Makindo Medical Notes.com

Disseminated strongyloidiasis occurs in immunosuppressed patients, can cause abdominal pain, shock, lung and CNS complications and septicaemia, and is potentially fatal.

About

• Nematode (roundworm) Strongyloides stercoralis
• Infects 30 million people in 70 countries

Aetiology

• Found in soil and penetrates bare feet
• Migrates through vasculature
• Reaches lungs ascends airway and swallowed
• Invades the small intestine and sheds more
• Eggs hatch into the intestinal mucosa
• Repeated endogenous reinfection results in chronic infection
• This can last for several decades

Clinical

• Often no symptoms.
• GI: diarrhoea, abdominal discomfort, bleeding, weight loss, nausea, and anorexia
• Lung: Loeffler syndrome
• Urticarial rashes in the buttocks and waist areas.
• Larva migrans: These are migratory, serpiginous, urticarial rashes

Differentials

Investigations

• FBC/DWCC: Blood eosinophilia is generally present during the acute and chronic stages, but may be absent with dissemination.
• Stool sample: single stool examination by use of conventional techniques fail to detect larvae in up to 70% of cases
• ELISA was 88% sensitive, 99% specific

Management

• Ivermectin is the best drug for the treatment of uncomplicated S. stercoralis infection. Well tolerated and more effective than Albendazole.
• Albendazole 400 mg BD for 3 days which may be repeated after 3 weeks

References