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Section 3. Summaries of Infectious Diseases
Strongyloidiasis
(Strongyloides stercoralis)
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Asymptomatic infection accompanied
by peripheral blood eosinophilia may be the only manifestation
of infection. Thus, strongyloidiasis should be considered in
any patient with unexplained eosinophilia. When symptoms occur,
they are related to the 3 stages of infection: skin invasion,
migration of larvae, and penetration of the intestinal mucosa
by adult worms. Infective larvae typically are acquired from
soil and enter the body through the skin, producing transient
pruritic papules at the site of penetration, usually on the
feet. Larvae then migrate to the lungs and can cause pneumonitis
or a Loeffler-like syndrome. Larvae then ascend the tracheobronchial
tree and are swallowed; once they are in the gastrointestinal
tract, they mature into adults and can cause vague abdominal
pain, malabsorption, vomiting, and diarrhea. Larval migration
from defecated stool can result in pruritic skin lesions in
the perianal area, buttocks, and upper thighs, which may present
as serpiginous, erythematous tracks called larva currens. Because
of the ability of a
Strongyloides organism to complete its life
cycle entirely in humans (autoinfection), a disseminated (hyperinfection)
syndrome can occur in immunocompromised people, characterized
by abdominal pain, rapidly changing or diffuse pulmonary infiltrates,
and septicemia or meningitis from enteric gram-negative bacilli.
ETIOLOGY: Strongyloides stercoralis is a
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Related text in Red Book:
- Drugs for Parasitic Infections
Red Book
2006: 790-820.
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