7.13 SFGH pearls – disseminated stronglyoides infection

  • Life cycle: hematogenous (usually through foot) –> GI –> cough –> swallow (auto-infection) -there’s a great diagram of the lifecycle at http://www.cdc.gov/parasites/strongyloides/biology.html
  • HIV is *not* a traditional risk factor for Strongyloides but there are case reports of Strongyloides in HIV patients
  • Classic symptoms: GI symptoms (diarrhea), respiratory symptoms (dry cough, throat irritation), skin (itchy red rash when worm enters skin and can get recurrent red rash along thighs & buttocks)
  • Disseminated strongyloides is more common in patients on high-dose steroids, hard-core immunosuppressives, or HTLV-1 infection
  • Can see fulminant form in the ICU which is often fatal
  • Diagnosis usually depends on visualization of the larvae in stool or respiratory culture
  • Treatment is usually ivermectin as first-line treatment, use up to 14 days in case of disseminated strongyloides
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