II. Epidemiology
- Nematode: Roundworm
- Responsible for most U.S. cases fatal Helminth disease
- Found in regions of poor sanitation
- Endemic areas
- Tropical Asia
- Sub-Saharan Africa
- Latin America
- Pockets in Rural southeastern United States
- Pockets in Eastern Europe
III. Pathophysiology
- Soil transmitted Helminth
- On soil contact, roundworm larvae penetrate skin
- Roundworms enter the venous system and are transported to the lungs
- Patient coughs, and worms are swallowed, resulting in intestinal infection
- Adult roundworms live in the Small Intestine and lay eggs
- Eggs may be passed in the stool and infect soil
- Eggs may also hatch and penetrate the Small Intestine wall, to recirculate via veins and into the lung
- Larvae may also infect perianal skin
IV. Risk Factors: Hyperinfection (Immunocompromised)
- Chronic Corticosteroid use
- Chemotherapy
- Human Immunodeficiency Virus (HIV)
V. Differential Diagnosis
VI. Symptoms
- Often asymptomatic in immunocompetent patients
- Larva currens
- Gastrointestinal side effects
- Pulmonary involvement
VII. Labs
-
Eosinophilia (blood or stool)
- May be only finding in immunocompetent patients
- Guaiac-positive stools
- Rhabditiform larvae present in sample
- Stool sample or duodenal aspiration
- False Negative test: 70% of cases
VIII. Management
-
Ivermectin (now preferred agent)
- Dose: 200 mcg/kg orally daily for 2 days
- Repeat every 15 days for disseminated infection until stool testing negative (and then one more treatment)
- Continuous dosing daily for hyperinfection (e.g. Sepsis, Meningitis) continued until stool and Sputum negative for 2 weeks
- Other agents
- Albendazole 400 mg orally twice daily for 7 days (for asymptomatic of intestinal infection)
- Thiabendazole (not available, poorly tolerated, less effective)
IX. Complications: Hyperinfection
X. Prognosis
- Hyperinfection mortality rate in immunosuppressed: 87%
XI. References
- Gilbert (2016) Sanford Guide, IOS version, accessed 9/12/2016
- Siddiqui (2001) Clin Infect Dis 33:1040-7 [PubMed]
- Schonau (2024) Am Fam Physician 109(6): 569-70 [PubMed]
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SnomedCT | 10823008 |
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Czech | Strongyloides |
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French | Anguillules, Strongyloides |
Polish | Węgorki |
Norwegian | Strongyloides |
Spanish | Strongyloides (organismo), género: Strongyloides, Strongyloides |
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Portuguese | Strongyloides |
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SnomedCT | 42625000 |
Swedish | Strongyloides stercoralis |
Czech | Strongyloides stercoralis, háďátko střevní |
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English | Strongyloides stercorali, stercoralis, Strongyloides, stercorali, Strongyloides, Strongyloides intestinalis, Strongyloides stercoralis (organism), Strongyloides stercoralis |
Polish | Węgorek jelitowy |
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Spanish | Strongyloides stercoralis (organismo), Strongyloides stercoralis |
French | Strongyloides stercoralis |
German | Strongyloides stercoralis |
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Italian | Strongiloidiasi, Strongiloidosi |
French | Strongyloïdiose, Strongyloïdose |
German | Strongylodiasis, Strongyloidiasis, nicht naeher bezeichnet, Strongyloidiasis |
Japanese | 糞線虫症, フンセンチュウショウ |
Swedish | Strongyloidiasis |
Czech | strongyloidiáza, Strongyloidóza |
Finnish | Strongyloidiaasi |
Russian | ANGUILLULA INTESTINALIS INVAZIIA, STRONGILOIDOZ, ANGUILLULA INTESTINALIS ИНВАЗИЯ, СТРОНГИЛОИДОЗ |
Korean | 상세불명의 분선충증, 분선충증 |
Croatian | STRONGILOIDIJAZA |
Polish | Zarażenie węgorkiem jelitowym, Węgorczyca, Strongyloidoza |
Hungarian | Strongyloidiasis, Strongylodiasis |
Spanish | [X]estrongiloidiasis, no especificada, [X]Strongyloidiasis, unspecified (disorder), [X]estrongiloidiasis, no especificada (trastorno), [X]Strongyloidiasis, unspecified, estrongiloidiasis, estrongiloidiosis, infección por Strongyloides (trastorno), infección por Strongyloides, Estrongiloidiasis |
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