Infection, Occupational




Strongyloides stercoralis; S. fulleborni;

Biomedical References

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INITIAL SYMPTOMS: Larvae penetrate the skin (dermatitis) and the lungs (pneumonitis) to develop into the adult worm in the intestinal mucosa (abdominal pain). [CCDM, p. 593] "Most infections are asymptomatic." [CDC Travel] FINDINGS: In this intestinal nematode infection, eggs hatch in the colon to become larvae that can reinfect the host either internally or externally. Infections persisting for decades have been documented. With acute infection, a pruritic rash may appear at the site of larval penetration. Migration of larvae through the lungs can produce cough, fever, dyspnea, wheezing, hemoptysis, and eosinophilia. Then, patients have diarrhea and abdominal pain. Findings in chronic infection may include: asymptomatic (50%); intermittent eosinophilia (75%); recurrent rashes of the thighs, buttocks, and perineum; a serpiginous rash (larva currens) that migrates up to 10 cm/hour; and GI symptoms with epigastric pain, diarrhea, blood in the stool; and, in heavy infections, bowel obstruction. Respiratory symptoms are uncommon in chronic, uncomplicated infections. Complications of hyperinfection include intestinal obstruction, gastrointestinal bleeding, pulmonary infection, meningitis, brain abscesses, and liver infection. Biopsies of petechial and purpuric linear rashes often reveal larvae. [PPID, p. 3205] Symptoms of hyperinfection are diarrhea, malabsorption, hepatomegaly, and paralytic ileus. Immunocompromised patients may present with pneumonia and pleural effusions. [Cohen, p. 1138, 1916] Filariform larvae may be found in pleural fluid. An immune-mediated arthritis has been reported. Leukopenia and thrombocytopenia are associated with disseminated infection and skin purpura (generalized or periumbilical). A polymicrobial sepsis is likely to accompany widespread dissemination of larvae. [Guerrant, p. 948, 808, 810] Recurrent urticaria, often of the buttocks and wrists, is the most common skin finding. With severe infections, eosinophilia is frequently absent. [Harrison ID, p. 1223] Person-to-person transmission is rare. {CDC Travel, p. 323] EPIDEMIOLOGY: Transmission may occur among institutionalized residents with poor personal hygiene. Cases reported of Ex-POWs carrying infection for decades; Hyperinfection usually occurs in patient taking corticosteroids or with depressed cell-mediated immunity, e.g. infected with human T-lymphotropic virus 1 (HTLV-1). Hyperinfection is not common in AIDS patients. Dog and cat strains of S. stercoralis occasionally infect humans. Primates are reservoirs for S. fulleborni in Africa. [CCDM, p. 593-5; ID, p. 2362-3; Guerrant, p. 943, 958; Merck Manual, p. 1350-2; PPID, p. 3205; Cecil, p. 2067-8; Harrison, p. 781-2]


2-4 weeks for larvae to appear in feces; [CCDM]


Identify larvae in concentrated stool specimens or by agar plate method; Repeated examinations may be necessary; Serology tests are positive in 80-85% of infected patients. [CCDM] Serologic testing available from CDC (404-718-4745); [CDC Travel]

ICD-9 Code


Effective Antimicrobics


Reference Link

CDC - Strongyloidiasis


Google Search: larva currens

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