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2.1
Cutaneous Strongyloidiasis
Strongyloides Cutaneous Larva Currens

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WIKIDATA, CC BY-SA 3.0
WIKIDATA, Public Domain

Presentation

We present a case where this infection was successfully treated and review the available literature. Cases may present many years after they have left an area endemic for Strongyloides infection, emphasizing the need for a full travel history. [doi.org]

Gastrointestinal

  • Diarrhea

    A 77-year-old Haitian male, with history of temporal arteritis on 40 mg of oral prednisone presented complaining of decreased oral intake, epigastric pain, and non-bloody diarrhea. [ncbi.nlm.nih.gov]

    The worms usually inhabit the small intestines, causing intestinal strongyloidiasis with diarrhea and ulceration of the mucosa. [medical-dictionary.thefreedictionary.com]

    CLINICAL PRESENTATION The major findings in tropical pancreatitis include postprandial abdominal pain (usually aggravated by the intake of fatty foods), diarrhea with steatorrhea, and weight loss. [aafp.org]

  • Abdominal Pain

    The patient's abdominal pain decreased after he began taking pancreatic enzyme supplements orally with low-fat meals. [aafp.org]

    Complicated strongyloidiasis should be suspected in immunocompromised hosts who present with abdominal pain, vomiting and diarrhoea, particularly in endemic areas. [ncbi.nlm.nih.gov]

  • Nausea

    Our patient complained of epigastric pain associated with nausea, vomiting and general weakness. [doi.org]

    The hyponatremia gradually improved initially, but the appetite loss, nausea, and hyponatremia continued. [ncbi.nlm.nih.gov]

    Gastrointestinal symptoms may include diarrhoea, abdominal pain and occasionally nausea and vomiting. Patients may also have a low-grade fever, coughing and wheezing, due to the migration of larvae through the lungs. [dermnetnz.org]

    The most common manifestations of infection are mild and may include epigastric pain, mild diarrhea, nausea, and vomiting. At the site of filariform penetration, skin may be inflamed and itchy-this is referred to as "ground itch." [mayomedicallaboratories.com]

    Some people may experience, nausea, vomiting, weight loss, weakness or constipation. In chronic infections skin and chest symptoms can persist. The time from infection until a person might develop symptoms is variable. [nt.gov.au]

  • Constipation

    All patients presented with gastrointestinal symptoms (abdominal pain, vomiting, diarrhea, constipation and paralytic ileus), as well as pulmonary symptoms (cough, dyspnea and blood-stained sputum). Albendazole 800 mg twice daily orally was started. [ncbi.nlm.nih.gov]

    Severe infection of the intestine is debilitating and causes vomiting, diarrhea, and constipation. This is often associated with the autoinfective cycle. [histopathology-india.net]

    Periodically they may experience vague abdominal discomfort, intermittent diarrhoea and constipation, and recurrent rashes. Recurrent rashes are known as larva currens or creeping infection. [dermnetnz.org]

    Profuse watery diarrhoea, sometimes alternating with constipation. Malabsorption. Weight loss. Pulmonary involvement (including Löffler's disease) can occur during pulmonary migration of the filariform larvae: Cough. Bronchospasm. Haemoptysis. [patient.info]

    If symptoms are present, they may include: upper abdominal burning or pain diarrhea, or alternating diarrhea and constipation a cough a rash red hives near the anus vomiting weight loss Rashes may occur immediately after contact with the S. stercoralis [healthline.com]

  • Chronic Diarrhea

    Uday C Ghoshal, Amit Goel, Ujjala Ghoshal, Manoj Jain, Asha Misra and Gourdas Choudhuri, Chronic diarrhea and malabsorption due to hypogammaglobulinemia: a report on twelve patients, Indian Journal of Gastroenterology, 30, 4, (170), (2011). [dx.doi.org]

    In classic cases, diarrhea is profuse, watery, and mucoid. Periods of alternation between diarrhea and constipation may occur. [emedicine.medscape.com]

    Among AIDS patients, strongyloidiasis is more commonly associated with chronic diarrhea ( 4, 7, 8 ). [ncbi.nlm.nih.gov]

Skin

  • Dermatitis

    Invading larvae cause transient dermatitis. Larvae migrating through the lungs may provoke cough, hemoptysis, and dyspnea, but most infections do not lead to pulmonary symptoms. [histopathology-india.net]

    Strongyloidiasis, a gastrointestinal infection by the helminth Strongyloides stercoralis, and Infective Dermatitis associated with HTLV-1 (IDH), appear to be risk factors for the development of HTLV-1 related diseases. [ncbi.nlm.nih.gov]

    Delusional parasitosis is sometimes difficult for doctors to diagnose because many actual skin disorders, such as allergies, dermatitis, or real parasites, also cause the itching sensations. [merckmanuals.com]

    CLINICAL PRESENTATION Patients may develop dermatitis when filariform hookworm larvae penetrate the skin. [aafp.org]

    Can cause dermatitis and balanoposthitis due to percutaneous entry, or diarrhea when the intestinal infection is very heavy. In kangaroos it is a stomach parasite causing gastritis. [medical-dictionary.thefreedictionary.com]

  • Urticaria

    Among these, 52 patients (61.9%) reported skin-related problems (pruritus, urticaria, angioedema, and/or rash). Forty-nine patients (58.3%) had asthma, and 73.8% had allergic rhinoconjunctivitis. [ncbi.nlm.nih.gov]

    Symptoms Strongyloidiasis may cause intermittent symptoms that mostly affect the intestine (abdominal pain and intermittent or persistent diarrhoea), the lungs (cough, wheezing, chronic bronchitis) or skin (pruritus, urticaria). [who.int]

    CLINICAL PRESENTATION The classically recognized triad of symptoms in chronic strongyloidiasis are urticaria (episodic, rapidly moving urticarial skin eruptions, most often on the buttocks and perianal area), abdominal pain and diarrhea. [aafp.org]

    The symptoms can include diarrhea, enteropathy with malabsorption, skin rashes, such as larva currens, or urticaria. In the context of pulmonary disease, hypereosinophilia is common. Finally there can be massive strongyloidiasis with dissemination. [coursera.org]

    The rash, likely an allergic response to the migrating filariform larvae, often manifests as a pruritic wheal or linear urticaria. [emedicine.medscape.com]

Treatment

Awareness of the interaction between HTLV-I and strongyloidiasis has important implications in terms of prognosis and treatment. [ncbi.nlm.nih.gov]

Prognosis

Awareness of the interaction between HTLV-I and strongyloidiasis has important implications in terms of prognosis and treatment. [ncbi.nlm.nih.gov]

Outlook (Prognosis) With proper treatment, the worms can be killed and full recovery is expected. Sometimes, treatment needs to be repeated. [ufhealth.org]

Prognosis Appropriate antihelminthic treatment results in a cure for the majority of patients, although re-infection is common in endemic areas. [patient.info]

Etiology

He was admitted with signs and symptoms of acute bacterial meningitis, reporting four other meningitis episodes in the past 6 years, with an etiological diagnosis of Escherichia coli and Enterococcus faecium in two cases. [ncbi.nlm.nih.gov]

Etiology The female nematodes, which measure 2.5 mm in length, live in the small intestine of humans. Eggs laid in the small intestine hatch to release larvae that are normally excreted in the faeces. [orpha.net]

A new insight of etiology? Med Hypothesis 2007;68:1351-8. 2. Rapini RP, Bolognia JL, Jorizzo JL. Dermatology. St Louis: Mosby; 2007. 3. Freedberg IM, Fitzpatrick TB. Fitzpatricks dermatology in general medicine. 6 th ed. [doi.org]

Anthelmintic Therapy Strongyloides infection should be suspected in a patient with nonspecific gastrointestinal, respiratory, or recurrent dermatologic symptoms of unclear etiology with risk factors for Strongyloides infection. [emedicine.medscape.com]

Newly arrived immigrants to the United States may present with nematodal ailments, such as strongyloidiasis, hookworm infection, clonorchiasis or cysticercosis, or they may have diseases that are not clearly of infectious etiology, such as tropical pancreatitis [aafp.org]

Epidemiology

Even though the diagnosis of strongyloidiasis is improved by advanced instrumentation techniques in isolated and complicated cases of hyperinfection or dissemination, efficient guidelines for screening the population in epidemiological surveys are lacking [ncbi.nlm.nih.gov]

Hospital admissions for malaria in Basel, Switzerland: an epidemiological review of 150 cases. J Travel Med 2000 ; 7 : 95 – 97. 10759578 3 et al. [dx.doi.org]

Pathophysiology

Now let’s discuss strongyloidiasis, pathophysiology, clinical manifestations and treatment. Strongyloidiasis transmission occurs by exposure to larvae in soil. The larvae penetrate the skin, enter the venous circulation, and migrate to the lungs. [coursera.org]

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Strongyloidiasis is caused by Strongyloides stercoralis, a nematode endemic to tropical and subtropical regions worldwide. [mayomedicallaboratories.com]

In: Harawi SJ, O'Hara CJ (eds) Pathology and pathophysiology of AIDS and HIV-related diseases. London: Chapman & Hall Medical, 1989:327. Google Scholar 3. Shikiya K, Saito A. Strongyloidiasis. Clin Microbiol 1993;6:1011–1015 (in Japanese). [link.springer.com]

Clinical Manifestations and Pathophysiology Transplant recipients are at risk for developing Strongyloides hyperinfection syndrome, from chronic intestinal Strongyloides infection, acquisition of primary Strongyloides infection in areas of endemicity, [academic.oup.com]

Prevention

Waterborne, and Environmental Diseases, Centers for Disease Controls and Prevention, Atlanta, Georgia, United States of America. [ncbi.nlm.nih.gov]

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