Diagnosis: Disseminated strongyloidiasis.
Wehner JH. Kirsch CM.
Pulmonary manifestations
of strongyloidiasis. [Review] [79 refs]
Seminars in Respiratory
Infections. 12(2):122-9, 1997 Jun.
Strongyloides stercoralis (SS) is endemic in tropical and subtropical
areas worldwide and in the southeastern United States. The
lifecycle of SS is both unique and complex. Human infection begins
with the penetration of skin by filariform larvae that migrate hematogenously
to the lungs. Larvae then ascend the airway, are swallowed, and mature
in the gut. Unlike other nematodes, SS can autoinfect the same host and
persist for decades. Categorization of infection includes acute, chronic-uncomplicated,
and
disseminated forms. Clinical manifestations depend on the particular
organs involved. Fifteen to thirty percent of chronically infected people
may be asymptomatic. On the other hand, SS may cause the adult respiratory
distress syndrome, septic shock, and death. The diagnosis of SS infection
is suspected in patients from endemic areas who have blood eosinophilia,
and gastrointestinal or pulmonary symptoms. A definitive diagnosis is established
by demonstration of SS larvae in stool, body fluids, or tissues. A presumptive
diagnosis of SS infection can be achieved by serology. Thiabendazole is
the mainstay of treatment, but repeat doses may be necessary if the parasite
is not initially eradicated. The low
incidence of disseminated SS in areas endemic for both SS and AIDS
is surprising and unexplained. [References: 79]
Worms at rest, wet mount of sputum.
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