C L I N I C A L  P R E S E N T A T I O N

            Symptoms of Strongyloidiasis are often vauge, general, and hard to define, according to Dr. Brian Blackburn of the Stanford University Department of Medicine and associate professor of Infectious Disease. Strongyloidiasis is often asymptomatic and lasts years in an infected host undetected, but mild to extremely severe symptoms are possible in the skin, pulmonary system and gastrointestinal system (2,4,7).

	Dermatologic symptoms can arise from the larvae penetration, resulting in lesions and ground itch, which is a papulovesicular pruritic rash. This occurs often on the foot where the infective filariform larvae are most likely to enter the body (4). Larva currens, which means “racing larvae,” is the result of migrating larvae through the skin. Chronic larva currens is actually more common than was originally thought (7), and can result in a sperpinginous urticarial rash and pruritis, a manifestation of an allergic reaction to the migrating larvae (4,7). This can occur for a few hours to days, or can cycle over weeks, months, or years in the case of an autoinfection. Cutaneous granulomas can also be present with autoinfection, and a petechial or purpuric rash can appear in disseminated disease (4).
	Gastrointestinal symptoms are more vague, including abdominal pain, diarrhea (often due to the female adult worms living in the small intestine), bloating, distension, constipation, or lower gastrointestinal bleeding (4). Infection can result in malabsorption in chronic infection or if malnutrition is already present. Ulceration of the small intestine can also occur, resulting in symptoms similar to duodenal ulcers (2).
	Pulmonary symptoms can include wheezing and mild cough upon the initial infection. In hyperinfection or the disseminated form of the disease, wheezing, dyspnea, cough, pleuric pain, hemoptysis, and acute respiratory distress syndrome are often present (4).

HYPERINFECTION SYNDROME results from a increase in the transformation of rhabditiform larvae into filariform larvae in the small intestine; this occurs when more hatched rhabditiform larvae enter into the autoinfection cycle as opposed to leaving the host through feces and entering the free-living cycle. This can result in severe debilitation and eventually death (2). Symptoms can include fever, gastrointestinal distress, dyspnea, wheezing, hemoptysis, cough, and weakness—essentially exaggerated symptoms of the infection.

DISSEMINATED STRONGYLOIDIASIS occurs mostly in patients who are already immunocompromised due to things like HTLV-1 (human T-cell lymphotropic virus), HIV/AIDS, malnutrition, diabetes, alcoholism, or immunosuppressive therapy (like chemotherapy or corticosteroid therapy)(4). This is the most advanced and dangerous form of the disease; it’s the “worst-case scenario” of Strongyloides infection. Symptoms can include stomach pain, distension, shock, septicemia, pulmonary complications, and meningeal symptoms. This form of the disease can be fatal (2,4,7).

Note: All symptomatic cartoons from tell.fll.purdue.edu.