A Case of Strongyloidiasis: An Immigrant Healthcare Worker Presenting with Fatigue and Weight Loss

Abstract

Background Strongyloides stercoralis is an intestinal nematode parasite classified as a soil-transmitted helminth, endemic in tropical and subtropical regions. Strongyloides stercoralis can remain dormant for decades after the initial infection. Case We describe a patient who was diagnosed with Strongyloides stercoralis infection three weeks after a left inguinal hernia repair and discuss approaches to prevention, diagnosis, and treatment. Conclusions Physicians in the United States often miss opportunities to identify patients with chronic strongyloidiasis. Symptoms may be vague and screening tests have limitations. We review current strategies for diagnosis and treatment of chronic intestinal strongyloidiasis in immigrant patients who have significant travel history to tropical regions and discuss the clinical features and management of the infection.

Double troubleStrongyloidiasis hyper infection and intestinal tuberculosis co-infection-A rare case report

“…The rhabditiform larval forms are transformed into infectious filariform larvae before being excreted in stools and a host is re-infected through the intestinal mucosa or perianal skin. [2][3][4][5] In a healthy individual, Strongyloides minor infection and chronic infection can be clinically inapparent. The usual gastrointestinal symptoms are stomach ache, nausea, vomiting, constipation etc.…”

The Worm that Clogs the Lungs: Strongyloides Hyper-Infection Leading to Fatal Acute Respiratory Distress Syndrome (ARDS)

“…Immunocompromised patients on steroid therapy and those who have hematological malignancies are the most susceptible patient populations for hyper-infection syndrome and disseminated diseases. Other conditions associated with increased risk include hypogammaglobinemia, anti-tumor necrosis factor receptor therapy, and organ transplant patients [6]. Disseminated Strongyloidiasis involves widespread dissemination of larvae outside of the gut and lungs, often involving the liver, brain, heart, and urinary tract [9–11].…”

“…Although most studies focus on finding the parasite larvae in the stool sample, this is negative in most cases due to low larvae output in stool [6]. Eosinophilia is a common laboratory finding that should raise a high index of suspicion for the presence of parasitic infections; however, this can be absent, leading to a delay in diagnosis [12].…”

“…The life cycle includes 2 forms: a free-living rhabditiform larvae (outside the host in the soil) and a parasitic infective filariform [6]. The filariform larvae are able to penetrate the skin, migrate to the submucosa of the host, making its way to the venous circulation, right heart, and lungs, larynx, and gastrointestinal tract [6]. Its hosts include reptiles, birds, and primates, including humans [4].…”