Documente Academic
Documente Profesional
Documente Cultură
file:///
Strongyloidiasis
Authors
Peter F Weller, MD, FACP
Karin Leder, MBBS, FRACP, PhD,
MPH, DTMH
Section Editor
Edward T Ryan, MD, DTMH
Deputy Editor
Elinor L Baron, MD, DTMH
Disclosures
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Mar 2016. | This topic last updated: Sep 10, 2015.
INTRODUCTION Strongyloidiasis is caused by infection with Strongyloides stercoralis.
Manifestations of infection can range from asymptomatic eosinophilia in the immunocompetent host to
disseminated disease with septic shock in the immunocompromised host.
EPIDEMIOLOGY Strongyloidiasis is endemic in tropical and subtropical regions and occurs
sporadically in temperate areas. In tropical and subtropical regions, the overall regional prevalence may
exceed 25 percent. The highest rates of infection in the United States are among residents of the
southeastern states [1,2] and among individuals who have been in endemic areas (including
immigrants, refugees, travelers, and military personnel) [3,4]. Transmission of strongyloidiasis in a
long-term care setting has also been described [2].
A Canadian study of newly arrived Southeast Asian refugees identified strongyloidiasis seroprevalence
among Kampucheans, Laotians, and Vietnamese (76, 56, and 12 percent, respectively) [4]. In another
study, over 40 percent of Cambodian immigrants to Australia had positive or equivocal strongyloides
serology indicating possible infection [5].
LIFE CYCLE The infection begins when human skin contacts filariform larvae (the infective larval
stage) of S. stercoralis, which are found in soil or other materials contaminated with human feces
(figure 1) [6,7]. The filariform larvae penetrate the skin and migrate hematogenously to the lungs
where they penetrate into the alveolar air sacs. The larvae then ascend the tracheobronchial tree and
are swallowed.
The larvae mature into adult worms that burrow into the mucosa of the duodenum and jejunum. Adult
worms may live for up to five years. The adult female produces eggs, from which noninfectious larvae
(rhabditiform larvae) develop within the lumen of the gastrointestinal tract. The rhabditiform larvae are
generally passed in the feces. The cycle from dermal penetration to appearance of larvae in the stool
requires approximately three to four weeks.
Autoinfection In contrast with other helminthic parasites, S. stercoralis can complete its life cycle
entirely within the human host [8]. As a result, the burden of adult worms in infected humans can
increase substantially through a cycle of autoinfection. During autoinfection, the rhabditiform larvae
mature into filariform larvae within the gastrointestinal tract. The filariform larvae can then penetrate
the perianal skin or colonic mucosa to complete the cycle of autoinfection. Larval transformation within
the gastrointestinal tract may also be accelerated by constipation, diverticula, other conditions that
reduce bowel motility, and steroid use.
Although autoinfection is limited by an intact immune response, a low level of autoinfection may permit
the organism to persist for decades and cause clinical manifestations long after the initial infection [9].
This has been observed in prisoners of war who were found to be infected more than 40 years after
18-May-16 10:10 PM
2 of 19
file:///
exposure in Thailand [10]. However, in patients with depressed cell-mediated immunity, autoinfection
may give rise to potentially fatal hyperinfection with disseminated disease [11,12]. (See 'Hyperinfection
syndrome' below.)
CLINICAL MANIFESTATIONS Most infected patients do not experience prominent symptoms. The
most common manifestations are mild waxing and waning gastrointestinal, cutaneous, or pulmonary
symptoms that persist for years; others simply have eosinophilia in the absence of symptoms.
Eosinophilia is not universally present in strongyloidiasis but may be the only clue that the patient
harbors a parasitic infection. One report, for example, evaluated 128 Indochinese patients with
eosinophilia, the cause of which was not apparent by routine screening [13]. Intestinal parasitism with
one or more organisms was responsible for the eosinophilia in 122; hookworm (55 percent) and S.
stercoralis (38 percent) were the most common organisms.
However, eosinophilia may be suppressed or absent in disseminated disease because of concomitant
pyogenic infection or steroid administration [14]. The serum immunoglobulin E (IgE) concentration is
often elevated in these settings [15].
Skin reactions S. stercoralis may produce cutaneous reactions when larvae penetrate the skin,
sometimes termed ground itch [16,17]. These reactions include inflammation, edema, petechiae,
serpiginous or urticarial tracts, and severe pruritus. The feet are the most commonly affected site with
initial infection, but dermal manifestations of primary infection rarely lead patients to seek medical
attention.
With chronic infection, urticaria or pruritis can develop. In addition, the dermal migration of larvae may
produce a distinctive eruption at other sites, most commonly on the buttocks. As larvae migrate, at a
rate detectable by observers, a serpiginous, raised, erythematous track develops, and these lesions are
pathognomonic of strongyloidiasis. This is known as larva currens ("running" larva). Other skin lesions
in chronic strongyloidiasis may include periumbilical purpura in disseminated infections [18],
nonpalpable purpura [19], angioedema [20,21], and erythroderma that mimics drug reaction [22].
Gastrointestinal symptoms The adult worms in the small bowel induce duodenitis, which can lead
to upper abdominal pain [23,24]. Patients may also experience diarrhea, anorexia, nausea, and
vomiting. Epigastric pain may mimic a duodenal ulcer, except that food ingestion may aggravate the
pain of strongyloidiasis. Chronic enterocolitis and malabsorption can result from a high intestinal worm
burden.
Pulmonary manifestations The transpulmonary migration of larvae can produce dry cough, throat
irritation, dyspnea, wheezing, and hemoptysis. A Loeffler's-like syndrome with eosinophilia is rarely
observed.
Some patients with chronic strongyloidiasis experience repeated episodes of fever and mild
pneumonitis, producing a picture that resembles recurrent bacterial pneumonia. Eosinophilia is often
absent initially but may develop later in the infection. Treatment of the strongyloidiasis terminates the
episodes of pneumonia.
Patients with chronic strongyloidiasis may also develop asthma that paradoxically worsens with
corticosteroid use [25,26] or dyspnea due to restrictive pulmonary disease [27]. Strongyloidiasis can
present as acute respiratory failure or pulmonary embolism [28].
Hyperinfection syndrome The cycle of autoinfection can lead to the hyperinfection syndrome by
greatly increasing the parasite burden. Autoinfection within the gastrointestinal tract begins when
rhabditiform larvae transform into filariform larvae, which penetrate the intestinal wall to enter the
bloodstream. The massive dissemination of filariform larvae to the lungs, liver, heart, central nervous
system, and endocrine glands induces inflammation that may result in symptomatic dysfunction of
these organs and even septic shock [11,29-31]. (See 'Life cycle' above.)
18-May-16 10:10 PM
3 of 19
file:///
18-May-16 10:10 PM
4 of 19
file:///
18-May-16 10:10 PM
5 of 19
file:///
18-May-16 10:10 PM
6 of 19
file:///
18-May-16 10:10 PM
7 of 19
file:///
18-May-16 10:10 PM
8 of 19
file:///
In patients with eosinophilia that persists for more than three months despite therapy, we recommend
evaluation for treatment failure or other causes of eosinophilia. (See "Approach to the patient with
unexplained eosinophilia".)
Use of UpToDate is subject to the Subscription and License Agreement
REFERENCES
1. Centers for Disease Control and Prevention. Notes from the field: Strongyloidiasis in a rural
setting--Southeastern Kentucky, 2013. MMWR Morb Mortal Wkly Rep 2013; 62:843.
2. Centers for Disease Control and Prevention. Notes from the field: strongyloides infection among
patients at a long-term care facility--Florida, 2010-2012. MMWR Morb Mortal Wkly Rep 2013;
62:844.
3. Posey DL, Blackburn BG, Weinberg M, et al. High prevalence and presumptive treatment of
schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis 2007; 45:1310.
4. Gyorkos TW, Genta RM, Viens P, MacLean JD. Seroepidemiology of Strongyloides infection in the
Southeast Asian refugee population in Canada. Am J Epidemiol 1990; 132:257.
5. Caruana SR, Kelly HA, Ngeow JY, et al. Undiagnosed and potentially lethal parasite infections
among immigrants and refugees in Australia. J Travel Med 2006; 13:233.
6. Schupf N, Ortiz M, Kapell D, et al. Prevalence of intestinal parasite infections among individuals
with mental retardation in New York State. Ment Retard 1995; 33:84.
7. Lindo JF, Robinson RD, Terry SI, et al. Age-prevalence and household clustering of Strongyloides
stercoralis infection in Jamaica. Parasitology 1995; 110 ( Pt 1):97.
8. Siddiqui AA, Genta RM, Berk SL. Chapter 111. In: Infectious Diseases - Principles, Practices and
Pathogens, Guerrant RL, Walker DH, Weller PF (Eds), Churchhill-Livingstone Elsevier, Philadelphia
2006. p.1274.
9. Chu E, Whitlock WL, Dietrich RA. Pulmonary hyperinfection syndrome with Strongyloides
stercoralis. Chest 1990; 97:1475.
10. Pelletier LL Jr, Baker CB, Gam AA, et al. Diagnosis and evaluation of treatment of chronic
strongyloidiasis in ex-prisoners of war. J Infect Dis 1988; 157:573.
11. Keiser PB, Nutman TB. Strongyloides stercoralis in the Immunocompromised Population. Clin
Microbiol Rev 2004; 17:208.
12. Haque AK, Schnadig V, Rubin SA, Smith JH. Pathogenesis of human strongyloidiasis: autopsy and
quantitative parasitological analysis. Mod Pathol 1994; 7:276.
13. Nutman TB, Ottesen EA, Ieng S, et al. Eosinophilia in Southeast Asian refugees: evaluation at a
referral center. J Infect Dis 1987; 155:309.
14. Arsi-Arsenijevi V, Dzami A, Dzami Z, et al. Fatal Strongyloides stercoralis infection in a young
woman with lupus glomerulonephritis. J Nephrol 2005; 18:787.
15. Robinson RD, Lindo JF, Neva FA, et al. Immunoepidemiologic studies of Strongyloides stercoralis
and human T lymphotropic virus type I infections in Jamaica. J Infect Dis 1994; 169:692.
16. Mackey SL, Wagner KF. Dermatologic manifestations of parasitic diseases. Infect Dis Clin North Am
1994; 8:713.
17. Meinking TL, Burkhart CN, Burkhart CG. Changing paradigms in parasitic infections: common
dermatological helminthic infections and cutaneous myiasis. Clin Dermatol 2003; 21:407.
18. Salluh JI, Bozza FA, Pinto TS, et al. Cutaneous periumbilical purpura in disseminated
strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease? Braz J
Infect Dis 2005; 9:419.
19. Reddy TS, Myers JW. Syndrome of inappropriate secretion of antidiuretic hormone and
18-May-16 10:10 PM
9 of 19
file:///
nonpalpable purpura in a woman with Strongyloides stercoralis hyperinfection. Am J Med Sci
2003; 325:288.
20. Van Dellen RG, Maddox DE, Dutta EJ. Masqueraders of angioedema and urticaria. Ann Allergy
Asthma Immunol 2002; 88:10.
21. Mehta RK, Shah N, Scott DG, et al. Case 4. Chronic urticaria due to strongyloidiasis. Clin Exp
Dermatol 2002; 27:84.
22. Ly MN, Bethel SL, Usmani AS, Lambert DR. Cutaneous Strongyloides stercoralis infection: an
unusual presentation. J Am Acad Dermatol 2003; 49:S157.
23. Scowden EB, Schaffner W, Stone WJ. Overwhelming strongyloidiasis: an unappreciated
opportunistic infection. Medicine (Baltimore) 1978; 57:527.
24. Berkmen YM, Rabinowitz J. Gastrointestinal manifestations of the stongyloidiasis. Am J Roentgenol
Radium Ther Nucl Med 1972; 115:306.
25. Sen P, Gil C, Estrellas B, Middleton JR. Corticosteroid-induced asthma: a manifestation of limited
hyperinfection syndrome due to Strongyloides stercoralis. South Med J 1995; 88:923.
26. Wehner JH, Kirsch CM, Kagawa FT, et al. The prevalence and response to therapy of Strongyloides
stercoralis in patients with asthma from endemic areas. Chest 1994; 106:762.
27. Lin AL, Kessimian N, Benditt JO. Restrictive pulmonary disease due to interlobular septal fibrosis
associated with disseminated infection by Strongyloides stercoralis. Am J Respir Crit Care Med
1995; 151:205.
28. Newberry AM, Williams DN, Stauffer WM, et al. Strongyloides hyperinfection presenting as acute
respiratory failure and gram-negative sepsis. Chest 2005; 128:3681.
29. Longworth DL, Weller PF. Hyperinfection syndrome with strongyloidiasis. In: Current Clinical Topics
in Infectious Diseases, Remington JS, Swartz MN (Eds), McGraw-Hill, New York 1986. p.1.
30. Woodring JH, Halfhill H 2nd, Reed JC. Pulmonary strongyloidiasis: clinical and imaging features.
AJR Am J Roentgenol 1994; 162:537.
31. Cebular S, Lee S, Tolaney P, Lutwick L. Community-acquired pneumonia in immunocompromised
patients. Opportunistic infections to consider in differential diagnosis. Postgrad Med 2003; 113:65.
32. Strazzella WD, Safirstein BH. Asthma due to parasitic infestation. N J Med 1989; 86:947.
33. Lam CS, Tong MK, Chan KM, Siu YP. Disseminated strongyloidiasis: a retrospective study of clinical
course and outcome. Eur J Clin Microbiol Infect Dis 2006; 25:14.
34. Nwokolo C, Imohiosen EA. Strongyloidiasis of respiratory tract presenting as "asthma". Br Med J
1973; 2:153.
35. Ghoshal UC, Ghoshal U, Jain M, et al. Strongyloides stercoralis infestation associated with
septicemia due to intestinal transmural migration of bacteria. J Gastroenterol Hepatol 2002;
17:1331.
36. Walker M, Zunt JR. Parasitic central nervous system infections in immunocompromised hosts. Clin
Infect Dis 2005; 40:1005.
37. Schaeffer MW, Buell JF, Gupta M, et al. Strongyloides hyperinfection syndrome after heart
transplantation: case report and review of the literature. J Heart Lung Transplant 2004; 23:905.
38. Adam M, Morgan O, Persaud C, Gibbs WN. Hyperinfection syndrome with Strongyloides stercoralis
in malignant lymphoma. Br Med J 1973; 1:264.
39. Cruz T, Reboucas G, Rocha H. Fatal strongyloidiasis in patients receiving corticosteroids. N Engl J
Med 1966; 275:1093.
40. Higenbottam TW, Heard BE. Opportunistic pulmonary strongyloidiasis complicating asthma treated
with steroids. Thorax 1976; 31:226.
41. Purtilo DT, Meyers WM, Connor DH. Fatal strongyloidiasis in immunosuppressed patients. Am J
Med 1974; 56:488.
42. Smith SB, Schwartzman M, Mencia LF, et al. Fatal disseminated strongyloidiasis presenting as
18-May-16 10:10 PM
10 of 19
file:///
acute abdominal distress in an urban child. J Pediatr 1977; 91:607.
43. Stemmermann GN. Strongyloidiasis in migrants. Pathological and clinical considerations.
Gastroenterology 1967; 53:59.
44. Davidson RA. Infection due to Strongyloides stercoralis in patients with pulmonary disease. South
Med J 1992; 85:28.
45. Safdar A, Malathum K, Rodriguez SJ, et al. Strongyloidiasis in patients at a comprehensive cancer
center in the United States. Cancer 2004; 100:1531.
46. Lemos LB, Qu Z, Laucirica R, Fred HL. Hyperinfection syndrome in strongyloidiasis: report of two
cases. Ann Diagn Pathol 2003; 7:87.
47. Hira PR, Al-Ali F, Shweiki HM, et al. Strongyloidiasis: challenges in diagnosis and management in
non-endemic Kuwait. Ann Trop Med Parasitol 2004; 98:261.
48. Orlent H, Crawley C, Cwynarski K, et al. Strongyloidiasis pre and post autologous peripheral blood
stem cell transplantation. Bone Marrow Transplant 2003; 32:115.
49. Centers for Disease Control and Prevention (CDC). Transmission of Strongyloides stercoralis
through transplantation of solid organs--Pennsylvania, 2012. MMWR Morb Mortal Wkly Rep 2013;
62:264.
50. Ghosh K, Ghosh K. Strongyloides stercoralis septicaemia following steroid therapy for eosinophilia:
report of three cases. Trans R Soc Trop Med Hyg 2007; 101:1163.
51. Concha R, Harrington W Jr, Rogers AI. Intestinal strongyloidiasis: recognition, management, and
determinants of outcome. J Clin Gastroenterol 2005; 39:203.
52. Schad GA. Cyclosporine may eliminate the threat of overwhelming strongyloidiasis in
immunosuppressed patients. J Infect Dis 1986; 153:178.
53. Porto MA, Alcntara LM, Leal M, et al. Atypical clinical presentation of strongyloidiasis in a patient
co-infected with human T cell lymphotrophic virus type I. Am J Trop Med Hyg 2005; 72:124.
54. Satoh M, Kiyuna S, Shiroma Y, et al. Predictive markers for development of strongyloidiasis in
patients infected with both Strongyloides stercoralis and HTLV-1. Clin Exp Immunol 2003;
133:391.
55. Rahim S, Drabu Y, Jarvis K, Melville D. Strongyloidiasis: a mistaken diagnosis and a fatal outcome
in a patient with diarrhoea. Trans R Soc Trop Med Hyg 2005; 99:215.
56. Carvalho EM, Da Fonseca Porto A. Epidemiological and clinical interaction between HTLV-1 and
Strongyloides stercoralis. Parasite Immunol 2004; 26:487.
57. Plumelle Y, Pascaline N, Nguyen D, et al. Adult T-cell leukemia-lymphoma: a clinico-pathologic
study of twenty-six patients from Martinique. Hematol Pathol 1993; 7:251.
58. Montes M, Sanchez C, Verdonck K, et al. Regulatory T cell expansion in HTLV-1 and
strongyloidiasis co-infection is associated with reduced IL-5 responses to Strongyloides stercoralis
antigen. PLoS Negl Trop Dis 2009; 3:e456.
59. Celedon JC, Mathur-Wagh U, Fox J, et al. Systemic strongyloidiasis in patients infected with the
human immunodeficiency virus. A report of 3 cases and review of the literature. Medicine
(Baltimore) 1994; 73:256.
60. Lessnau KD, Can S, Talavera W. Disseminated Strongyloides stercoralis in human
immunodeficiency virus-infected patients. Treatment failure and a review of the literature. Chest
1993; 104:119.
61. Kim AC, Lupatkin HC. Strongyloides stercoralis infection as a manifestation of immune restoration
syndrome. Clin Infect Dis 2004; 39:439.
62. Taylor CL, Subbarao V, Gayed S, Ustianowski AP. Immune reconstitution syndrome to
Strongyloides stercoralis infection. AIDS 2007; 21:649.
63. Brown M, Cartledge JD, Miller RF. Dissemination of Strongyloides stercoralis as an immune
restoration phenomenon in an HIV-1-infected man on antiretroviral therapy. Int J STD AIDS 2006;
18-May-16 10:10 PM
11 of 19
file:///
17:560.
64. Viney ME, Brown M, Omoding NE, et al. Why does HIV infection not lead to disseminated
strongyloidiasis? J Infect Dis 2004; 190:2175.
65. Seet RC, Lau LG, Tambyah PA. Strongyloides hyperinfection and hypogammaglobulinemia. Clin
Diagn Lab Immunol 2005; 12:680.
66. Sathiyasekaran M, Shibalan S. Intestinal strongyloidiasis and common variable immunodeficiency
syndrome. Indian Pediatr 2005; 42:391.
67. Boatright MD, Wang BW. Clinical infection with Strongyloides sterocoralis following etanercept use
for rheumatoid arthritis. Arthritis Rheum 2005; 52:1336.
68. Krishnamurthy R, Dincer HE, Whittemore D. Strongyloides stercoralis hyperinfection in a patient
with rheumatoid arthritis after anti-TNF-alpha therapy. J Clin Rheumatol 2007; 13:150.
69. Marty FM. Strongyloides hyperinfection syndrome and transplantation: a preventable, frequently
fatal infection. Transpl Infect Dis 2009; 11:97.
70. Vilela EG, Clemente WT, Mira RR, et al. Strongyloides stercoralis hyperinfection syndrome after
liver transplantation: case report and literature review. Transpl Infect Dis 2009; 11:132.
71. Valar C, Keitel E, Dal Pr RL, et al. Parasitic infection in renal transplant recipients. Transplant Proc
2007; 39:460.
72. Mejia R, Nutman TB. Screening, prevention, and treatment for hyperinfection syndrome and
disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis 2012; 25:458.
73. Roxby AC, Gottlieb GS, Limaye AP. Strongyloidiasis in transplant patients. Clin Infect Dis 2009;
49:1411.
74. Nuesch R, Zimmerli L, Stockli R, et al. Imported strongyloidosis: a longitudinal analysis of 31
cases. J Travel Med 2005; 12:80.
75. Gill GV, Welch E, Bailey JW, et al. Chronic Strongyloides stercoralis infection in former British Far
East prisoners of war. QJM 2004; 97:789.
76. Johnston FH, Morris PS, Speare R, et al. Strongyloidiasis: a review of the evidence for Australian
practitioners. Aust J Rural Health 2005; 13:247.
77. Lim S, Katz K, Krajden S, et al. Complicated and fatal Strongyloides infection in Canadians: risk
factors, diagnosis and management. CMAJ 2004; 171:479.
78. Agrawal V, Agarwal T, Ghoshal UC. Intestinal strongyloidiasis: a diagnosis frequently missed in the
tropics. Trans R Soc Trop Med Hyg 2009; 103:242.
79. Al-Hasan MN, McCormick M, Ribes JA. Invasive enteric infections in hospitalized patients with
underlying strongyloidiasis. Am J Clin Pathol 2007; 128:622.
80. Beal CB, Viens P, Grant RG, Hughes JM. A new technique for sampling duodenal contents:
demonstration of upper small-bowel pathogens. Am J Trop Med Hyg 1970; 19:349.
81. Boulware DR, Stauffer WM 3rd, Walker PF. Hypereosinophilic syndrome and mepolizumab. N Engl J
Med 2008; 358:2839; author reply 2839.
82. Rosenblatt JE. Clinical importance of adequately performed stool ova and parasite examinations.
Clin Infect Dis 2006; 42:979.
83. Hirata T, Nakamura H, Kinjo N, et al. Increased detection rate of Strongyloides stercoralis by
repeated stool examinations using the agar plate culture method. Am J Trop Med Hyg 2007;
77:683.
84. Ramanathan R, Nutman T. Strongyloides stercoralis infection in the immunocompromised host.
Curr Infect Dis Rep 2008; 10:105.
85. Greiner K, Bettencourt J, Semolic C. Strongyloidiasis: a review and update by case example. Clin
Lab Sci 2008; 21:82.
86. Eveland LK, Kenney M, Yermakov V. Laboratory diagnosis of autoinfection in strongyloidiasis. Am J
Clin Pathol 1975; 63:421.
18-May-16 10:10 PM
12 of 19
file:///
18-May-16 10:10 PM
13 of 19
file:///
single-dose veterinary preparation of ivermectin versus 7-day high-dose albendazole for chronic
strongyloidiasis. Int J Antimicrob Agents 2008; 31:46.
110. Segarra-Newnham M. Manifestations, diagnosis, and treatment of Strongyloides stercoralis
infection. Ann Pharmacother 2007; 41:1992.
111. 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 2005;
73:122.
112. Leung V, Al-Rawahi GN, Grant J, et al. Case report: failure of subcutaneous ivermectin in treating
Strongyloides hyperinfection. Am J Trop Med Hyg 2008; 79:853.
113. Turner SA, Maclean JD, Fleckenstein L, Greenaway C. Parenteral administration of ivermectin in a
patient with disseminated strongyloidiasis. Am J Trop Med Hyg 2005; 73:911.
114. Tarr PE, Miele PS, Peregoy KS, et al. Case report: Rectal adminstration of ivermectin to a patient
with Strongyloides hyperinfection syndrome. Am J Trop Med Hyg 2003; 68:453.
115. Marty FM, Lowry CM, Rodriguez M, et al. Treatment of human disseminated strongyloidiasis with a
parenteral veterinary formulation of ivermectin. Clin Infect Dis 2005; 41:e5.
116. Salluh JI, Feres GA, Velasco E, et al. Successful use of parenteral ivermectin in an
immunosuppressed patient with disseminated strongyloidiasis and septic shock. Intensive Care
Med 2005; 31:1292.
117. Miller MA, Church LW, Salgado CD. Strongyloides hyperinfection: a treatment dilemma. Am J Med
Sci 2008; 336:358.
118. Pornsuriyasak P, Niticharoenpong K, Sakapibunnan A. Disseminated strongyloidiasis successfully
treated with extended duration ivermectin combined with albendazole: a case report of intractable
strongyloidiasis. Southeast Asian J Trop Med Public Health 2004; 35:531.
119. Kobayashi J, Sato Y, Toma H, et al. Application of enzyme immunoassay for postchemotherapy
evaluation of human strongyloidiasis. Diagn Microbiol Infect Dis 1994; 18:19.
120. Biggs BA, Caruana S, Mihrshahi S, et al. Management of chronic strongyloidiasis in immigrants
and refugees: is serologic testing useful? Am J Trop Med Hyg 2009; 80:788.
121. El Masry HZ, O'Donnell J. Fatal stongyloides hyperinfection in heart transplantation. J Heart Lung
Transplant 2005; 24:1980.
122. Terashima A, Alvarez H, Tello R, et al. Treatment failure in intestinal strongyloidiasis: an indicator
of HTLV-I infection. Int J Infect Dis 2002; 6:28.
123. Jeyamani R, Joseph AJ, Chacko A. Severe and treatment resistant strongyloidiasis--indicator of
HTLV-I infection. Trop Gastroenterol 2007; 28:176.
Topic 5714 Version 19.0
2016 UpToDate, Inc. All rights reserved.
18-May-16 10:10 PM
14 of 19
file:///
18-May-16 10:10 PM
15 of 19
file:///
18-May-16 10:10 PM
16 of 19
file:///
18-May-16 10:10 PM
17 of 19
file:///
being carried successively to the lungs, the bronchial tree, the pharynx, and the small
intestine where they mature into adults; or they may disseminate widely in the body. To date,
occurrence of autoinfection in humans with helminthic infections is recognized only in
Strongyloides stercoralis and Capillaria philippinensis infections. In the case of Strongyloides,
autoinfection may explain the possibility of persistent infections for many years in persons
who have not been in an endemic area and of hyperinfections in immunodepressed
individuals.
Geographic distribution: Tropical and subtropical areas, but cases also occur in temperate
areas (including the South of the United States). More frequently found in rural areas,
institutional settings, and lower socioeconomic groups.
Reproduced from: Centers for Disease Control and Prevention. DPDx: Strongyloidiasis. Available at:
http://www.cdc.gov/dpdx/strongyloidiasis/index.html.
18-May-16 10:10 PM
18 of 19
file:///
Strongyloides stercoralis
18-May-16 10:10 PM
19 of 19
file:///
Endoscopy - strongyloidiasis
18-May-16 10:10 PM