Strongyloidiasis (threadworm infection) is a parasitic intestinal infection that occurs worldwide. It's endemic in the tropics and subtropics as well as areas associated with poor hygiene. Outbreaks also occur in facilities. Its incidence in the United States is low.
Susceptibility to strongyloidiasis is universal; infection doesn't confer immunity. Because the reproductive cycle of the threadworm may continue in the untreated host for as long as 45 years after the initial infection, autoinfection is highly probable.
Most patients with strongyloidiasis recover completely, but debilitation from protein loss occasionally is fatal. Massive autoinfection, especially in immunocompromised patients, also can be fatal.
S. stercoralis is fairly common in warm moist areas. Rarely it can be found as far north as Canada.
This tiny worm is barely visible to the naked eye. Its life cycle is very similar to the hookworm: Young roundworms penetrate the skin. They migrate through the bloodstream to the lungs and up the large airways. The worms are swallowed. The young worms mature and bury themselves into the intestinal wall and adult roundworms begin producing eggs in the intestines.
Exposure occurs when skin has direct contact with contaminated soil. Unlike the hookworm life cycle, where the eggs must pass in the feces and mature in wet soil, the roundworm eggs hatch and the larvae can infect others even at the time they are passed in the feces.
Because of this, the larvae may move through the skin near the anus after being passed in the stool and repeat the cycle. A person becomes more heavily infected with each cycle. Areas where the larvae go through the skin may become red and painful.
Symptoms and Signs
Common Symptoms includes:
Diagnostic testsObservation of S. stercoralis larvae in a fresh stool specimen allows diagnosis (2 hours after excretion, rhabditoid larvae look like hookworm larvae). Repeated testing may be needed. During the pulmonary phase, sputum may show many eosinophils and larvae.
Because of the potential for autoinfection, the patient needs treatment with thiabendazole for 2 to 3 days. The total dose shouldn't exceed 3 g. He also may need protein replacement, blood transfusions, and I.V.fluids.
Treatment is necessary if S. stercoralis remains in stools after therapy. Corticosteroids are contraindicated because they increase the risk of autoinfection and dissemination and also predispose the patient to GI ulceration.
Good personal hygiene can reduce the risk of strongyloidiasis. Adequate public health services and sanitary facilities provide good control of infection.
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