Infectious Disease Compendium

Strongyloides stercoralis

Microbiology

A nematode.

Epidemiologic Risks

Walking barefoot in human stool. It is found throughout the third and developing world, including Kentucky (PubMed) and the US South.

Syndromes

Local irritation where you stepped, gi upset.

With steroids or hematologic malignancy, the organism can disseminated with a hyper-infection syndrome (PubMed)  from the bowel to everywhere and anywhere, often accompanied with poly-microbial bacteremia from the bowel (PubMed), hyper-eosinophilia and 2/3 will die (PubMed). About a third will haveThey can get the thumbprint sign of the skin: the organism goes up the umbilical veins to the skin and cause a hemorrhagic rash.

It can cause disease both from reactivation and be acquired from the transplanted organ (PubMed).

People from endemic areas should be screened before immunosuppression, but most will not think of the disease.

And, for an off the wall cause of recurrent meningitis, chronic strongyloidiasis with human T­-lymphotropic virus type 1 (PubMed).

Treatment

Ivermectin 200 micrograms /kg for 2d is probably the treatment of choice; transplant patients may require longer courses of therapy (PubMed).

Thiabendazole 25 mg/kg bid for 2 days (maximum of 3 g/day). Albendazole 200 mg/kg/day for 1 to 2 days. In the hyper infection syndrome treatment for 2 to 3 weeks.

Also 7-day course of oral albendazole 800 mg daily is INFERIOR to Ivermectin single dose (200 microgram/kilogram body weight), or double doses, given 2 weeks apart, in Thai patients with chronic strongyloidiasis (PubMed).

Notes

There s a case of one person manifesting 75 years (seventy five, so you know it is not a typo) after leaving an endemic area (PubMed).