What are the approach considerations in the treatment of strongyloidiasis?

Updated: Jun 20, 2019
  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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All persons found to harbor Strongyloides organisms should be treated, even if they are asymptomatic, because of the risk of hyperinfection. However, for infected pregnant patients, clinicians may prefer to defer treatment for strongyloidiasis until after the first trimester. All of the anthelmintic medications discussed in this article are US Food and Drug Administration (FDA) category C agents.

Strongyloides species are the hardest worms to eradicate. Treatment of early infection is with symptomatic support, because specific therapy is more effective once intestinal infection is established. Posttherapy stool examinations at 6 and 12 months posttreatment are recommended to verify Strongyloides eradication and to exclude other parasitic infections. [68] A posttreatment/pretreatment ratio of 0.6 or less suggests successful treatment. Patients with hyperinfection should undergo multiple followup stool examinations starting at two weeks posttreatment. [69]

Empiric corticosteroid administration used to treat wheezing is problematic, because it may cause life-threatening hyperinfection. Thus, Strongyloides hyperinfection syndrome, usually precipitated by immune suppression, should be considered in patients who have resided in endemic regions. [70] Attempts at the detection and eradication of this infection are recommended to prevent this potentially fatal complication.

Surgical intervention may be required in the rare instance of acute abdominal symptoms (peritonitis) due to bowel obstruction or infarction in the context of severe strongyloidiasis.

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