Date:   8/7/2006 1:14:20 AM ( 19 y ago)
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URL:   https://www.curezone.org/forums/fm.asp?i=483605

(From emedicine)
Most Strongyloides infections are asymptomatic and can survive decades undiagnosed. Symptomatic infections typically manifest in gastrointestinal, pulmonary, and dermatologic systems.

Infections are initiated when exposed skin contacts contaminated soil. Autoinfection commonly occurs allowing infection to persist decades. The longest documented asymptomatic infection was more than 65 years. Hyperinfection typically is triggered by drug-induced or disease-associated defects in cellular immunity, which allows a massive increase in parasite burden and dissemination to nearly all organ systems.

Skin penetration by infective larvae can elicit ground itch, a cutaneous eruption of pruritic papulovesicular lesions. Typically, skin penetration is on the feet but may be at any site that contacted infected soil. Larva currens (racing larvae), the pathognomonic rash of Strongyloides infection, is a serpiginous urticarial rash that creeps 5-15 cm/h up the body. This rash, likely an allergic response to the migrating larvae, often manifests as a pruritic wheal or linear urticaria. This dermatologic manifestation may last hours to days but in autoinfection cycles can recur over weeks, months, and years. Rarely, in disseminated strongyloidiasis, a petechial purpuric eruption may be present secondary to vessel injury during larval migration.

Gastrointestinal symptoms are vague: anorexia, weight loss, nausea, chronic diarrhea, constipation, bloating and, rarely small bowel obstruction. Strongyloides is an important cause of failure to thrive and cachexia in immunocompetent children. Malabsorption syndromes may occur in chronic infections.
Initial infection may trigger wheezing and mild cough. Hyperinfection and disseminated disease are frequently associated with wheezing, dyspnea, cough, pleuric pain, tachypnea, hemoptysis, acute respiratory distress syndrome (ARDS), and may require mechanical ventilation.

Hyperinfection syndrome
Hyperinfection and disseminated disease occur during amplification of the autoinfective life cycle. Classically, the syndrome presents in a chronically infected person after immunosuppressive therapy is initiated for an underlying condition. With diminished T-cell immunity, larvae migrate in frequently massive numbers to the lungs and often aberrantly to other tissues, triggering local inflammation and antigen stimulation. Bacteremia, meningitis, and gram-negative sepsis can occur, as intestinal flora attached to the larvae also migrate throughout the body. Fever is almost always present in disseminated disease.
Risk factors for disseminated Strongyloides include immunosuppressive therapy, transplantation, hematologic malignant disease, human T-lymphotropic virus type 1 (HTLV-1) infection, human immunodeficiency virus, malnutrition, diabetes mellitus, chronic renal failure, and chronic alcohol consumption. HTLV-1, the retrovirus associated with adult T-cell leukemia, has a bidirectional relationship with Strongyloides. Co-infection of Strongyloides shortens the preleukemic phase of HTLV-1 infection. The Strongyloides antigen accelerates leukemogenesis, and treatment of the infection may actually decrease HTLV-1 viral load. Recent studies suggest that Strongyloides infection may be associated with increased incidence of GI lymphoma.
Physical: Fever is typically present in disseminated disease.

Dermatologic
Ground itch - Papulovesicular pruritic rash, usually on the feet
Larva currens - Serpiginous urticarial rash often on the trunk and buttocks
Generalized urticaria
Cutaneous granulomas (with chronic autoinfection)
Petechial/purpuric rash (with disseminated disease)
Case reports have been made of multiple atypical dermatologic presentations.

Gastrointestinal
Bloating, distension
Diffuse abdominal pain
Diarrhea, typically nonbloody
Pulmonary
Wheezing
Cough
Hemoptysis (in disseminated disease or hyperinfection syndrome)

Central nervous system - Meningeal symptoms may be present in disseminated disease.
Reproductive: A case report has demonstrated infertility as a presentation for disseminated strongyloidiasis with larvae found in ejaculate and conception occurring after treatment.

 

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