extremities, and chronic urticaria.

Neurologic complications include meningitis due to enteric bacteria and brain abscess.

Vascular complications include hyperinfection syndrome presenting as bacteremia (occasionally recurrent) due to enteric microorganisms (eg, Escherichia coli, Klebsiella pneumoniae, Enterococcus species including vancomycin-resistant E faecium, Streptococcus bovis).

Renal complications can rarely include nephrotic syndrome[43] (eg, minimal-change nephrotic syndrome[44] ). Resolution of the proteinuria occurs after administration of antihelmintic therapy with ivermectin. Incidence of nephrotic syndrome in children in the developing world is increased in those with underlying strongyloidiasis.[45] In addition, the syndrome of inappropriate antidiuretic hormone (SIADH) has been observed in patients with severe Strongyloides infection.[46]

Rarely, a musculoskeletal complication such as reactive arthritis may occur.

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Contributor Information and Disclosures
Author

Pranatharthi Haran Chandrasekar, MBBS, MD  Professor, Department of Internal Medicine, Director of Infectious Disease Fellowship, Harper Hospital, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Leslie L Barton, MD  Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

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: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Mark Louden, MD, FACEP  Assistant Medical Director, Emergency Department, Duke Raleigh Hospital

Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Antonio Muñiz, MD  Professor of Emergency Medicine and Pediatrics, University of Texas Medical School at Houston; Medical Director of the Pediatric Emergency Department, Children's Memorial Hermann Hospital

Antonio Muñiz, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, American Medical Association, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

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.

Hari Polenakovik, MD  Assistant Professor of Medicine, Wright State University, Boonshoft School of Medicine

Hari Polenakovik, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Sylvia Polenakovik, MD  Clinical Instructor, Internist, Department of Internal Medicine, Wayne Hospital, Wright State University, Boonshoft School of Medicine

Sylvia Polenakovik, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Allison J Richard, MD  Assistant Professor of Emergency Medicine, Keck School of Medicine, University of Southern California; Associate Director, Division of International Medicine; Attending Physician, Los Angeles County-University of Southern California Hospital Emergency Department

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-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.

Mordechai M Tarlow, MD  Clinical Associate, Department of Dermatology, University of Pennsylvania School of Medicine

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.

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Eric L Weiss, MD  DTM&H, Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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.

Specialty Editor Board

Wesley W Emmons, MD, FACP  Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE

Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Ramesh A Bharadwaj, MD, Emily Anne Carpenter Rose, MD, and Ashir Kumar, MD, MBBS, FAAP, to the development and writing of the source articles.

References

  1. Arsic-Arsenijevic V, Dzamic A, Dzamic Z, Milobratovic D, Tomic D. Fatal Strongyloides stercoralis infection in a young woman with lupus glomerulonephritis. J Nephrol. Nov-Dec 2005;18(6):787-90. [Medline].

  2. Weller PF, Leder KL. Strongyloidiasis. Available at http://www.uptodate.com/contents/strongyloidiasis?source=search_result&selectedTitle=1%7E4. Accessed January 29, 2008.

  3. Asdamongkol N, Pornsuriyasak P, Sungkanuparph S. Risk factors for strongyloidiasis hyperinfection and clinical outcomes. Southeast Asian J Trop Med Public Health. Sep 2006;37(5):875-84. [Medline].

  4. Robson D, Welch E, Beeching NJ, Gill GV. Consequences of captivity: health effects of far East imprisonment in World War II. QJM. Feb 2009;102(2):87-96. [Medline].

  5. Fardet L, Généreau 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].

  6. Gonçalves AL, Machado GA, Gonçalves-Pires MR, Ferreira-Júnior 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].

  7. 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].

  8. Porto AF, Neva FA, Bittencourt H, Lisboa W, Thompson R, Alcântara L, et al. HTLV-1 decreases Th2 type of immune response in patients with strongyloidiasis. Parasite Immunol. Sep 2001;23(9):503-7. [Medline].

  9. Satoh M, Toma H, Sato Y, Takara M, Shiroma Y, Kiyuna S, et al. Reduced efficacy of treatment of strongyloidiasis in HTLV-I carriers related to enhanced expression of IFN-gamma and TGF-beta1. Clin Exp Immunol. Feb 2002;127(2):354-9. [Medline]. [Full Text].

  10. Porto MA, Alcântara LM, Leal M, Castro N, Carvalho EM. Atypical clinical presentation of strongyloidiasis in a patient co-infected with human T cell lymphotrophic virus type I. Am J Trop Med Hyg. Feb 2005;72(2):124-5. [Medline].

  11. Carvalho EM, Da Fonseca Porto A. Epidemiological and clinical interaction between HTLV-1 and Strongyloides stercoralis. Parasite Immunol. Nov-Dec 2004;26(11-12):487-97. [Medline].

  12. Thompson BF, Fry LC, Wells CD, Olmos M, Lee DH, Lazenby AJ, et al. The spectrum of GI strongyloidiasis: an endoscopic-pathologic study. Gastrointest Endosc. Jun 2004;59(7):906-10. [Medline].

  13. DeVault GA Jr, King JW, Rohr MS, Landreneau MD, Brown ST 3rd, McDonald JC. Opportunistic infections with Strongyloides stercoralis in renal transplantation. Rev Infect Dis. Jul-Aug 1990;12(4):653-71. [Medline].

  14. Schaeffer MW, Buell JF, Gupta M, Conway GD, Akhter SA, Wagoner LE. Strongyloides hyperinfection syndrome after heart transplantation: case report and review of the literature. J Heart Lung Transplant. Jul 2004;23(7):905-11. [Medline].

  15. Stone WJ, Schaffner W. Strongyloides infections in transplant recipients. Semin Respir Infect. Mar 1990;5(1):58-64. [Medline].

  16. Roxby AC, Gottlieb GS, Limaye AP. Strongyloidiasis in transplant patients. Clin Infect Dis. Nov 1 2009;49(9):1411-23. [Medline]. [Full Text].

  17. Shoop WL, Michael BF, Eary CH, Haines HW. Transmammary transmission of Strongyloides stercoralis in dogs. J Parasitol. Jun 2002;88(3):536-9. [Medline].

  18. Said T, Nampoory MR, Nair MP, Halim MA, Shetty SA, Kumar AV, et al. Hyperinfection strongyloidiasis: an anticipated outbreak in kidney transplant recipients in Kuwait. Transplant Proc. May 2007;39(4):1014-5. [Medline].

  19. Croker C, Reporter R, Redelings M, Mascola L. Strongyloidiasis-related deaths in the United States, 1991-2006. Am J Trop Med Hyg. Aug 2010;83(2):422-6. [Medline]. [Full Text].

  20. Dawson-Hahn EE, Greenberg SL, Domachowske JB, Olson BG. Eosinophilia and the seroprevalence of schistosomiasis and strongyloidiasis in newly arrived pediatric refugees: an examination of Centers for Disease Control and Prevention screening guidelines. J Pediatr. Jun 2010;156(6):1016-8, 1018.e1. [Medline].

  21. Gill GV, Welch E, Bailey JW, Bell DR, Beeching NJ. Chronic Strongyloides stercoralis infection in former British Far East prisoners of war. QJM. Dec 2004;97(12):789-95. [Medline].

  22. 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].

  23. Lim S, Katz K, Krajden S, Fuksa M, Keystone JS, Kain KC. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. CMAJ. Aug 31 2004;171(5):479-84. [Medline]. [Full Text].

  24. Keystone JS. Can one afford not to screen for parasites in high-risk immigrant populations?. Clin Infect Dis. Nov 15 2007;45(10):1316-8. [Medline].

  25. 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].

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

  27. Genta RM. Global prevalence of strongyloidiasis: critical review with epidemiologic insights into the prevention of disseminated disease. Rev Infect Dis. Sep-Oct 1989;11(5):755-67. [Medline].

  28. Glinz D, Silué KD, Knopp S, Lohourignon LK, Yao KP, Steinmann P, et al. Comparing diagnostic accuracy of Kato-Katz, Koga agar plate, ether-concentration, and FLOTAC for Schistosoma mansoni and soil-transmitted helminths. PLoS Negl Trop Dis. Jul 20 2010;4(7):e754. [Medline]. [Full Text].

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

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

  31. Moon TD, Oberhelman RA. Antiparasitic therapy in children. Pediatr Clin North Am. Jun 2005;52(3):917-48, viii. [Medline].

  32. Reddy IS, Swarnalata G. Fatal disseminated strongyloidiasis in patients on immunosuppressive therapy: report of two cases. Indian J Dermatol Venereol Leprol. Jan-Feb 2005;71(1):38-40. [Medline].

  33. Newberry AM, Williams DN, Stauffer WM, Boulware DR, Hendel-Paterson BR, Walker PF. Strongyloides hyperinfection presenting as acute respiratory failure and gram-negative sepsis. Chest. Nov 2005;128(5):3681-4. [Medline]. [Full Text].

  34. Lam CS, Tong MK, Chan KM, Siu YP. Disseminated strongyloidiasis: a retrospective study of clinical course and outcome. Eur J Clin Microbiol Infect Dis. Jan 2006;25(1):14-8. [Medline].

  35. Csermely L, Jaafar H, Kristensen J, Castella A, Gorka W, Chebli AA, et al. Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding. World J Gastroenterol. Oct 21 2006;12(39):6401-4. [Medline].

  36. Boulware DR, Stauffer WM, Hendel-Paterson BR, Rocha JL, Seet RC, Summer AP, et al. Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey. Am J Med. Jun 2007;120(6):545.e1-8. [Medline]. [Full Text].

  37. Ly MN, Bethel SL, Usmani AS, Lambert DR. Cutaneous Strongyloides stercoralis infection: an unusual presentation. J Am Acad Dermatol. Aug 2003;49(2 Suppl Case Reports):S157-60. [Medline].

  38. 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].

  39. Pacanowski J, Santos MD, Roux A, LE Maignan C, Guillot J, Lavarde V, 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].

  40. Butterfield JH, Kephart GM, Frankson JL. Eosinophilic oophoritis: association with positive Strongyloides stercoralis serology and clinical response to ivermectin. J Pediatr Adolesc Gynecol. Oct 2006;19(5):329-32. [Medline].

  41. Harish K, Sunilkumar R, Varghese T, Feroze M. Strongyloidiasis presenting as duodenal obstruction. Trop Gastroenterol. Oct-Dec 2005;26(4):201-2. [Medline].

  42. Komenaka IK, Wu GC, Lazar EL, Cohen JA. Strongyloides appendicitis: unusual etiology in two siblings with chronic abdominal pain. J Pediatr Surg. Sep 2003;38(9):E8-10. [Medline].

  43. Morimoto J, Kaneoka H, Sasatomi Y, Sato YN, Murata T, Ogahara S, et al. Disseminated strongyloidiasis in nephrotic syndrome. Clin Nephrol. May 2002;57(5):398-401. [Medline].

  44. Hsieh YP, Wen YK, Chen ML. Minimal change nephrotic syndrome in association with strongyloidiasis. Clin Nephrol. Dec 2006;66(6):459-63. [Medline].

  45. Copelovitch L, Sam Ol O, Taraquinio S, Chanpheaktra N. Childhood nephrotic syndrome in Cambodia: an association with gastrointestinal parasites. J Pediatr. Jan 2010;156(1):76-81. [Medline].

  46. Hayashi E, Ohta N, Yamamoto H. Syndrome of inappropriate secretion of antidiuretic hormone associated with strongyloidiasis. Southeast Asian J Trop Med Public Health. Mar 2007;38(2):239-46. [Medline].

  47. Pirisi M, Salvador E, Bisoffi Z, Gobbo M, Smirne C, Gigli C, et al. Unsuspected strongyloidiasis in hospitalised elderly patients with and without eosinophilia. Clin Microbiol Infect. Aug 2006;12(8):787-92. [Medline].

  48. 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].

  49. Masseau A, Hervier B, Leclair F, Grossi O, Mosnier JF, Hamidou M. [Strongyloides stercoralis infection simulating polyarteritis nodosa]. Rev Med Interne. Aug 2005;26(8):661-3. [Medline].

  50. 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].

  51. Anamnart W, Pattanawongsa A, Intapan PM, Maleewong W. Factors affecting recovery of Strongyloides stercoralis larvae: an approach to a newly modified formalin-ether concentration technique for diagnosis of strongyloidiasis. J Clin Microbiol. Jan 2010;48(1):97-100. [Medline]. [Full Text].

  52. 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].

  53. Gam AA, Neva FA, Krotoski WA. Comparative sensitivity and specificity of ELISA and IHA for serodiagnosis of strongyloidiasis with larval antigens. Am J Trop Med Hyg. Jul 1987;37(1):157-61. [Medline].

  54. Rodrigues RM, de Oliveira MC, Sopelete MC, Silva DA, Campos DM, Taketomi EA, et al. IgG1, IgG4, and IgE antibody responses in human strongyloidiasis by ELISA using Strongyloides ratti saline extract as heterologous antigen. Parasitol Res. Oct 2007;101(5):1209-14. [Medline].

  55. Bon B, Houze S, Talabani H, Magne D, Belkadi G, Develoux M, et al. Evaluation of a rapid enzyme-linked immunosorbent assay for diagnosis of strongyloidiasis. J Clin Microbiol. May 2010;48(5):1716-9. [Medline]. [Full Text].

  56. [Best Evidence] Ramanathan R, Burbelo PD, Groot S, Iadarola MJ, Neva FA, Nutman TB. A luciferase immunoprecipitation systems assay enhances the sensitivity and specificity of diagnosis of Strongyloides stercoralis infection. J Infect Dis. Aug 1 2008;198(3):444-51. [Medline].

  57. Montes M, Sawhney C, Barros N. Strongyloides stercoralis: there but not seen. Curr Opin Infect Dis. Oct 2010;23(5):500-4. [Medline]. [Full Text].

  58. Taniuchi M, Verweij JJ, Noor Z, Sobuz SU, Lieshout L, Petri WA Jr, et al. High throughput multiplex PCR and probe-based detection with Luminex beads for seven intestinal parasites. Am J Trop Med Hyg. Feb 2011;84(2):332-7. [Medline]. [Full Text].

  59. Basuni M, Muhi J, Othman N, Verweij JJ, Ahmad M, Miswan N, et al. A pentaplex real-time polymerase chain reaction assay for detection of four species of soil-transmitted helminths. Am J Trop Med Hyg. Feb 2011;84(2):338-43. [Medline]. [Full Text].

  60. 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]. [Full Text].

  61. Kishimoto K, Hokama A, Hirata T, Ihama Y, Nakamoto M, Kinjo N, et al. Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection. World J Gastroenterol. Mar 21 2008;14(11):1768-73. [Medline]. [Full Text].

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

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

  64. Fardet L, Généreau T, Cabane J, Kettaneh A. Severe strongyloidiasis in corticosteroid-treated patients. Clin Microbiol Infect. Oct 2006;12(10):945-7. [Medline].

  65. Datry A, Hilmarsdottir I, Mayorga-Sagastume R, Lyagoubi M, Gaxotte P, Biligui S, et al. Treatment of Strongyloides stercoralis infection with ivermectin compared with albendazole: results of an open study of 60 cases. Trans R Soc Trop Med Hyg. May-Jun 1994;88(3):344-5. [Medline].

  66. Marti H, Haji HJ, Savioli L, Chwaya HM, Mgeni AF, Ameir JS, et al. A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop Med Hyg. Nov 1996;55(5):477-81. [Medline].

  67. Steinmann P, Zhou XN, Du ZW, Jiang JY, Xiao SH, Wu ZX, et al. Tribendimidine and albendazole for treating soil-transmitted helminths, Strongyloides stercoralis and Taenia spp.: open-label randomized trial. PLoS Negl Trop Dis. 2008;2(10):e322. [Medline]. [Full Text].

  68. Santiago M, Leitão B. Prevention of strongyloides hyperinfection syndrome: a rheumatological point of view. Eur J Intern Med. Dec 2009;20(8):744-8. [Medline].

  69. Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York, NY: CV Mosby; 2004:503-15,:1186-7.

  70. Long SS, Pickering LK, Prober CG. Principles and Practice of Pediatric Infectious Diseases. 2nd ed. New York, NY: Churchill Livingstone; 2003:1337-9.

  71. Fusco DN, Downs JA, Satlin MJ, Pahuja M, Ramos L, Barie PS, et al. Non-oral treatment with ivermectin for disseminated strongyloidiasis. Am J Trop Med Hyg. Oct 2010;83(4):879-83. [Medline]. [Full Text].

 
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First stage, life cycle of Strongyloides stercoralis. Illustration by Tessa Kalman.
Second stage, life cycle of Strongyloides stercoralis. Illustration by Tessa Kalman.
Third stage, life cycle of Strongyloides stercoralis. Illustration by Tessa Kalman.
Fourth stage, life cycle of Strongyloides stercoralis. Illustration by Tessa Kalman.
Fifth stage, life cycle of Strongyloides stercoralis. Illustration by Tessa Kalman.
Rhabditiform larva of Strongyloides stercoralis in stool specimen (wet mount stained with iodine).
 
 
 
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