Makindo Medical Notes

⚠️ Disseminated strongyloidiasis occurs in immunosuppressed patients and can cause severe complications — abdominal pain, septic shock, CNS involvement, and death if untreated. Early recognition and treatment are lifesaving.

📖 About

• Strongyloides stercoralis 🪱 — a soil-transmitted parasitic nematode infecting millions worldwide, especially in tropical & subtropical regions.
• Unique among helminths: can persist for decades due to its ability to autoinfect the host.
• In healthy hosts: often asymptomatic. In immunosuppressed (e.g. steroids, HTLV-1, transplant): risk of hyperinfection syndrome and dissemination.

🧬 Aetiology & Life Cycle

• Infective larvae penetrate skin (often via bare feet 👣).
• Travel through bloodstream ➝ lungs ➝ ascend airway ➝ swallowed ➝ mature in small intestine.
• Eggs hatch into larvae in bowel; some excreted, others re-enter host (autoinfection).
• Leads to chronic carriage — even after decades abroad.

🩺 Clinical Features

• Most asymptomatic, but may cause:
  • 🌿 GI: abdominal pain, diarrhoea, anorexia, weight loss.
  • 🫁 Respiratory: dry cough, wheeze, Loeffler’s syndrome (transient eosinophilic pneumonia).
  • 🌐 Skin: urticarial rash (buttocks/waist), serpiginous “larva currens” tracks.
• ⚠️ Disseminated disease: sepsis, meningitis, respiratory failure — often fatal.

🔎 Investigations

• 📊 FBC: eosinophilia common (but absent in disseminated disease).
• 💩 Stool microscopy: insensitive (may miss up to 70% cases).
• 🧪 Serology (ELISA): high sensitivity/specificity ➝ useful for screening migrants from endemic areas.
• Consider multiple stool samples or culture techniques (Baermann, agar plate) for higher yield.

💊 Management

• ✅ Ivermectin: drug of choice (200 µg/kg daily for 1–2 days; longer in disseminated disease).
• 💊 Albendazole: 400 mg BD for 3 days (less effective, but an option if ivermectin unavailable).
• 📌 In disseminated disease: prolonged ivermectin courses ± combination with albendazole. Treat co-infections and support organ failure.
• 🔄 Screen and treat before starting steroids in patients from endemic regions.

💡 Teaching Pearls

• Think of strongyloides in any migrant with unexplained eosinophilia 🌍🩸.
• Hyperinfection syndrome is triggered by steroids, immunosuppression, or HTLV-1.
• Unlike most worms, strongyloides can persist for decades due to autoinfection.
• UK exam trick: eosinophilia + abdominal symptoms + history of living abroad = 💡 consider strongyloides.

📚 References

• CDC: Strongyloides (CDC)
• Grove DI. Strongyloidiasis: A clinical review. Clin Microbiol Rev. 1996.
• NICE CKS: Helminth infections.