Strongyloidosis

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What is it about ?

Strongyloidiasis is an infection caused by the nematode (roundworm) Strongyloides stercoralis. This parasite needs to be harbored by humans (host) in order to survive. It has a particular life cycle. The larvae simply mature on the ground and penetrate human skin after direct contact with contaminated soil (walking barefoot!). Through the bloodstream, they enter the lungs and then travel up the trachea to the throat, where they are swallowed. They are finally found in the first part of the small intestine, where the larvae transform into adult worms about 2 mm long. The females lay eggs there which develop into larvae. These are excreted with the stool and end up outside. New larvae develop there, after which the cycle can start again. But some larvae enter through the intestinal wall or the skin around the anus, allowing them to resume their cycle without going outside (self-infection). The parasite can also be passed from person to person through close direct contact.

Where and how often does it occur?

Strongyloidiasis is widespread in the tropics and subtropics. It is also present in southern Europe. The disease is estimated to affect 30 to 100 million people worldwide. But these numbers are probably underestimated. In many of these areas, people have little access to health care, sometimes they cannot get it at all. The disease is often endemic. This term means that large parts of the population are infected. Poor hygienic conditions are a major risk factor.

How to recognize it?

One in three people with the disease have no symptoms. It can take decades for you to have symptoms.

Symptoms reflect the cycle of the worm:

  • A rash in the form of small, slightly raised patches (papules), accompanied by itching (itchy), may develop upon penetration through the skin. It is linked to an allergic reaction. In the case of self-infection, the itchy papules progress rapidly, they appear and disappear abruptly within a few hours.
  • Respiratory problems predominate when passing through the lungs: dry cough, shortness of breath on exertion and sometimes wheezing which suggests asthma.
  • Nesting of the parasites in the intestines leads to stomach pain, vomiting, mucous diarrhea, and weight loss. Sometimes there are no symptoms in the stomach.

The disease can be particularly serious in people with severely weakened resistance, such as with AIDS and when taking drugs that weaken resistance. In these people, the “parasite load” (ie the total number of worms) is so great that the disease can become fatal.

How is the diagnosis made?

The doctor can tell if the larvae are present by examining the stool. Antibodies to the disease can be detected in the blood. Sometimes cloudy spots are visible on an x-ray of the lungs.

What can you do ?

Always wear shoes in risky areas, even on the beach. Good hygiene is very important. Always wash your hands after using the toilet.
On your return, see the doctor if you have one or more of the symptoms described above.

What can your doctor do?

Strongyloidiasis should always be treated, even if there are no symptoms. The doctor will prescribe a dewormer (antiparasitic medicine) for you. Usually the healing is rapid.
To detect self-infection and to see if the treatment is working, a further stool examination is necessary after three weeks. If necessary, the treatment should be repeated.

Want to know more?

Are you looking for more specialized help?

Source

Foreign clinical practice guide ‘Anguillulosis or strongyloidosis’ (2010), updated on 02/28/2017 and adapted to the Belgian context on 12/28/2019 – ebpracticenet

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