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Highlights & Basics
- Strongyloides infection should be considered in all migrants or residents from endemic areas regardless of time since immigration.
- Clinical clues include wheezing, abdominal distress, and eosinophilia.
- Stool ova and parasite tests are relatively insensitive for detection of strongyloides larvae but are currently the tests of choice.
- Treatment with ivermectin is recommended, regardless of resource setting.
- Rapid spread of infection can lead to hyperinfection syndrome and disseminated disease, both of which are associated with a high mortality rate in immunosuppressed patients.
Quick Reference
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Definition
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Citations
World Gastroenterology Organisation. WGO practice guideline: management of strongyloidiasis. February 2018 [internet publication].[Full Text]
Loutfy MR, Wilson M, Keystone JS, et al. Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area. Am J Trop Med Hyg. 2002 Jun;66(6):749-52.[Abstract]
Henriquez-Camacho C, Gotuzzo E, Echevarria J, et al. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016 Jan 18;(1):CD007745.[Abstract][Full Text]
1. World Gastroenterology Organisation. WGO practice guideline: management of strongyloidiasis. February 2018 [internet publication].[Full Text]
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4. Bisoffi Z, Buonfrate D, Montresor A, et al. Strongyloides stercoralis: a plea for action. PLoS Negl Trop Dis. 2013 May 9;7(5):e2214.[Abstract][Full Text]
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7. Román-Sánchez P, Pastor-Guzmán A, Moreno-Guillén S, et al. High prevalence of Strongyloides stercoralis among farm workers on the Spanish Mediterranean coast. Analysis of the predictive factors of infection in developed countries. Am J Trop Med Hyg. 2003 Sep;69(3):336-40.[Abstract]
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10. Kim JH, Kim DS, Yoon YK, et al. Donor-derived strongyloidiasis infection in solid organ transplant recipients: a review and pooled analysis. Transplant Proc. 2016 Sep;48(7):2442-9.[Abstract]
11. Boulware DR, Stauffer WM, Hendel-Paterson BR, et al. Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey. Am J Med. 2007 Jun;120(6):545.e1-8.[Abstract][Full Text]
12. de Silva S, Saykao P, Kelly H, et al. Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7-20 years after resettlement in Australia. Epidemiol Infect. 2002 Jun;128(3):439-44.[Abstract][Full Text]
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15. Loutfy MR, Wilson M, Keystone JS, et al. Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area. Am J Trop Med Hyg. 2002 Jun;66(6):749-52.[Abstract]
16. Siddiqui AA, Berk SL. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis. 2001 Oct 1;33(7):1040-7.[Abstract][Full Text]
17. Sousa-Figueiredo JC, Day M, Betson M, et al. Field survey for strongyloidiasis in eastern Uganda with observations on efficacy of preventive chemotherapy and co-occurrence of soil-transmitted helminthiasis/intestinal schistosomiasis. J Helminthol. 2011 Sep;85(3):325-33.[Abstract]
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21. Newberry AM, Williams DN, Stauffer WM, et al. Strongyloides hyperinfection presenting as acute respiratory failure and gram-negative sepsis. Chest. 2005 Nov;128(5):3681-4.[Abstract][Full Text]
22. Jeyamani R, Joseph AJ, Chacko A. Severe and treatment resistant strongyloidiasis - indicator of HTLV-I infection. Trop Gastroenterol. 2007 Oct-Dec;28(4):176-7.[Abstract]
23. Zaha O, Hirata T, Uchima N, et al. Comparison of anthelmintic effects of two doses of ivermectin on intestinal strongyloidiasis in patients negative or positive for anti-HTLV-1 antibody. J Infect Chemother. 2004 Dec;10(6):348-51.[Abstract]
24. Marcos LA, Terashima A, Dupont HL, et al. Strongyloides hyperinfection syndrome: an emerging global infectious disease. Trans R Soc Trop Med Hyg. 2008 Apr;102(4):314-8.[Abstract]
25. Garn JV, Wilkers JL, Meehan AA, et al. Interventions to improve water, sanitation, and hygiene for preventing soil-transmitted helminth infection. Cochrane Database Syst Rev. 2022 Jun 21;6(6):CD012199.[Abstract][Full Text]
26. Swanson SJ, Phares CR, Mamo B, et al. Albendazole therapy and enteric parasites in United States-bound refugees. N Engl J Med. 2012 Apr 19;366(16):1498-507.[Abstract]
27. Centers for Disease Control and Prevention. Overseas refugee health guidance. Parasitic treatment: strongyloidiasis, schistosomiasis, and soil-transmitted helminth infections. 4 June 2021 [internet publication].[Full Text]
28. Esum M, Wanji S, Tendongfor N, et al. Co-endemicity of loiasis and onchocerciasis in the South West Province of Cameroon: implications for mass treatment with ivermectin. Trans R Soc Trop Med Hyg. 2001 Nov-Dec;95(6):673-6.[Abstract]
29. Ducorps M, Gardon-Wendel N, Ranque S, et al. Secondary effects of the treatment of hypermicrofilaremic loiasis using ivermectin [in French]. Bull Soc Pathol Exot. 1995;88(3):105-12.[Abstract]
30. Gardon J, Gardon-Wendel N, Demanga-Ngangue, et al. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet. 1997 Jul 5;350(9070):18-22.[Abstract]
31. Centers for Disease Control and Prevention. DPDx - Laboratory identification of parasites of public health concern: strongyloidiasis. Jul 2019 [internet publication].[Full Text]
32. Repetto SA, Ruybal P, Solana ME, et al. Comparison between PCR and larvae visualization methods for diagnosis of Strongyloides stercoralis out of endemic area: a proposed algorithm. Acta Trop. 2016 May;157:169-77.[Abstract]
33. Loutfy MR, Wilson M, Keystone JS, et al. Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area. Am J Trop Med Hyg. 2002 Jun;66(6):749-52.[Abstract]
34. Salazar SA, Gutierrez C, Berk SL. Value of the agar plate method for the diagnosis of intestinal strongyloidiasis. Diagn Microbiol Infect Dis. 1995 Dec;23(4):141-5.[Abstract]
35. Seybolt LM, Christiansen D, Barnett ED. Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia. Clin Infect Dis. 2006 Feb 1;42(3):363-7.[Abstract][Full Text]
36. Centers for Disease Control and Prevention. Parasites - strongyloides: resources for health professionals. Mar 2023 [internet publication].[Full Text]
37. Centers for Disease Control and Prevention. Presumptive treatment and screening for strongyloidiasis, infections caused by other soil-transmitted helminths, and schistosomiasis among newly arrived refugees. Mar 2021 [internet publication].[Full Text]
38. Henriquez-Camacho C, Gotuzzo E, Echevarria J, et al. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016 Jan 18;(1):CD007745.[Abstract][Full Text]
39. Suputtamongkol Y, Kungpanichkul N, Silpasakorn S, et al. Efficacy and safety of a single-dose veterinary preparation of ivermectin versus 7-day high-dose albendazole for chronic strongyloidiasis. Int J Antimicrob Agents. 2008 Jan;31(1):46-9.[Abstract]
40. Marti H, Haji HJ, Savioli L, et al. A comparative trial of a single dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil transmitted helminth infections in children. Am J Trop Med Hyg. 1996 Nov;55(5):477-81.[Abstract]
41. Bisoffi Z, Buonfrate D, Angheben A, et al. Randomized clinical trial on ivermectin versus thiabendazole for the treatment of strongyloidiasis. PLoS Negl Trop Dis. 2011 Jul;5(7):e1254.[Abstract][Full Text]
42. Nontasut P, Muennoo C, Sa-nguankiat S, et al. Prevalence of strongyloides in Northern Thailand and treatment with ivermectin vs albendazole. Southeast Asian J Trop Med Public Health. 2005 Mar;36(2):442-4.[Abstract]
43. Turner SA, Maclean JD, Fleckenstein L, et al. Parenteral administration of ivermectin in a patient with disseminated strongyloidiasis. Am J Trop Med Hyg. 2005 Nov;73(5):911-4.[Abstract]
44. Toma H, Sato Y, Shiroma Y, et al. Comparative studies on the efficacy of three anti-helminthics on treatment of human strongyloidiasis in Okinawa, Japan. Southeast Asian J Trop Med Public Health. 2000 Mar;31(1):147-51.[Abstract]
45. Suputtamongkol Y, Premasathian N, Bhumimuang K, et al. Efficacy and safety of single and double doses of ivermectin versus 7-day high dose albendazole for chronic strongyloidiasis. PLoS Negl Trop Dis. 2011 May 10;5(5):e1044.[Abstract][Full Text]
46. Buonfrate D, Salas-Coronas J, Muñoz J, et al. Multiple-dose versus single-dose ivermectin for Strongyloides stercoralis infection (Strong Treat 1 to 4): a multicentre, open-label, phase 3, randomised controlled superiority trial. Lancet Infect Dis. 2019 Nov;19(11):1181-90.[Abstract]
47. Barda B, Sayasone S, Phongluxa K, et al. Efficacy of moxidectin versus ivermectin against Strongyloides stercoralis infections: a randomized, controlled noninferiority trial. Clin Infect Dis. 2017 Jul 15;65(2):276-81.[Abstract][Full Text]
48. Pornsuriyasak P, Niticharoenpong K, Sakapibunnan A. Disseminated strongyloidiasis successfully treated with extended duration ivermectin combined with albendazole: a case report of intractable strongyloidiasis. Southeast Asian J Trop Med Public Health. 2004 Sep;35(3):531-4.[Abstract]
49. Gyapong JO, Chinbuah MA, Gyapong M. Inadvertent exposure of pregnant women to ivermectin and albendazole during mass drug administration for lymphatic filariasis. Trop Med Int Health. 2003 Dec;8(12):1093-101.[Abstract]
50. Biggs BA, Caruana S, Mihrshahi S, et al. Management of chronic strongyloidiasis in immigrants and refugees: is serologic testing useful? Am J Trop Med Hyg. 2009 May;80(5):788-91.[Abstract]
51. Kobayashi J, Sato Y, Toma H, et al. Application of enzyme immunoassay for postchemotherapy evaluation of human strongyloidiasis. Diagn Microbiol Infect Dis. 1994 Jan;18(1):19-23.[Abstract]
52. Salvador F, Sulleiro E, Sánchez-Montalvá A, et al. Usefulness of strongyloides stercoralis serology in the management of patients with eosinophilia. Am J Trop Med Hyg. 2014 May;90(5):830-4.[Abstract][Full Text]
53. Centers for Disease Control and Prevention. Parasites - strongyloides: resources for health professionals. Jun 2023 [internet publication].[Full Text]
54. Boulware DR, Stauffer WM, Hendel-Paterson BR, et al. Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey. Am J Med. 2007 Jun;120(6):545.e1-8.[Abstract][Full Text]
55. Newberry AM, Williams DN, Stauffer WM, et al. Strongyloides hyperinfection presenting as acute respiratory failure and gram-negative sepsis. Chest. 2005 Nov;128(5):3681-4.[Abstract][Full Text]
