Strongyloidiasis management

Definition

Strongyloidiasis is a small intestinal infestation caused by Strongyloides stercoralis. It is usually asymptomatic in immunocompetent adults but can cause life-threatening hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, with high mortality rates.

Clinical presentation

• Pruritic papulo-vesicular rash at the site of larval penetration

• Urticarial rash involving the perineal region and extending to the buttocks, thighs, and abdomen

• Chronic cough

• Colicky abdominal pain

• Chronic diarrhoea

• Passage of mucus in stool

• Weight loss

• Hyperinfection syndrome

Investigations

• Stool examination:

  • Evidence of rhabditiform larvae on wet mount microscopy

• Serology:

  • ELISA demonstrating anti-Strongyloides antibodies

Pharmacological treatment

Albendazole

• Dose: 400 mg

• Route: Oral (PO)

• Frequency: Every 12 hours

• Duration: 3 days

Follow-up

• Repeat treatment after 4 weeks if stool findings remain positive.

OR

Ivermectin

• Dose: 200 micrograms/kg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 2 days

Management of disseminated or hyperinfection syndrome

• Continue treatment for 10 days in cases of disseminated strongyloidiasis or hyperinfection syndrome.

Possible complications

• Hyperinfection syndrome

• Disseminated strongyloidiasis

• Severe gastrointestinal disease

• Severe pulmonary involvement

• High mortality in immunocompromised patients