Ver el código de «Strongyloides stercoralis»

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==Background==

*Intestinal nematode; roundworm
*Endemic in tropical/subtropical areas such as Africa, Southeast Asia, Central/South America<ref>Buonfrate D, Requena-Mendez A, Angheben A, Munoz J, Gobi F, Van Den Ende J, Bisoffi Z.  Severe strongyloidiasis: a systematic review of case reports. BMC Infectious Diseases 2013, 13: 78.  doi:10.1186/1471-2334-13-78</ref>


===Life Cycle===

*Present in contaminated soil → larvae penetrate skin of hosts walking barefoot → enter venous circulation, migrate to lungs, then are expectorated to pharynx and swallowed → larvae develop into females that lay eggs asexually into GI tract, which hatch into larvae and are excreted into stool
*Larvae either become sexually reproducing males/females or filariform larvae that can reinfect host
*Autoinfection: Unique to Strongyloides; GI larvae can migrate from GI tract to venous system, then to lungs and proceed with life cycle
**Can lead to dramatic increase in worm burden and hyperinfection in immunocompromised


===Risk factors===

*[[Special:MyLanguage/Corticosteroid|Corticosteroid]] use, immunosuppression
*[[Special:MyLanguage/transplant complications|Transplantation]]
*Hematologic neoplasm (e.g. [[Special:MyLanguage/leukemia|leukemia]])
*Human T-lymphotropic virus-1 infection (HTLV-1)
*[[Special:MyLanguage/Malnutrition|Malnutrition]]
*[[Special:MyLanguage/Diabetes|Diabetes]]
*Chronic [[Special:MyLanguage/renal failure|renal failure]]
*Chronic [[Special:MyLanguage/alcohol Abuse|alcohol use]]


===Clinical significance===

*Chronic infection in immunosuppressed can lead to fulminant dissemination with case fatality rate as high as 70%; strong index of suspicion is needed in such cases


==Clinical Features==

*Asymptomatic in up to 60% of those infected<ref>Greaves D, Coggle S, Pollar C, Aliyu SH, Moore EM. Strongyloides stercoralis infection. BMJ 2013;347:f4610 doi: 10.1136/bmj.f4610 (Published 30 July 2013).</ref>
*Nonspecific GI complaints are most common presentation
**Weight loss, [[Special:MyLanguage/diarrhea|diarrhea]], [[Special:MyLanguage/abdominal pain|abdominal pain]], [[Special:MyLanguage/vomiting|vomiting]]

===Dermatologic===

*Larva currens: rapidly progressive pruritic linear eruption due to migration of larvae
*Perianal [[Special:MyLanguage/pruritus|pruritus]]
*Foot [[Special:MyLanguage/pruritus|pruritus]] (“ground itch”)


===Respiratory===

*Dry [[Special:MyLanguage/cough|cough]]
*[[Special:MyLanguage/Wheezing|Wheezing]]
*Loeffler’s-like syndrome: [[Special:MyLanguage/fever|fever]], [[Special:MyLanguage/shortness of breath|shortness of breath]], [[Special:MyLanguage/wheezing|wheezing]], pulmonary infiltrates


====Immunocompromised patients====

*Respiratory and systemic symptoms such as fever will be more common<ref>Lim S, Katz K, Krajden S, Fuksa M, Keystone JS, Kain KC.  Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. CMAJ 2004; 171 (5): 479-484.</ref>
*Disseminated disease will invade multiple organ systems, including liver and brain


==Differential Diagnosis==

*[[Special:MyLanguage/Inflammatory bowel disease|Inflammatory bowel disease]]
*[[Special:MyLanguage/Schistosomiasis|Schistosomiasis]]
*[[Special:MyLanguage/Filariasis|Filariasis]]
*[[Special:MyLanguage/Hookworm|Hookworm]]
*[[Special:MyLanguage/Toxocara canis|Toxocara canis]]
*[[Special:MyLanguage/Atopic dermatitis|Atopic dermatitis]]
*[[Special:MyLanguage/Asthma|Asthma]]
*Allergic bronchopulmonary [[Special:MyLanguage/aspergillosis|aspergillosis]]
*[[Special:MyLanguage/Coccidioidomycosis|Coccidioidomycosis]]
*[[Special:MyLanguage/HIV|HIV]]
*[[Special:MyLanguage/Churg-Strauss syndrome|Churg-Strauss syndrome]]
*Eosinophilic [[Special:MyLanguage/leukemia|leukemia]]


==Evaluation==

*Establish possibility of infection (travel to endemic areas, etc)
*Uncomplicated strongyloidiasis: 3 serial stool samples screened for ova and parasites, as well as ELISA for Strongyloides
**Complicated strongyloidiasis: blood/sputum cultures, in addition to above
*Notable [[Special:MyLanguage/eosinophilia|eosinophilia]] in up to 70% of cases, though can be absent in immunosuppressed
*Gram negative bacteremia may be present in immunocompromised


==Management==


===Uncomplicated strongyloidiasis, normal immune system===

*[[Special:MyLanguage/Ivermectin|Ivermectin]] 200 mcg/kg daily x 1-2d (drug of choice)
'''OR'''
*[[Special:MyLanguage/Albendazole|Albendazole]] 400mg BID x 7d
*Can consider albendazole prophylaxis in immigrants from endemic regions with consistent clinical presentation


===Immunosuppressed===

*Combination therapy: [[Special:MyLanguage/albendazole|albendazole]] 400mg BID x 7d AND [[Special:MyLanguage/ivermectin|ivermectin]] 200 mcg/kg daily x 1-2d<ref name="treat">Feely NM, Waghorn DJ, Dexter T, Gallen I, Chiodini.  Strongyloides stercoralis hyperinfection: difficulties in diagnosis and treatment.  Anaesthesia 2010; 65: 298-301.</ref>
*Antibiotics may need to be continued until there is evidence that parasite is cleared<ref name="treat" />


==Disposition==

*Discharge uncomplicated cases in those who are not immunosuppressed
*Admit if immunocompromised or systemic symptoms


==References==

<references/>

[[Category:Tropical Medicine]]
[[Category:ID]]
[[Category:GI]]
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