II. Classification
- Nematode: Roundworm
III. Epidemiology
- Responsible for most U.S. cases fatal Helminth disease
- Endemic areas
- Tropical Asia
- Sub-Saharan Africa
- Latin America
- Pockets in Rural southeastern United States
- Pockets in Eastern Europe
IV. Pathophysiology
- Adult roundworms live in the Small Intestine
- Larvae infect perianal skin
V. Risk Factors: Hyperinfection (Immunocompromised)
- Chronic Corticosteroid use
- Chemotherapy
- Human Immunodeficiency Virus (HIV)
VI. Differential Diagnosis
VII. Symptoms
- Often asymptomatic in immunocompetent patients
- Larva currens
- Recurrent serpiginous Urticaria
- Onset in perianal area
- Migratory rash to buttocks, groin, trunk
- Gastrointestinal side effects
- Pulmonary involvement
VIII. 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
IX. 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)
X. Complications: Hyperinfection
XI. Prognosis
- Hyperinfection mortality rate in immunosuppressed: 87%
XII. References
- Gilbert (2016) Sanford Guide, IOS version, accessed 9/12/2016
- Siddiqui (2001) Clin Infect Dis 33:1040-7 [PubMed]