eMedicine Specialties > Infectious Diseases > Gastrointestinal Tract and Intra-abdominal Infections

Strongyloidiasis: Follow-up

Author: Pranatharthi Haran Chandrasekar, MD, Director of Infectious Disease Fellowship, Professor, Department of Internal Medicine, Harper Hospital, Wayne State University School of Medicine
Coauthor(s): Ramesh A Bharadwaj, MD, Fellow in Infectious Diseases, Detroit Medical Center, Wayne State University; Hari Polenakovik, MD, Assistant Professor of Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH; Sylvia Polenakovik, MD, Clinical Instructor, Internist, Department of Internal Medicine, Wayne Hospital, Wright State University
Contributor Information and Disclosures

Updated: Apr 3, 2009

Follow-up

Further Inpatient Care

  • Consider contact isolation in patients with severe strongyloidiasis because sputum, stool, vomitus, and other bodily excreta may contain infective (filariform) larvae.

Further Outpatient Care

  • Medication: Repeat courses of ivermectin in immunocompromised patients because relapse is common in this population.
  • Follow-up examination
    • To ensure a parasitologic cure, repeat stool examinations and/or duodenal aspirations every 2-3 months.
    • Alternatively, schedule follow-up strongyloides serology studies (4-8 mo after therapy) to monitor the patient's response to therapy.
    • Ensure that the Strongyloides antibody titer declines to low or undetectable levels within 6-18 months after successful treatment.
    • A nondeclining titer may indicate a need for additional anthelmintic therapy.

Inpatient & Outpatient Medications

  • Conduct definitive treatment with anthelmintic drugs (see Medication).
  • Treat bacterial complications (eg, bacteremia, meningitis) for 2-4 weeks with antibiotics according to the results of in vitro testing against the bacterial isolate(s).

Deterrence/Prevention

  • Instruct travelers to endemic areas to avoid walking barefoot in places or soil that potentially contain infective larvae. Shoes help protect against infection.
  • No prophylactic regimens are accepted, and no vaccines are available for strongyloidiasis.

Complications

Prognosis

  • Acute and chronic strongyloidiasis carry a good prognosis.
  • Hyperinfection syndrome and disseminated strongyloidiasis carry a poor prognosis.

Miscellaneous

Medicolegal Pitfalls

  • The diagnosis of strongyloidiasis requires a high index of suspicion, as patients with the infection present with no distinctive clinical features, and ancillary laboratory, imaging, and endoscopic findings are often nonspecific.
  • Obtaining an appropriate travel and residence history is important. Furthermore, the possibility of strongyloidiasis should always be considered in any immunocompromised patient who suddenly deteriorates.
  • Delay in diagnosing strongyloidiasis frequently results in death, despite vigorous treatment.

Special Concerns

  • Pregnancy: Clinicians may prefer to defer treatment for strongyloidiasis until after the first trimester. All of the medications listed are FDA category C agents.
  • Immunocompromise: In patients with an appropriate geographic history, rule out strongyloidiasis by means of thorough evaluation, including several stool examinations for ova and parasites, special larvae detection techniques, and/or serology in all transplant candidates or others who are likely to receive a prolonged course of steroids or other immunosuppressive medications. Among the immunosuppressive agents, only cyclosporine A is known to possess anthelmintic activity. This was initially confirmed in animal models and subsequently observed in clinical practice. To date, no cases of severe strongyloidiasis developing in transplant recipients treated with cyclosporine have been reported.
 


More on Strongyloidiasis

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

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Keywords

strongyloidiasis, hyperinfection syndrome, disseminated strongyloidiasis, Strongyloides, threadworm infection, Cochin China diarrhea, parasitic nematodes, Strongyloides stercoralis, S stercoralis, Strongyloides fuelleborni, S fuelleborni, bacterial meningitis, rhabditiform larvae, parthenogenesis, filariform, bacteremia, Escherichia coli, E coli, Klebsiella species, helminth, strongyloidosis, acute strongyloidiasis, chronic strongyloidiasis, intestinal strongyloidiasis

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Contributor Information and Disclosures

Author

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

Ramesh A Bharadwaj, MD, Fellow in Infectious Diseases, Detroit Medical Center, Wayne State University
Ramesh A Bharadwaj, MD is a member of the following medical societies: American College of Physicians and Michigan State Medical Society
Disclosure: Nothing to disclose.

Hari Polenakovik, MD, Assistant Professor of Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH
Hari Polenakovik, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

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

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, 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; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
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.

 
 
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