Strongyloidiasis - Symptoms & Treatment
Strongyloidiasis is a human parasitic disease. It is caused by the nematode ( roundworm ) Strongyloides stercoralis. S. stercoralis is a roundworm that is fairly common in warm, moist areas. Rarely, it can be found as far north as Canada. The tiny worm is barely visible to the naked eye. Young roundworms can move through a person's skin and into the bloodstream to the lungs and airways. As the worms grow older, they bury themselves in the walls of the intestines. Later, they produce eggs in the intestines. Areas where the worms go through the skin may become red and painful. People catch the infection when they come in contact with soil contaminated with the worms. Autoinfection occurs when noninfective rhabditiform larvae prematurely transform into infective filariform larvae (ie, before leaving the body) and reenter the circulation by 1 of 3 methods. For the first, the larvae penetrate the mucosa of the colon and cause indirect endoautoinfection.
Strongyloidiasis has no predilection for either sex. Strongyloidiasis has no predilection for any racial or ethnic group. Advanced age is a risk factor for severe strongyloidiasis because it may be associated with an immunosuppressed state. Strongyloidiasis is uncommon, although endemic foci exist in rural areas of the southeastern states and the Appalachia region, with prevalence rates close to 4%. . Strongyloidiasis is typically acquired when the infective (filariform) larvae penetrate the skin during contact with contaminated soil, although ingestion of filariform larvae (fecal-oral route) may also result in infection Infection can occur in individuals at any age, although infection is more common during childhood than at other times. Populations with higher prevalence rates include patients in long-term institutionalized care, immigrants or refugees from tropical and subtropical countries, and persons stationed in Southeast Asia during World War II and the Vietnam War
Causes of Strongyloidiasis
Common causes of Strongyloidiasis
- Neoplasms, particularly hematologic malignancies (lymphoma, leukemia).
- Organ transplantation.
- Malabsorption states.
- End-stage renal disease.
- Diabetes mellitus Advanced age.
- HIV-1 infection.
- Human T-cell leukemia virus.
Symptoms of Strongyloidiasis
Common Symptoms of Strongyloidiasis
- Red hive-like areas near the anus
- Abdominal pain.
- Weight loss.
- Epigastric pain.
Treatment of Strongyloidiasis
Common Treatment of Strongyloidiasis
- The pathogen in strongyloidiasis cannot be extracted from the area of eruption because it is not localized in any single area.
- Anthelmintic therapy is the standard treatment.
- Supportive therapy should be administered as indicated.
- In instances in which co-infection with enteric bacteria is suspected, antibiotic therapy is indicated as well.
- Cyclosporine, an immunosuppressive agent, has anthelmintic activity. To date, no cases of severe strongyloidiasis development have been reported in patients receiving this agent
- Thiabendazole is used, uncomplicated infection is treated with 25 mg/kg po bid for 2 days (maximum 3 g/day) and results in 80 to 90% cure. Repeated courses may be required. In hyperinfection syndrome, 25 mg/kg po bid should be given for a minimum of 5 to 7 days.
- Administer anthelmintic therapy.
- Provide supportive treatment as indicated (eg, intravenous fluids if volume depletion, blood transfusion if gastrointestinal or alveolar hemorrhage, mechanical ventilation if respiratory failure).
- Provide antibiotic( Ivermectin , Albendazole, Thiabendazole) therapy directed toward enteric pathogens.