Strongyloidiasis: Difference between revisions

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{{SI}}
__NOTOC__
{{CMG}}
{{About1|Strongyloides stercoralis}}
{{Infobox disease |
  Name          = Strongyloidiasis |
  Image          = Strongyloides_-_very_high_mag_-_2.jpg |
  Caption        = [[Micrograph]] showing strongyloidiasis; a fragment of a worm is seen in the lower right hand corner. [[H&E stain]]. Source: https://commons.wikimedia.org/wiki/File%3AStrongyloides_-_very_high_mag_-_2.jpg |
}}


== Overview ==
'''For patient information, click [[Strongyloidiasis (patient information)|here]]'''
{{Strongyloidiasis}}
{{CMG}}; {{AE}} {{ADG}}


Also known as: '''Strongyloides Infection'''
{{SK}} Strongyloides infection, Hyperinfection syndrome, Intestinal strongyloidiasis, Infection by strongylus.


== Epidemiology and Demographics ==
==[[Strongyloidiasis overview|Overview]]==
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. <ref>http://www.dpd.cdc.gov/dpdx/HTML/Strongyloidiasis.htm</ref>


== Pathophysiology & Etiology==
==[[Strongyloidiasis historical perspective|Historical Perspective]]==
The nematode (roundworm) Strongyloides stercoralis.  Other Strongyloides include S. fülleborni, which infects chimpanzees and baboons and may produce limited infections in humans.


'''Life Cycle'''
==[[Strongyloidiasis classification|Classification]]==


[[Image:Strongyloides LifeCycle.gif|left|frame|Life cycle of Strongyloides stercoralis]]
==[[Strongyloidiasis pathophysiology|Pathophysiology]]==


The Strongyloides life cycle is more complex than that of most nematodes with its alternation between free-living and parasitic cycles, and its potential for autoinfection and multiplication within the host.  Two types of cycles exist:
==[[Strongyloidiasis causes|Causes]]==


'''Free-living cycle:''' The rhabditiform larvae passed in the stool '''1''' can either molt twice and become infective filariform larvae (direct development) '''6''' or molt four times and become free living adult males and females '''2''' that mate and produce eggs '''3''' from which rhabditiform larvae hatch '''4''' .  The latter in turn can either develop '''5''' into a new generation of free-living adults (as represented in '''2'''), or into infective filariform larvae '''6''' .  The filariform larvae penetrate the human host skin to initiate the parasitic cycle '''6'''.
==[[Strongyloidiasis differential diagnosis|Differentiating Strongyloidiasis from other Diseases]]==


'''Parasitic cycle:''' Filariform larvae in contaminated soil penetrate the human skin '''6''' , and are transported to the lungs where they penetrate the alveolar spaces; they are carried through the bronchial tree to the pharynx, are swallowed and then reach the small intestine '''7''' . In the small intestine they molt twice and become adult female worms '''8''' The females live threaded in the epithelium of the small intestine and by parthenogenesis produce eggs '''9''' , which yield rhabditiform larvae.  The rhabditiform larvae can either be passed in the stool '''1''' (see "Free-living cycle" above), or can cause autoinfection '''10''' .  In autoinfection, the rhabditiform larvae become infective filariform larvae, which can penetrate either the intestinal mucosa (internal autoinfection) or the skin of the perianal area (external autoinfection); in either case, the filariform larvae may follow the previously described route, 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.<ref>http://www.dpd.cdc.gov/dpdx/HTML/Strongyloidiasis.htm</ref>
==[[Strongyloidiasis epidemiology and demographics|Epidemiology and Demographics]]==


==Diagnosis==
==[[Strongyloidiasis risk factors|Risk Factors]]==
===Symptoms===
 
*[[Abdominal Pain]]
== [[Strongyloidiasis screening|Screening]] ==
*[[Diarrhea]].


Pulmonary symptoms (including Loeffler’s syndrome) can occur during pulmonary migration of the filariform larvae.  Dermatologic manifestations include urticarial rashes in the buttocks and waist areas.  Disseminated strongyloidiasis occurs in immunosuppressed patients, can present with [[Abdominal Pain]], Distension, [[shock]], pulmonary and neurologic complications and [[septicemia]], and is potentially fatal.
==[[Strongyloidiasis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


===Laboratory Findings===
==Diagnosis==
====Eosinophilia====
Blood eosinophilia is generally present during the acute and chronic stages, but may be absent with dissemination.<ref>http://www.dpd.cdc.gov/dpdx/HTML/Strongyloidiasis.htm</ref>


=== Laboratory Findings ===
[[Strongyloidiasis history and symptoms|History and Symptoms]] | [[Strongyloidiasis physical examination|Physical Examination]] | [[Strongyloidiasis laboratory findings|Laboratory Findings]] | [[Strongyloidiasis x ray|X-ray]] | [[Strongyloidiasis CT|CT scan]]| [[Strongyloidiasis ultrasound|Ultrasound]] | [[Strongyloidiasis other imaging findings|Other Imaging findings]] | [[Strongyloidiasis other diagnostic studies|Other Diagnostic Studies]]
Rhabditiform larvae of Strongyloides stercoralis in wet mounts after fixation in formalin 10%.  Diagnostic characteristics: length 200 to 250 µm (up to 380 µm); buccal cavity short, and prominent genital primordium.


[[Image:Strongyl larva1 DPDx.jpg|left|frame|A: Strongyloides stercoralis]]
==Treatment==
{{clr}}


'''A:''' The prominent genital primordium in the mid-section of the larva (black arrow) is readily evident.  Note also the Entamoeba coli cyst (white arrow) near the posterior end of the larva.
[[Strongyloidiasis medical therapy|Medical Therapy]] | [[Strongyloidiasis surgery|Surgery]] | [[Strongyloidiasis primary prevention|Primary Prevention]] | [[Strongyloidiasis secondary prevention|Secondary Prevention]] | [[Strongyloidiasis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Strongyloidiasis future or investigational therapies|Future or Investigational Therapies]]


== Treatment ==
==Case Studies==
=== Pharmacotherapy ===
The drug of choice for the treatment of uncomplicated strongyloidiasis is ivermectin with albendazole as the alternative.  All patients who are at risk of disseminated strongyloidiasis should be treated. (Albendazole is approved by the FDA, but considered investigational for this purpose).<ref>http://www.dpd.cdc.gov/dpdx/HTML/Strongyloidiasis.htm</ref>


==References==
[[Strongyloidiasis case study one|Case #1]]
{{Reflist|2}}


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[[Category:Disease]]
[[Category:Disease]]
[[Category:Emergency mdicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Dermatology]]
[[Category:Neurology]]
[[Category:Pulmonology]]

Latest revision as of 00:19, 30 July 2020

This page is about clinical aspects of the disease.  For microbiologic aspects of the causative organism(s), see Strongyloides stercoralis.
Strongyloidiasis
Classification and external resources
Micrograph showing strongyloidiasis; a fragment of a worm is seen in the lower right hand corner. H&E stain. Source: https://commons.wikimedia.org/wiki/File%3AStrongyloides_-_very_high_mag_-_2.jpg

For patient information, click here

Strongyloidiasis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Strongyloidiasis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Strongyloidiasis On the Web

Most recent articles

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American Roentgen Ray Society Images of Strongyloidiasis

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Directions to Hospitals Treating Strongyloidiasis

Risk calculators and risk factors for Strongyloidiasis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Synonyms and keywords: Strongyloides infection, Hyperinfection syndrome, Intestinal strongyloidiasis, Infection by strongylus.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Strongyloidiasis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X-ray | CT scan| Ultrasound | Other Imaging findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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