Strongyloidiasis - Symptoms, Diagnosis, and Treatment

Creator: Dr. Shakshi Jain
Published: 2023-02-13T17:30:39

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Though uncommon, strongyloidiasis is becoming an important parasitic disease in the United States, especially in the immunocompromised immigrant population. Read the article to know more.

Written by

Dr. Shakshi Jain

Medically reviewed by

Dr. Shubadeep Debabrata Sinha

February 13, 2023

July 27, 2023

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Contents

How Does It Spread?
Who is at Risk for Strongyloidiasis?
What Are the Signs and Symptoms of Strongyloidiasis?
How Is Strongyloidiasis Diagnosed?
What Is the Treatment of Strongyloidiasis?
Who Are Not Recommended to Take the Dosage?
What Are the Complications of Strongyloidiasis?
How Can It Be Prevented?

Introduction:

Strongyloidiasis is a small intestine infection caused by a type of roundworm called Strongyloidiasis stercoralis and Strongyloidiasis fuelleborni. The most common worm present in humans is Strongyloidiasis stercoralis. The disease is transmitted by soil and causes severe disease in immunocompromised persons. The disease is prevalent in developed countries, especially where immigrants are present. The disease affects 30 to 1000 million people, mostly tropical and subtropical areas. S. stercoralis can transform into a fatal disease or illness under certain conditions linked with the host's immunity. Better approaches to identifying, screening, monitoring, and treating the population at risk will likely decrease the mortality rate and morbidity associated with the infection.

How Does It Spread?

Strongyloidiasis stercoralis involves both free-living and parasitic stages. Adult worms lay eggs in the intestinal mucosa of the small intestine in humans that change into rhabditiform larvae which discard in the stool. The three types of the life cycle are direct, indirect, and autoinfection.

In the Direct Cycle - This rhabditiform larva in-person tool converts into the filiform larvae in the soil. The infective form of larvae (filiform larvae) lives in soil contaminated by an infected person's stool. When a person comes in contact with soil, the larvae may penetrate the skin and travel to the lungs and gut, becoming adult worms.
In an Indirect Cycle - The eggs are excreted from the infected person's stool to the soil to live as free-living adults and convert to filiform larvae that penetrate the host through perianal skin (skin around the anus).
In Autoinfection - The infective filiform larvae complete their development in the host intestine.

Rhabditiform larvae are non-infective, whereas filiform larvae are in the infective stage. The incubation period ranges between two to four days.

Who is at Risk for Strongyloidiasis?

The following people are at risk for Strongyloidiasis:

Tourists who live in South America, Africa, and other tropical areas.
Poor personal hygiene.
Individuals who travel to rural areas where personal hygiene and sanitation are poor.
A weakened immune system, such as HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome).
Organ transplant patients.
Individuals come in contact with soil regularly due to their job.
Children because of poor sanitation.
Areas without adequate public health services.
The immigrant population shows a high percentage of infection.
Agriculturists.

What Are the Signs and Symptoms of Strongyloidiasis?

Most of the population infected with Strongyloidiasis do not have symptoms. Symptoms present may include:

Acute Strongyloidiasis:

The symptoms include;

Local reaction at the entry site of the larvae lasts up to several weeks.
Pulmonary symptoms include cough and tracheal irritation when the larvae migrate via the lungs.
Gastrointestinal symptoms include diarrhea, constipation, and abdominal pain showing about two weeks after infection.

Chronic Strongyloidiasis:

It may be asymptomatic or characterized by gastrointestinal, pulmonary, or cutaneous symptoms.

Gastrointestinal symptoms include abdominal pain, nausea, vomiting, diarrhea, and intestinal obstruction.
Pulmonary symptoms include cough, wheezing, and respiratory failure.
Cutaneous symptoms include a recurrent maculopapular or urticarial rash found anywhere on the skin but mainly on the buttocks, perineum, and thighs.

Hyperinfection Syndrome:

The syndrome is mainly found in immunocompromised individuals, particularly in patients on steroids and after organ transplants. It includes pulmonary symptoms like dyspnea and respiratory failure. The central nervous system (CNS) includes brain abscesses and parasitic meningitis.

How Is Strongyloidiasis Diagnosed?

The most common diagnostic methods are duodenal aspiration and stool tests. The following test may be performed to diagnose the infection:

Sputum Culture - The doctor uses the test to examine the fluid from the lungs.
Stool Test - To check the larvae in the stool.
Duodenal Aspiration - The health professional will take the fluid from the duodenum of the small intestine to examine the fluid under a microscope for the presence of the parasite.
Complete Blood Count (CBC) Test - To rule out other causes of the symptoms and find the symptoms of Strongyloidiasis.
Blood Antigen Test - The test can help the health professional look for antigens related to the disease. This test is performed only when the host has an infection but cannot find the parasite in duodenal aspiration and stool test samples. This test does not conclusively determine past or present infection.

What Is the Treatment of Strongyloidiasis?

Treatment is challenging for clinicians due to the autoinfection and impairment of host immunity. The main aim of the treatment is to remove the worms. The medicine prescribed for the treatment is antiparasitic drugs.

1. Acute and Chronic Strongyloidiasis

Ivermectin, an antiparasitic, is recommended to treat Strongyloidiasis. The recommended dose for Ivermectin is 200mg/kg (milligram per kilogram) per day orally for two weeks.
Albendazole and Thiabendazole are recommended at 25mg/kg twice daily for five days.
Continued treatment is needed if treatment resolves.

2. Hyperinfection Syndrome

Immunosuppressive therapy is stopped or reduced, and Ivermectin 200mg/kg orally once a day is recommended until sputum and stool tests are negative for two weeks. Broad-spectrum antibiotics are prescribed to treat simultaneous polymicrobial bacterial infections.

Who Are Not Recommended to Take the Dosage?

Ivermectin is not recommended for pregnant or lactating women, and Albendazole is contraindicated during the first trimester of pregnancy.

What Are the Complications of Strongyloidiasis?

Eosinophilic Pneumonia (An Infection That Affects the Lungs) - occurs due to an increase in several eosinophils when the lung swells.
Malnutrition (Lack of Proper Nutrition) - Infected individuals cannot absorb nutrients effectively.
Disseminated Strongyloidiasis - (the larvae invade many organs) occurs when the S.stercoralis enters the intestine and re-enters the bloodstream. It only happens when the patient is taking immunosuppressive agents. In this case, the larvae travel to other body parts like the brain, heart, kidney, liver, and lungs.

How Can It Be Prevented?

Strongyloidiasis can be prevented by the following:

Avoid direct skin contact with soil.
Wearing shoes while walking.
Good personal hygiene.
Using sanitary practices.
Avoid contact with sewage and fecal matter.
Proper disposal of fecal matter.
Hand washing.
Avoid traveling to tropical areas or areas where the disease is common.

Conclusion:

Strongyloidiasis is a serious disease requiring effective treatment and guidance by health professionals. Once discharged, the patient needs to follow up with the nurse. Healthcare professionals must raise awareness about personal hygiene, handwashing, and sanitation to eliminate the disease at the community level.

Frequently Asked Questions

1. What Is the Medical Condition Known as Strongyloidiasis?

Strongyloidiasis is a disease caused by the parasitic roundworm Strongyloides stercoralis. This infection is prevalent in areas with poor sanitation and is commonly found in tropical and subtropical regions. The symptoms of strongyloidiasis can range from mild skin irritation to severe respiratory and gastrointestinal issues; in rare cases, it can be fatal. The choice of treatment options is contingent upon the extent of the infection's severity.

2. What Are the Possible Treatments for Strongyloides?

Treatment options for strongyloidiasis depend on the severity of the infection. Mild infections can often be treated with medications such as ivermectin or albendazole. Severe cases may require hospitalization and more aggressive treatment, such as corticosteroids to reduce inflammation or endoscopy to remove worms from the digestive tract. Patients need to seek medical attention if they suspect they have strongyloidiasis.

3. How Can the Spread of Strongyloides Be Prevented?

Improving sanitation and hygiene practices can prevent the spread of Strongyloides. Proper disposal of human waste and using clean water sources can limit the transmission of this parasite. Additionally, wearing protective clothing when working in areas where the parasite may be present and avoiding contact with contaminated soil can further reduce the risk of infection.

4. How Is the Transmission of Strongyloides from Person to Person Carried Out?

Strongyloides are transmitted through contact with soil or water contaminated with the parasite's larvae. Infection can occur when the larvae penetrate the skin or are ingested, and it can also be spread through organ transplantation or blood transfusion. There is no evidence that Strongyloides are transmitted through casual contact or sexual activity.

5. How Prevalent Is Strongyloidiasis?

Strongyloides can survive outside the human body for up to 15 days under ideal conditions. The parasite can persist in soil and contaminated water sources, particularly in warm and humid environments. It is important to take precautions to avoid contact with potentially contaminated soil and water to reduce the risk of infection.

6. How Long Can Strongyloides Survive Outside the Human Body?

Strongyloides can cause skin symptoms, including itching, rash, and redness. The larvae can penetrate the skin and cause an allergic reaction. In severe cases, the skin may become infected and develop ulcers. Skin symptoms are not always present in a strongyloidiasis infection, and the severity can vary widely depending on the individual.

7. In What Ways Do Strongyloides Affect the Skin?

Strongyloides can cause skin symptoms, including itching, rash, and redness. The larvae can penetrate the skin and cause an allergic reaction. In severe cases, the skin may become infected and develop ulcers. Skin symptoms are not always present in a strongyloidiasis infection, and the severity can vary widely depending on the individual.

8. What Is the Physical Appearance of Strongyloides?

Strongyloides stercoralis is a thread-like parasitic roundworm that can infect humans. Adult worms are tiny, measuring only a few millimeters in length. These organisms are barely discernible to the unaided eye and possess slender bodies that narrow at both ends gradually. The males have curved tails, while the females have straight. The larvae responsible for the infection are smaller and cannot be seen without a microscope. A long, slender body with a pointed tail and a rounded head characterizes the larvae.

9. How Does an Infection with Strongyloides Feel Like?

Strongyloides infection can cause various symptoms, including abdominal pain, diarrhea, nausea, vomiting, and weight loss. In some cases, there are symptoms at all. The intensity of symptoms can be influenced by the individual's immune system reaction to the infection and the duration and extent of the infection. Strongyloidiasis can also lead to complications such as sepsis, meningitis, and pneumonia, particularly in individuals with weakened immune systems.

10. Is It Possible for Strongyloides to Be Transmitted Sexually?

There is no evidence that Strongyloides is transmitted through sexual activity. The parasite is spread through contact with contaminated soil or water sources, typically in areas with poor sanitation. In rare cases, transmission occurs with organ transplantation or blood transfusion. Practicing good hygiene and avoiding exposure to contaminated sources is essential, particularly if traveling to endemic areas.

11. What Geographic Areas Are Affected by Strongyloidiasis?

Strongyloidiasis is found in tropical and subtropical regions worldwide, including Africa, Asia, and Latin America. It is most common in rural areas with poor sanitation, where the parasite can persist in contaminated soil and water sources. The infection is also prevalent in certain populations, such as refugees and immigrants from endemic areas. Travelers to these regions are also at risk of contracting strongyloidiasis.

12. What Is an Effective Way to Eliminate Strongyloides from the Human Body?

Treatment for strongyloidiasis typically involves medications such as ivermectin or albendazole, which can effectively kill the parasite. In severe cases, hospitalization becomes necessary for intravenous medications or supportive care. It is essential to take prompt medical attention if symptoms of infection occur or if there is reason to suspect exposure to contaminated sources. In addition to treatment, preventive measures such as improved sanitation and hygiene can help to control the spread of Strongyloides.

13. What Is Another Term Used to Describe Strongyloidiasis?

Strongyloidiasis is also known as threadworm infection or threadworm disease. The infection is caused by the parasitic roundworm Strongyloides stercoralis, which can penetrate the skin and migrate to the lungs and digestive tract. The parasite is particularly prevalent in tropical and subtropical regions with poor sanitation. Strongyloidiasis can cause a range of symptoms and can lead to complications in individuals with weakened immune systems. Treatment typically involves medications to kill the parasite.

14. What Is the Underlying Cause of Strongyloidiasis?

The cause of strongyloidiasis is infection with the parasitic roundworm Strongyloides stercoralis. The parasite can enter the body through contact with contaminated soil or water sources, typically in areas with poor sanitation. In rare cases, transmission occurs through organ transplantation or blood transfusion. The larvae can penetrate the skin and migrate to the lungs and digestive tract, developing into adult worms. The severity of the infection can depend on the individual's immune system response and the duration and extent of the infection.

15. Is It Possible to Detect Strongyloides in Stool Samples?

Strongyloides larvae can sometimes be visible in stool samples, particularly during acute infections. However, the larvae are often difficult to detect and may require specialized laboratory techniques. Therefore, stool testing may not always be reliable for diagnosing strongyloidiasis, and additional tests such as blood antibody tests or imaging studies may be necessary. It is essential to take medical attention if there is reason to suspect an infection, even if stool testing is negative.

Sources

Dr. Shubadeep Debabrata Sinha

Infectious Diseases

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