Strongyloidiasis

Strongyloidiasis is caused by Strongyloides stercoralis, which has a worldwide distribution and is predominantly prevalent in South America (Brazil and Columbia) and in

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Southeast Asia. Strongyloidiasis is primarily seen among institutionalized populations (those in mental hospitals and children's hospitals) and immunocompromised individuals (those with HIV infection, AIDS, and patients with hematologic malig-

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nancies). The worm is usually found in the upper intestine where the eggs are deposited and hatch to form the rhabditiform larvae. The rhabditiform larva (male and female) migrate to the bowel where they may be excreted in the feces. If excreted in the feces, the larva can evolve into either one of two forms after copulation: a free-living noninfectious rhabditiform larvae, or an infectious filariform larvae. The filari-form larva can penetrate host skin and migrate to the lungs and produce progeny, a process called autoinfection. This can result in hyperinfection (i.e., an increased number of larva in the intestine, lungs, and other internal organs), especially in an immun-ocompromised host.

Patients with acute infection may develop a localized pruritic rash, but heavy infestations can produce eosinophilia (10-15%), diarrhea, abdominal pain, and intestinal obstruction. Administration of corticosteroids or other immunosuppressive drugs to an infected individual can result in hyperinfections and disseminated strongyloidi-

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asis. ' Diagnosis of strongyloidiasis is made by identification of the rhabditiform larva in stool, sputum, or duodenal fluid, or from small bowel biopsy specimens or via antigen testing (ELISA essay). Multiple stool and other samples may need to be checked, both for diagnosis and to ensure eradication of the larva in patients after treatment.

Treatment

The drug of choice for strongyloidiasis is oral ivermectin 200 mcg/kg/day for 2 days, while albendazole 400 mg twice daily is given for 7 days as an alternative.12,39 With hyperinfection or disseminated strongyloidiasis, immunosuppressive drugs should be discontinued and treatment should be initiated with ivermectin 200 mcg/kg/ day until all symptoms are resolved. Patients should be tested periodically to ensure the elimination of the larva. Individuals from an endemic area who are candidates for organ transplantation should be screened for S. stercoralis.

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