Strongyloidiasis Differential Diagnoses

Updated: Nov 04, 2016
  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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DDx

Diagnostic Considerations

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. [48] Complicating diagnosis is the fact that presentation is often decades after primary infection.

Multiple case reports exist of patients with fatal outcomes after treatment with steroids for a severe disease of unknown etiology that pathology later demonstrated as disseminated Strongyloides infection. [37] It is important for a clinician to be aware that Strongyloides is a cause of pulmonary infiltrates, acute respiratory distress syndrome (ARDS), small bowel obstruction, and multisystem organ failure, and rapid clinical decline.

Obtaining an appropriate travel and residence history is important. Imported strongyloidosis should be considered in travelers to and immigrants from endemic areas. [49] Furthermore, infected immunocompromised patients are at high risk of developing severe disseminated disease. [30] 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.

When evaluating a patient with suspected strongyloidiasis, other parasitic conditions should also be considered, including acute schistosomiasis (Katayama fever); ascariasis; amebiasis; human hookworm infection with Ancylostoma duodenale or Necator americanus; zoonotic infection with Strongyloides myopotami, S procyonis, Ancylostoma braziliensis, or A caninum.

Nonparasitic conditions that are part of the differential diagnosis include polyarteritis nodosa [50] ; systemic lupus erythematosus; contact dermatitis; erythema annulare centrifugum; scabies; urticaria; anaphylaxis; drug reaction; Henoch-Schönlein purpura; eosinophilia; eosinophilic or bacterial gastroenteritis; malabsorption; malnutrition; upper and lower gastrointestinal bleeding; peptic ulcer disease; transient pulmonary eosinophilic syndrome; pneumonia; meningitis; and sepsis and/or septic shock.

Strongyloides colitis is an easily curable yet potentially lethal mimic of ulcerative colitis. [51] Clinicians should have a high index of suspicion and be aware of gastrointestinal similarities with ulcerative colitis.

Differential Diagnoses