Strongyloidiasis history and symptoms
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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
Uncomplicated Disease
Frequently asymptomatic. Gastrointestinal system symptoms include abdominal pain and diarrhea. Pulmonary symptoms (including Löffler's syndrome) can occur during pulmonary migration of the filariform larvae. Dermatologic manifestations include urticarial rashes 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 immunosuppressed. It presents with abdominal pain, distension, shock, pulmonary and neurologic 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] and the bacteria may spread to other organs where they may cause localized infection such as meningitis.[3]
Dissemination can occur many decades after the initial infection[4] and has been associated with high dose corticosteroids, organ transplant, HIV,[5][6] lepromatous leprosy, tertiary syphilis, aplastic anemia, malnutrition, advanced tuberculosis and radiation poisoning.[7] 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
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
- ↑ 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) - ↑ 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) - ↑ Graeff-Teixeira C, da Silva AC, Yoshimura K (2009). "Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance". Clinical Microbiology Reviews. 22 (2): 322–48. doi:10.1128/CMR.00044-08. PMC 2668237. PMID 19366917. Unknown parameter
|month=ignored (help) - ↑ Gill GV, Beeching NJ, Khoo S; et al. (2004). "A British Second World War veteran with disseminated strongyloidiasis". Trans R Soc Trop Med Hyg. 98 (6): 382–6. doi:10.1016/j.trstmh.2003.11.002. PMID 15099996.
- ↑ Kramer MR, Gregg PA, Goldstein M, Llamas R, Krieger BP. (1990). "Disseminated strongyloidiasis in AIDS and non-AIDS immunocompromised hosts: diagnosis by sputum and bronchoalveolar lavage". South Med J. 83 (10): 1226–9. doi:10.1097/00007611-199010000-00024. PMID 2218668.
- ↑ Gompels MM, Todd J, Peters BS, Main J, Pinching AJ. (1991). "Disseminated strongyloidiasis in AIDS: uncommon but important". AIDS. 5 (3): 329–32. doi:10.1097/00002030-199103000-00015. PMID 2059374.
- ↑ Purtilo DT, Meyers WM, Connor DH (1974). "Fatal strongyloidiasis in immunosuppressed patients". Am J Med. 56 (4): 488–93. doi:10.1016/0002-9343(74)90481-1. PMID 4818417.