strongyloidiasis

Strongyloidiasis: A Chronic Intestinal Infection

Strongyloidiasis is a chronic parasitic infection caused by the roundworm, Strongyloides stercoralis. This intestinal infection can affect people worldwide, except in the far north and south, and is often underestimated due to the lack of precise data from endemic areas [1].

Characteristics of the Infection

The S. stercoralis roundworm is a type of parasite that lives in the body of humans for decades without causing symptoms [3]. This infection can be asymptomatic or cause mild gastrointestinal symptoms, such as stomachaches and diarrhea [11]. However, in some cases, it can lead to severe complications, including hyperinfection syndrome and disseminated strongyloidiasis [10].

Transmission and Prevalence

Strongyloidiasis is a soil-transmitted parasitic disease that affects an estimated 30-100 million people worldwide [5]. The infection is endemic in tropical and subtropical regions, including rural areas of the southern United States, where bare skin is exposed to infective larvae in contaminated soil [5].

Symptoms and Complications

The symptomatic spectrum of Strongyloides infection ranges from subclinical in acute and chronic infection to severe and fatal in hyperinfection syndrome and disseminated strongyloidiasis [12]. In some cases, the infection can cause cutaneous manifestations such as serpiginous urticarial rash, cough, dyspnea, gastrointestinal symptoms (including pain), and other systemic complications [8].

Diagnosis

Doctors diagnose strongyloidiasis by examining stool, sputum samples, and chest x-rays. Blood tests to detect eosinophilia and antibodies to Strongyloides are also used to confirm the infection [14]. In some cases, doctors may need to examine many stool samples under a microscope to detect the presence of Strongyloides larvae.

References

[1] - The global burden of strongyloidiasis is still underestimated due to the unavailability of precise data from endemic areas. [3] - S. stercoralis roundworm can live and reproduce in human hosts for up to 30 years, causing minimal or no symptoms. [5] - Strongyloidiasis is a soil-transmitted parasitic disease that affects an estimated 30-100 million people worldwide. [8] - The infection can cause cutaneous manifestations such as serpiginous urticarial rash, cough, dyspnea, gastrointestinal symptoms (including pain), and other systemic complications. [10] - In some cases, the infection can lead to severe complications, including hyperinfection syndrome and disseminated strongyloidiasis. [11] - Strongyloides is a type of nematode or roundworm parasite that can infect people through exposed skin, such as bare feet. [12] - The symptomatic spectrum of Strongyloides infection ranges from subclinical in acute and chronic infection to severe and fatal in hyperinfection syndrome and disseminated strongyloidiasis. [14] - Doctors diagnose strongyloidiasis by examining stool, sputum samples, and chest x-rays. Blood tests to detect eosinophilia and antibodies to Strongyloides are also used to confirm the infection.

Common Signs and Symptoms of Strongyloidiasis

Strongyloidiasis, a parasitic infection caused by the roundworm Strongyloides stercoralis, can manifest in various ways. The symptoms can range from mild to severe and may include:

• Abdominal pain: Pain or discomfort in the upper abdomen is a common symptom of strongyloidiasis [1][3][6].
• Diarrhea: Intermittent or persistent diarrhea is another frequent symptom, which can be bloody in some cases [2][4][8].
• Rash: An itchy, red rash may appear on the skin, particularly around the anus [1][5].
• Cough: A dry cough can also occur as a result of the infection [4][7].
• Stomachache: Bloating and heartburn are other possible symptoms [1].

In severe cases, strongyloidiasis can cause more serious symptoms, including:

• Severe abdominal pain: Sudden onset of severe abdominal pain, nausea, vomiting, bloody diarrhea, and coughing can occur in severe infections [8].
• Weight loss: Weight loss can be a sign of chronic infection or severe disease [4].

It's essential to note that many people infected with S. stercoralis may not exhibit any symptoms at all, making it crucial for individuals who have traveled to areas where the parasite is common or have been exposed to contaminated soil to seek medical attention if they experience any of these symptoms.

References: [1] - Context result 1 [2] - Context result 2 [3] - Context result 3 [4] - Context result 4 [5] - Context result 5 [6] - Context result 6 [7] - Context result 7 [8] - Context result 8

Diagnostic Tests for Strongyloidiasis

Strongyloidiasis, a parasitic infection caused by the roundworm Strongyloides stercoralis, can be challenging to diagnose due to its low parasitic load and cross-reactivity with other filarial infections. Various diagnostic tests are available to detect this condition, which is essential for effective treatment.

Serologic Tests

Serologic tests, such as Enzyme Immunoassay (EIA), are quite sensitive but can cross-react with other filarial infections [9]. These tests detect anti-strongyloides antibodies in serum and are recommended due to their high sensitivity [9].

Stool Examination

Traditional stool examinations, including direct microscopy and enrichment techniques, are relatively insensitive and may require up to seven exams to reach a sensitivity of 100% [1]. However, they remain the primary technique for detecting S. stercoralis infection [6][7].

Detection of Larvae in Stool

The most accurate diagnosis is achieved by detecting larvae in stool through direct microscopy [2][7]. This method has good specificity and sensitivity but may require multiple exams to confirm the diagnosis.

Immunodiagnostic Tests

Several immunodiagnostic tests are available, including ELISA testing, which has shown high accuracy for diagnosing strongyloidiasis with a detection rate of approximately 85% to 90% [4].

Importance of Early Detection and Accurate Diagnosis

Early detection and accurate diagnosis of strongyloidiasis are crucial for effective treatment. The diagnostic process involves a combination of serologic testing, stool examination, and sometimes duodenal or colonic aspirates obtained at endoscopy [13]. It is essential to consider the clinical syndrome when selecting the appropriate diagnostic tests.

References

[1] Context result 1 [2] Context result 7 [4] Context result 4 [6] Context result 6 [7] Context result 7 [9] Context result 9 [13] Context result

Treatment Options for Strongyloidiasis

Strongyloidiasis, an infection caused by the parasitic worm Strongyloides, can be effectively treated with various medications. The primary goal of treatment is to eliminate the parasite from the body and prevent complications.

First-Line Treatment: Ivermectin

Ivermectin is currently considered the first-line drug for treating strongyloidiasis [12][11]. It is a highly potent, broad-spectrum anthelmintic medication that has been shown to be effective in eliminating the parasite from the body. A single oral dose of 200 µg/kg is typically prescribed, and repeated doses may be necessary for immunosuppressed patients or those with hyperinfection/severe dissemination [11].

Alternative Treatment Options

Other medications used to treat strongyloidiasis include:

• Albendazole: This benzimidazole drug has been shown to be effective in treating strongyloidiasis, particularly in cases of hyperinfection syndrome and disseminated disease [13].
• Thiabendazole: This medication is another option for treating strongyloidiasis, although it may not be as effective as ivermectin [15].

Treatment Protocols

The treatment protocol for strongyloidiasis typically involves a single oral dose of ivermectin or repeated doses in cases of hyperinfection/severe dissemination. In some instances, alternative routes of administration, such as rectal preparations or subcutaneous injections, may be necessary [8].

Prevention and Early Treatment

Early treatment is essential to prevent severe illness and complications associated with strongyloidias

Differential Diagnosis of Strongyloidiasis

Strongyloidiasis, a parasitic infection caused by the soil-transmitted helminth Strongyloides stercoralis, can be challenging to diagnose due to its nonspecific clinical features. When assessing patients for suspected strongyloidiasis, it is essential to consider other parasitic conditions that may present with similar symptoms.

Other Parasitic Conditions

• Acute Schistosomiasis (Katayama Fever): This condition can cause fever, abdominal pain, and diarrhea, making it a differential diagnosis for strongyloidiasis.
• Ascariasis: Infection with the roundworm Ascaris lumbricoides can lead to symptoms such as abdominal pain, diarrhea, and weight loss, which may be similar to those experienced in strongyloidiasis.
• Amebiasis: This parasitic infection caused by Entamoeba histolytica can cause symptoms like diarrhea, abdominal pain, and weight loss, making it a differential diagnosis for strongyloidiasis.
• Human Hookworm Infection (Ancylostoma duodenale or Necator americanus): This condition can lead to symptoms such as abdominal pain, diarrhea, and weight loss, which may be similar to those experienced in strongyloidiasis.
• Zoonotic Infections: Certain zoonotic infections, such as those caused by Toxoplasma gondii, can also present with nonspecific symptoms that may be similar to those of strongyloidiasis.

Diagnostic Considerations

The diagnosis of strongyloidiasis requires a high index of suspicion, as patients with the infection often present with no distinctive clinical features. Ancillary laboratory, imaging, and endoscopic findings are often nonspecific, making it essential to consider other parasitic conditions in the differential diagnosis.

References

• [3] Laboratory Diagnosis: Strongyloidiasis is usually diagnosed by microscopic identification of Strongyloides stercoralis larvae (rarely eggs) in stool or duodenal contents.
• [13] The strongyloides antibody test shows cross-reactivity with other helminth infections such as filariasis, ascariasis, and acute schistosomiasis.