Strongyloides stercoralis - Revision history

Aidan: /* Clinical Presentation */ capitalization

2022-10-16T19:07:52Z

Clinical Presentation: capitalization

← Older revision		Revision as of 19:07, 16 October 2022
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	==Clinical Presentation==		==Clinical Presentation==
	===Larva ~~currens~~===		===Larva Currens===

	*Itchy linear rash that can be watched spreading over hours (10 cm/h)		*Itchy linear rash that can be watched spreading over hours (10 cm/h)
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	*Much faster than cutaneous larva migrans (caused by hookworm)		*Much faster than cutaneous larva migrans (caused by hookworm)

	===Intestinal ~~strongyloidiasis~~===		===Intestinal Strongyloidiasis===

	*Incubation period is about [[Usual incubation period::2 weeks]]		*Incubation period is about [[Usual incubation period::2 weeks]]
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	*May have larva currens or non-specific itchy rash, usually perianal		*May have larva currens or non-specific itchy rash, usually perianal

	===Hyperinfection ~~syndrome~~===		===Hyperinfection Syndrome===

	*Occurs in immunosuppressed patients, including post-transplant, GVHD, prolonged steroids, TNF-alpha inhibitors, heme malignancies, diabetes, and HTLV-1 infection (but ''not'' HIV)		*Occurs in immunosuppressed patients, including post-transplant, GVHD, prolonged steroids, TNF-alpha inhibitors, heme malignancies, diabetes, and HTLV-1 infection (but ''not'' HIV)
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	*Often no eosinophilia (because immunosuppressed)		*Often no eosinophilia (because immunosuppressed)

	===Disseminated ~~strongyloidiasis~~===		===Disseminated Strongyloidiasis===

	*Severe hyperinfection with dissemination of the larvae to any organ		*Severe hyperinfection with dissemination of the larvae to any organ

Aidan: /* Epidemiology */

2021-09-02T13:35:23Z

Epidemiology

← Older revision		Revision as of 13:35, 2 September 2021
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	**Non-endemic areas include Australia, North America, and Western Europe		**Non-endemic areas include Australia, North America, and Western Europe
	***However, it may still be endemic in Florida, Kentucky, and Virginia, and among Aboriginal Australians		***However, it may still be endemic in Florida, Kentucky, and Virginia, and among Aboriginal Australians
			*Seroprevalence by country of origin among migrants[[CiteRef::asundi2019pr]]
			**East Asia and the Pacific (17.3%), sub-Saharan Africa (14.6%), Latin America and the Caribbean (11.4%) were highest
			**Middle East and north Africa (5.5%), South Asia (4.9%)
			**Eastern Europe and central Asia (0%)
	*Has been transmitted through organ donation		*Has been transmitted through organ donation
	*Infections can last years or decades		*Infections can last years or decades

Aidan: /* Treatment */

2021-04-22T17:36:06Z

Treatment

@@ Line 28: / Line 28: @@
 *Immune suppression
 **[[Prednisone]] ≥20 mg/day for ≥2 weeks (but actually, '''even one dose''')
 **Immunomodulatory agents, including alkylating agents, antimetabolites, immunosuppression for [[solid organ transplantation]], immunosuppression for [[multiple sclerosis]], TNF inhibitors, IL-1 inhibitors, adhesin inhibitors, and lymphocyte depleting agents
 **[[Transplantation]]
 **[[Hematologic malignancy]]
@@ Line 124: / Line 124: @@
 ==Management==
-=== Deciding to Treat ===
+===Risk Assessment===
-** If from a highly endemic area and immunosuppression cannot wait, consider empiric treatment
+**High risk: from highly endemic area and risk factors for disseminated disease
-** Moderate and low risk: send diagnostic specimens
+**Very low risk: from non-endemic area
-=== Treatment ===
+=== Management by Risk Category ===
 *First-line: [[ivermectin]] 200 mcg/kg po once, repeated after 2 weeks
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 *[[HTLV-1]] coinfection: may need to treat 2 days every 2 weeks to keep suppressed
 {{DISPLAYTITLE:''Strongyloides stercoralis''}}
 [[Category:Nematodes]]

Aidan at 22:42, 11 September 2020

2020-09-11T22:42:17Z

@@ Line 1: / Line 1: @@
 ==Background==
-* Commonly known as '''threadworm'''
+*Commonly known as '''threadworm'''
 ===Life Cycle===
@@ Line 16: / Line 16: @@
 *Endemic in the tropics, especially Jamaica, Haiti, Laos, Cambodia, Vietnam, and the beaches of western Africa
 *Has been transmitted through organ donation
 *Infections can last years or decades
@@ Line 23: / Line 27: @@
 *Immune suppression
-**[[Prednisone]] ('''even one dose''')
+**[[Prednisone]] ≥20 mg/day for ≥2 weeks (but actually, '''even one dose''')
 **[[Transplantation]]
 **[[Hematologic malignancy]]
@@ Line 61: / Line 66: @@
 *Severe hyperinfection with dissemination of the larvae to any organ
-*Not limited to gut and lung, can involve brain, kidneys, liver, etc
+**Not limited to gut and lung, can involve brain, kidneys, liver, etc
 *Usually no eosinophilia
 *Mortality is 100% without treatment, about 65%  with treatment
@@ Line 73: / Line 79: @@
 *If unwell, check for larvae in blood, sputum, CSF, and urine
 *On colonoscopy, it can mimic ulcerative colitis
 ==Management==
 *First-line: [[ivermectin]] 200 mcg/kg po once, repeated after 2 weeks
-**'''DO NOT''' use if onchocerciasis or loiasis
+**'''DO NOT''' use if [[onchocerciasis]] or [[loiasis]]
 *Second-line: [[albendazole]] 400 mg po BID for 10-14 days, but not as effective
 *Hyperinfection or dissemination:
 **Stop any immune-supressing medications
-**[[Ivermectin]] 200 mcg/kg po daily until stool O&amp;P is negative for 2 weeks
+**[[Ivermectin]] 200 mcg/kg PO/SC daily plus [[albendazole]] 400 mg PO bid
 *To confirm eradication, check feces up to 1 year after treatment, and serology 1 to 2 years after treatment
 **IgG should decline or serorevert 6 to 12 months after treatment
 **[[Eosinophilia]] (if present) should resolve
-*[[HTLV-1]] coinfection
+*[[HTLV-1]] coinfection: may need to treat 2 days every 2 weeks to keep suppressed
 {{DISPLAYTITLE:''Strongyloides stercoralis''}}

Aidan: /* Intestinal strongyloidiasis */

2020-08-05T13:58:42Z

Intestinal strongyloidiasis

← Older revision		Revision as of 13:58, 5 August 2020
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	===Intestinal strongyloidiasis===		===Intestinal strongyloidiasis===

	*Incubation period is about 2 weeks		*Incubation period is about [[Usual incubation period::2 weeks]]
	*Most are asymptomatic, with or without fluctuating [[eosinophilia]]		*Most are asymptomatic, with or without fluctuating [[eosinophilia]]
	**Eosinophilia can be as high as 10-15% of leukocytes		**Eosinophilia can be as high as 10-15% of leukocytes

Aidan at 23:37, 29 July 2020

2020-07-29T23:37:41Z

Show changes

Aidan: Updated category

2019-12-13T19:32:06Z

Updated category

← Older revision		Revision as of 19:32, 13 December 2019
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	{{DISPLAYTITLE:''Strongyloides stercoralis''}}		{{DISPLAYTITLE:''Strongyloides stercoralis''}}
	[[Category:~~Helminths~~]]		[[Category:Nematodes]]

Aidan: /* Management */

2019-11-26T13:45:07Z

Management

← Older revision		Revision as of 13:45, 26 November 2019
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	== Management ==		== Management ==
	* First-line: ivermectin 200 mcg/kg po ~~daily~~ ~~for~~ 2 ~~days~~		* First-line: ivermectin 200 mcg/kg po once, repeated after 2 weeks
	** Needs special access, as it it a veterinary medication		** Needs special access, as it it a veterinary medication
	** '''DO NOT''' use if onchocerciasis or loiasis		** '''DO NOT''' use if onchocerciasis or loiasis

Aidan: /* Disseminated strongyloidiasis */

2019-11-26T13:44:14Z

Disseminated strongyloidiasis

← Older revision		Revision as of 13:44, 26 November 2019
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	* Not limited to gut and lung, can involve brain, kidneys, liver, etc		* Not limited to gut and lung, can involve brain, kidneys, liver, etc
	* Usually no eosinophilia		* Usually no eosinophilia
			* Mortality is 100% without treatment, about 65% with treatment

	== Diagnosis ==		== Diagnosis ==

Aidan: reorganized sections

2019-11-26T13:43:07Z

reorganized sections

← Older revision		Revision as of 13:43, 26 November 2019
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	* Commonly known as '''threadworm'''		* Commonly known as '''threadworm'''
			== Background ==
		⚫	=== Microbiology ===

		⚫	=== Life Cycle ===
⚫	= Microbiology =

⚫	= Life Cycle =

	* Eggs are released in the small intestine, then hatch to release '''rhabditiform larvae'''		* Eggs are released in the small intestine, then hatch to release '''rhabditiform larvae'''
	* The rhabditiform larvae are excreted, where they molt and develop into infective '''filariform larvae''' or into '''free-living adult''' males and females		* The rhabditiform larvae are excreted, where they molt and develop into infective '''filariform larvae''' or into '''free-living adult''' males and females
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	* In the small bowel, adult female begins releasing eggs through parthogenesis (no male needed)		* In the small bowel, adult female begins releasing eggs through parthogenesis (no male needed)

	= Epidemiology =		=== Epidemiology ===

	* Endemic in the tropics, especially Jamaica, Haiti, Laos, Cambodia, Vietnam, and the beaches of western Africa		* Endemic in the tropics, especially Jamaica, Haiti, Laos, Cambodia, Vietnam, and the beaches of western Africa
	* May still be endemic in Appalachia, southeastern US, Europe, Australia, and Japan		* May still be endemic in Appalachia, southeastern US, Europe, Australia, and Japan
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	* Infections can last years or decades		* Infections can last years or decades

	= Risk ~~factors~~ =		=== Risk Factors for Severe Disease ===

	* Immune suppression		* Immune suppression
	** Prednisone ('''even one dose''')		** Prednisone ('''even one dose''')
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	* Chronic alcohol abuse		* Chronic alcohol abuse

	= Clinical Presentation =		== Clinical Presentation ==
		⚫	=== Larva currens ===

⚫	== Larva currens ==

	* Itchy linear rash that can be watched spreading over hours (10 cm/h)		* Itchy linear rash that can be watched spreading over hours (10 cm/h)
	* From intradermal migration of the filariform larva		* From intradermal migration of the filariform larva
	* Much faster than cutaneous larva migrans (caused by hookworm)		* Much faster than cutaneous larva migrans (caused by hookworm)

	== Intestinal strongyloidiasis ==		=== Intestinal strongyloidiasis ===

	* Incubation period is about 2 weeks		* Incubation period is about 2 weeks
	* Most are asymptomatic, with or without fluctuating eosinophilia		* Most are asymptomatic, with or without fluctuating eosinophilia
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	* May have larva currens or non-specific itchy rash, usually perianal		* May have larva currens or non-specific itchy rash, usually perianal

	== Hyperinfection syndrome ==		=== Hyperinfection syndrome ===

	* Occurs in immunosuppressed patients, including post-transplant, GVHD, prolonged steroids, TNF-alpha inhibitors, heme malignancies, diabetes, and HTLV-1 infection (but ''not'' HIV)		* Occurs in immunosuppressed patients, including post-transplant, GVHD, prolonged steroids, TNF-alpha inhibitors, heme malignancies, diabetes, and HTLV-1 infection (but ''not'' HIV)
	* Still adheres to the usual gut-to-lung-to-gut cycle		* Still adheres to the usual gut-to-lung-to-gut cycle
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	* Often no eosinophilia (because immunosuppressed)		* Often no eosinophilia (because immunosuppressed)

	== Disseminated strongyloidiasis ==		=== Disseminated strongyloidiasis ===

	* Severe hyperinfection with dissemination of the larvae to any organ		* Severe hyperinfection with dissemination of the larvae to any organ
	* Not limited to gut and lung, can involve brain, kidneys, liver, etc		* Not limited to gut and lung, can involve brain, kidneys, liver, etc
	* Usually no eosinophilia		* Usually no eosinophilia

	= Diagnosis =		== Diagnosis ==

	* Stool O&P is 75% sensitive, so it's done three times to improve it to 90%		* Stool O&P is 75% sensitive, so it's done three times to improve it to 90%
	* Serology can be negative early in disease		* Serology can be negative early in disease
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	* On colonoscopy, it can mimic ulcerative colitis		* On colonoscopy, it can mimic ulcerative colitis

	= Management =		== Management ==

	* First-line: ivermectin 200 mcg/kg po daily for 2 days		* First-line: ivermectin 200 mcg/kg po daily for 2 days
	** Needs special access, as it it a veterinary medication		** Needs special access, as it it a veterinary medication