39 Strongyloides

Starts the exact same as hookworm, burrowing through skin.

Into blood, then lungs, then coughed and swallowed.

Can cause loefflers and all that

THE DIFFERENCE IS THEY DON’T LEAVE THE BODY

Eggs laid in the wall of the duodenum. They can survive core temperature.

So it’s larvae that pass in stool. Any left on skin after? They’ll burrow back in. They’ll autoinfect!

This happens in the same parts of the tropics as all the rest.

39.1 Clinical Presentation

Skin - “Larva Currens” - Much faster than cutaneous larva migrans. Occurs over hours. Moves linearly.

Lungs - Loefflers

Late - Often asymptomatic. But non specific gi upset in some. Can live UP TO DECADES in people.

The problem then is what if they need immunosuppression, or get immunosuppresed from HTLV1 (not really from HIV though, not understood why). This Hyperinfection you’ve nothing to control worms. They then don’t respect boundaries and go into blood lungs brain peritoneum, taking bacteria with them. This can cause rare pneumonias. It’s so very commonly fatal.

39.2 Diagnosis

Diagnose with larva currens

Or larva in stool (but only 50% NPV)

Serology (ELISA IgG) - prob best test

39.3 Dx Hyperinfection

• Eosinophilia is rare (cos immunosuppresed)
• Check for larvae in sputum
• Serology unlikely

39.4 Treat

Needs to be IVERMECTIN

Albendazole no use here