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Strongyloides infection occurs in five forms. On acquiring the infection, there may be respiratory symptoms ([[Löffler's syndrome]]). The infection may then become chronic with mainly digestive symptoms. On reinfection (when larvae migrate through the body), there may be respiratory, skin and digestive symptoms. Finally, the hyperinfection syndrome causes symptoms in many organ systems, including the [[central nervous system]].<ref name=Montes>{{cite journal | author=Montes M, Sawhney C, Barros N | title=Strongyloides stercoralis: there but not seen | journal=Curr Opin Infect Dis | year=2010 | month=Oct | volume=23 | issue=5 | pages=500–4 | pmid=20733481 | pmc=2948977 | doi=10.1097/QCO.0b013e32833df718}}</ref><ref name=Marcos>{{cite journal | author=Marcos LA, Terashima A, Dupont HL, Gotuzzo E | title=Strongyloides hyperinfection syndrome: an emerging global infectious disease | journal=Trans R Soc Trop Med Hyg | year=2008 | month=Apr | volume=102 | issue=4 | pages=314–8 | pmid=18321548 | doi=10.1016/j.trstmh.2008.01.020}}</ref>
Strongyloides infection occurs in five forms. On acquiring the infection, there may be respiratory symptoms ([[Löffler's syndrome]]). The infection may then become chronic with mainly digestive symptoms. On reinfection (when larvae migrate through the body), there may be respiratory, skin and digestive symptoms. Finally, the hyperinfection syndrome causes symptoms in many organ systems, including the [[central nervous system]].<ref name=Montes>{{cite journal | author=Montes M, Sawhney C, Barros N | title=Strongyloides stercoralis: there but not seen | journal=Curr Opin Infect Dis | year=2010 | month=Oct | volume=23 | issue=5 | pages=500–4 | pmid=20733481 | pmc=2948977 | doi=10.1097/QCO.0b013e32833df718}}</ref><ref name=Marcos>{{cite journal | author=Marcos LA, Terashima A, Dupont HL, Gotuzzo E | title=Strongyloides hyperinfection syndrome: an emerging global infectious disease | journal=Trans R Soc Trop Med Hyg | year=2008 | month=Apr | volume=102 | issue=4 | pages=314–8 | pmid=18321548 | doi=10.1016/j.trstmh.2008.01.020}}</ref>
==History and Symptoms==
==History and Symptoms==
===Uncomplicated Disease===
Frequently [[asymptomatic]]. [[Gastrointestinal system]] [[symptom]]s include abdominal [[pain]] and [[diarrhea]].  [[Lungs|Pulmonary]] symptoms (including [[Löffler's syndrome]]) can occur during pulmonary migration of the filariform larvae.  [[Dermatology|Dermatologic]] manifestations include [[urticaria]]l [[rash]]es in the buttocks and waist areas.  [[Blood]] [[eosinophilia]] is generally present.
Strongyloidiasis can become chronic and then become completely asymptomatic.
===Disseminated Disease===
Disseminated strongyloidiasis occurs when patients with chronic strongyloidiasis become [[immunosuppression|immunosuppress]]ed. It presents with abdominal pain, distension, [[Shock (circulatory)|shock]], pulmonary and neurologic [[complication (medicine)|complications]] and [[septicemia]], and is potentially fatal.  The worms enter the bloodstream from the bowel wall, simultaneously allowing entry of bowel bacteria such as ''[[Escherichia coli]]''. This may cause symptoms such as [[sepsis]] (bloodstream infection),{{citation needed | date=June 2011}} and the bacteria may spread to other organs where they may cause localized infection such as [[meningitis]].<ref name=Graeff>{{cite journal | author=Graeff-Teixeira C, da Silva AC, Yoshimura K | title=Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance | journal=Clinical Microbiology Reviews | year=2009 | month=Apr | volume=22 | issue=2 | pages=322–48 | pmid=19366917 | pmc=2668237 | doi=10.1128/CMR.00044-08 | url=http://cmr.asm.org/cgi/content/full/22/2/322}}</ref>
Dissemination can occur many decades after the initial infection<ref>{{cite journal | journal=Trans R Soc Trop Med Hyg | year=2004 | volume=98 | issue=6 | pages=382–6 | title=A British Second World War veteran with disseminated strongyloidiasis | author=Gill GV, Beeching NJ, Khoo S, ''et al.'' | doi=10.1016/j.trstmh.2003.11.002 |pmid=15099996 |url=http://linkinghub.elsevier.com/retrieve/pii/S0035920304000173}}</ref> and has been associated with high dose [[corticosteroids]], [[organ transplant]], [[HIV]],<ref name="Kramer1990">{{cite journal | title=Disseminated strongyloidiasis in AIDS and non-AIDS immunocompromised hosts: diagnosis by sputum and bronchoalveolar lavage | author=Kramer MR, Gregg PA, Goldstein M, Llamas R, Krieger BP. | journal=South Med J | year=1990 | volume=83 | issue=10 | pages=1226–9 | pmid=2218668 | doi=10.1097/00007611-199010000-00024
}}</ref><ref name="Gompels1991">{{cite journal | author=Gompels MM, Todd J, Peters BS, Main J, Pinching AJ. | title=Disseminated strongyloidiasis in AIDS: uncommon but important | journal=AIDS | year=1991 | volume=5 | issue=3 | pages=329–32 | pmid=2059374 | doi=10.1097/00002030-199103000-00015 }}</ref> lepromatous [[leprosy]], tertiary [[syphilis]], [[aplastic anemia]], malnutrition, advanced [[tuberculosis]] and [[radiation poisoning]].<ref>{{cite journal | journal=Am J Med | year=1974 | volume=56 | issue=4 | pages=488–93 | author=Purtilo DT, Meyers WM, Connor DH | title=Fatal strongyloidiasis in immunosuppressed patients | doi=10.1016/0002-9343(74)90481-1 |pmid=4818417 |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9343(74)90481-1}}</ref>  It is often recommended that patients being started on immunosuppression be screened for chronic strongyloidiasis; however, this is often impractical (screen tests are often unavailable) and in developed countries, the prevalence of chronic strongyloidiasis is very small, so screening is usually not cost-effective, except in endemic areas.
===Gastrointestinal===
*[[Abdominal Pain]]
*[[Diarrhea]].
===Pulmonary===
Pulmonary symptoms (including [[Loeffler’s syndrome]]) can occur during pulmonary migration of the filariform larvae.
===Skin===
Dermatologic manifestations include urticarial rashes in the buttocks and waist areas.  Disseminated strongyloidiasis occurs in immunosuppressed patients, can present with [[Abdominal Pain]], [[abdominal distension]], [[shock]], pulmonary and neurologic complications and [[septicemia]], and is potentially fatal.


==References==
==References==

Revision as of 20:00, 19 June 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Strongyloides infection occurs in five forms. On acquiring the infection, there may be respiratory symptoms (Löffler's syndrome). The infection may then become chronic with mainly digestive symptoms. On reinfection (when larvae migrate through the body), there may be respiratory, skin and digestive symptoms. Finally, the hyperinfection syndrome causes symptoms in many organ systems, including the central nervous system.[1][2]

History and Symptoms

References

  1. ↑ Montes M, Sawhney C, Barros N (2010). "Strongyloides stercoralis: there but not seen". Curr Opin Infect Dis. 23 (5): 500–4. doi:10.1097/QCO.0b013e32833df718. PMC 2948977. PMID 20733481. Unknown parameter |month= ignored (help)
  2. ↑ Marcos LA, Terashima A, Dupont HL, Gotuzzo E (2008). "Strongyloides hyperinfection syndrome: an emerging global infectious disease". Trans R Soc Trop Med Hyg. 102 (4): 314–8. doi:10.1016/j.trstmh.2008.01.020. PMID 18321548. Unknown parameter |month= ignored (help)

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