Strongyloides stercoralis is a nematode, or roundworm.
These parasites are adapted to living in the top 15cm of soil. Humans are infected when the larvae of strongyloides stercoralis burrow through their skin, typically on their barefeet. Once in the skin, the larvae burrow into the bloodstream. Here they mature and infiltrate various organs.
Most commonly, this parasite effects the GI system, leading to intestinal infection. Many times it can be asymptomatic for long periods of time. On the other end of the spectrum, symptoms such as vomiting, diarrhea and epigastric pain may be seen.
With uncomplicated strongyloides stercoralis, patients can develop Loffler's syndrome which is pulmonary eosinophilia, which occurs from parasitic invasion. Clinically, this can manifest as eosinophilic pneumonia.
Patients can also develop urticarial rashes at the site of larval penetration and other classic areas. This dermatitis is seen in the feet, buttocks and waist.
Disseminated strongyloidiasis occurs when those who are infected become immunosuppressed. Disseminated disease can then cause septicemia, meningitis and possibly death.
The treatment of choice for uncomplicated disease is ivermectin, which only kills adult worms and not larvae. Thus, redosing may be necessary to eradicate infection.
Albendazole is another effective drug in treating strongyloidiasis, and may be used when ivermectin fails or when disseminated disease occurs.
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