Gastrointestinal symptoms include abdominal pain and diarrhea. Pulmonary symptoms
(including Loefflers syndrome) can occur during pulmonary migration of the
filariform larvae. Dermatologic manifestations include urticarial rashes in the
buttocks and waist areas. Disseminated strongyloidiasis occurs in immunosuppressed
patients, can present with abdominal pain, distension, shock, pulmonary and neurologic
complications and septicemia, and is potentially fatal. Blood eosinophilia is
generally present during the acute and chronic stages, but may be absent with
Diagnosis rests on the
microscopic identification of larvae (rhabditiform and occasionally filariform) in the
stool or duodenal fluid. Examination of serial samples may be necessary, and not
always sufficient, because stool examination is relatively insensitive.
The stool can be examined in wet mounts:
- after concentration
- after recovery of the larvae by
the Baermann funnel technique
- after culture by the
Harada-Mori filter paper technique
- after culture in agar plates
The duodenal fluid can be
examined using techniques such as the Enterotest string or duodenal aspiration.
Larvae may be detected in sputum from patients with disseminated strongyloidiasis.
The drug of
choice for the treatment of uncomplicated strongyloidiasis is ivermectin
with albendazole* as the alternative. All patients who are at risk
of disseminated strongyloidiasis should be treated.
*This drug is
approved by the FDA, but considered investigational for this purpose.