Strongyloides

1. Classification
   1. Nematode: Roundworm
2. Epidemiology
   1. Responsible for most U.S. cases fatal Helminth disease
   2. Endemic areas
      1. Tropical Asia
      2. Sub-Saharan Africa
      3. Latin America
      4. Pockets in Rural southeastern United States
      5. Pockets in Eastern Europe
3. Risk factors for Hyperinfection (Immunocompromised)
   1. Chronic Corticosteroid use
   2. Chemotherapy
   3. Human Immunodeficiency Virus (HIV)
4. Differential Diagnosis
   1. Peptic Ulcer Disease
5. Symptoms
   1. Often asymptomatic
   2. Larva currens
      1. Recurrent serpiginous Urticaria
      2. Onset in perianal area
      3. Migratory rash to buttocks, groin, trunk
   3. Gastrointestinal side effects
      1. Abdominal Pain or abdominal bloating
      2. Diarrhea
   4. Pulmonary involvement
      1. Cough
      2. Shortness of Breath
6. Labs
   1. Eosinophilia in stool
   2. Guaiac-positive stools
   3. Rhabditiform larvae present in sample
      1. Stool sample or duodenal aspiration
      2. False negative test: 70% of cases
7. Management
   1. Ivermectin (now preferred agent)
      1. Better tolerated than Thiabendazole
      2. Higher cure rate than Thiabendazole
   2. Other agents
      1. Thiabendazole
      2. Albendazole
8. Prognosis
   1. Hyperinfection mortality rate in immunosuppressed: 87%
9. References
   1. Siddiqui (2001) Clin Infect Dis 33:1040-7