Arch IM 1987;147:1257

Cause:Strongyloides stercoralis

Pathophys:Much tissue damage in gi tract; perhaps exotoxin release. As noted above, may in severe cases develop internal autoreinfection

Skin penetration by filariform larval form, migrates to blood vessels, then to lung, from there up to the pharynx where is ingested back down the gi tract where imbeds and produces live young which are released into feces. Can mature in gi tract and autoreinfect or mature on the ground

Increased prevalence in institutions for retarded; southern areas

Sx:Abdominal pain, midepigastric; nausea, vomiting, and bloody diarrhea (60-100%); perineal pruritus

May persist >30 yr in active stage

Superinfections w secondary gram-neg bacteremias, bowel obstruction and malabsorption in pts w diminished resistance, eg, on steroids (can cause death if already infected—Nejm 1966;275:1093), Hodgkin's, leukemia, SLE, leprosy (Ann IM 1970;72:199)

Acute pneumonitis due to sensitivity reaction w tissue migration; rx with steroids (L. Weinstein, 1987)

r/o Angiostrongylus, rat worm; get in Carribean, Pacific and Southeast Asia from raw undercooked mollusks and crustaceans; causes transient benign eosinophilic meningitis (Nejm 2002;346:668)

Lab:

Bact:Stool shows rhabditiform larvae in feces sporadically; must use fresh stool, neg in 25%; duodenal aspirate best and most reliable

Hem:Eosinophilia (50%)

Rx:

Prevent by wearing shoes, digging latrines

of disease

• Thiabendazole 25 mg/kg (3 gm max) bid × 2 d; both tissue and intestinal phases hit; cure in 65%; or
• Ivermectin