Strongyloidiasis history and symptoms: Difference between revisions

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==Overview==
==Overview==
[[Strongyloides]] infection can present in various forms. On acquiring the infection, there may be respiratory symptoms ([[Löffler's syndrome]]). The infection may then become chronic with mainly digestive symptoms. On reinfection (when larvae migrate through the body), there may be [[respiratory]], [[skin]] and [[digestive]] symptoms. Finally, the hyperinfection syndrome causes symptoms in many organ systems, including the [[central nervous system]].<ref name="pmid20733481">{{cite journal |vauthors=Montes M, Sawhney C, Barros N |title=Strongyloides stercoralis: there but not seen |journal=Curr. Opin. Infect. Dis. |volume=23 |issue=5 |pages=500–4 |year=2010 |pmid=20733481 |pmc=2948977 |doi=10.1097/QCO.0b013e32833df718 |url=}}</ref><ref name="Marcos">{{cite journal | author=Marcos LA, Terashima A, Dupont HL, Gotuzzo E | title=Strongyloides hyperinfection syndrome: an emerging global infectious disease | journal=Trans R Soc Trop Med Hyg | year=2008 | month=Apr | volume=102 | issue=4 | pages=314–8 | pmid=18321548 | doi=10.1016/j.trstmh.2008.01.020}}</ref>
[[Strongyloides|''Strongyloides'']] infection can present in various forms. The majority of people infected with [[Strongyloides|''Strongyloides'']] are asymptomatic. The symptomatic spectrum of strongyloidiasis ranges from subclinical in acute and chronic infection to severe and fatal in hyper infection syndrome. On acquiring the infection, there may be respiratory symptoms ([[Löffler's syndrome]]). The infection may progress to chronic stage with mainly digestive symptoms. On reinfection there may be [[respiratory]], [[skin]], and [[Digestive system|digestive]] symptoms. Finally, hyper infection syndrome sets in and cause symptoms in many organ systems, including the [[central nervous system]].


==History==
==History==
The significant information that needs to focused in the history of the patient includes:
The significant information that needs to be focused on in the history of the patient includes:
*Any history of travel to the endemic areas
*History of travel to the endemic areas
*Any ill contact with similar complaints
*History of exposure to individuals with similar complaints


==Symptoms==
==Symptoms==
The majority of people infected with [[strongyloides]] are without symptoms. The symptomatic spectrum of [[strongyloides]] ranges from subclinical in [[acute]] and [[chronic]] infection to severe and [[fatal]] in hyperinfection syndrome and [[Strongyloidiasis|disseminated strongyloidiasis,]] which have case-fatality rates that approach 90%. In either case, patients’ symptoms are a result of the [[Parasites|parasite’s]] larval form migrating through various [[organs]] of the body. Those who do develop symptoms tend to have non-specific, or generalized complaints. Some people develop [[abdominal pain]], [[bloating]], [[heartburn]], intermittent episodes of [[diarrhea]] and [[constipation]], a dry [[cough]], and [[rashes]].  
The majority of people infected with ''[[strongyloides]]'' are [[asymptomatic]]. The symptomatic spectrum of strongyloidiasis ranges from [[Subclinical infection|subclinical]] in [[acute]] and [[chronic]] infection to severe and [[fatal]] in hyperinfection syndrome and [[Strongyloidiasis|disseminated strongyloidiasis,]] which have case-fatality rates that approach 90%. In either case, patients’ symptoms are a result of the [[Parasites|parasite’s]] larval form migrating through various [[organs]] of the body. Those who do develop symptoms tend to have non-specific, or generalized complaints. Some patients develop [[abdominal pain]], [[bloating]], [[heartburn]], intermittent episodes of [[diarrhea]] and [[constipation]], a dry [[cough]], and [[rashes]].<ref name="pmid20733481">{{cite journal |vauthors=Montes M, Sawhney C, Barros N |title=Strongyloides stercoralis: there but not seen |journal=Curr. Opin. Infect. Dis. |volume=23 |issue=5 |pages=500–4 |year=2010 |pmid=20733481 |pmc=2948977 |doi=10.1097/QCO.0b013e32833df718 |url=}}</ref><ref name="pmid18321548">{{cite journal |vauthors=Marcos LA, Terashima A, Dupont HL, Gotuzzo E |title=Strongyloides hyperinfection syndrome: an emerging global infectious disease |journal=Trans. R. Soc. Trop. Med. Hyg. |volume=102 |issue=4 |pages=314–8 |year=2008 |pmid=18321548 |doi=10.1016/j.trstmh.2008.01.020 |url=}}</ref>
 
===Acute strongyloidiasis===
===Acute strongyloidiasis===
*The initial sign of acute [[strongyloidiasis]], if noticed at all, is a localized [[Pruritic Urticarial Papules and Plaques of Pregnancy|pruritic]], [[erythematous]] [[rash]] at the site of skin penetration.  
*The initial sign of acute [[strongyloidiasis]], if noticed at all, is a localized, [[Pruritic Urticarial Papules and Plaques of Pregnancy|pruritic]], [[erythematous]] [[rash]] at the site of skin penetration.  
*Patients may then develop [[Trachea|tracheal]] irritation and a [[dry cough]] as the larvae migrate from the [[lungs]] up through the [[trachea]].
*Patients may then develop [[Trachea|tracheal]] irritation and a [[dry cough]] as the larvae migrate from the [[lungs]] up through the [[trachea]].
*After the larvae are swallowed into the [[gastrointestinal tract]], patients may experience [[diarrhea]], [[constipation]], [[abdominal pain]], and [[anorexia]].
*After the larvae are swallowed into the [[gastrointestinal tract]], patients may experience [[diarrhea]], [[constipation]], [[abdominal pain]], and [[anorexia]].
===Chronic strongyloidiasis===
===Chronic strongyloidiasis===
*[[Chronic]] [[strongyloidiasis]] is generally asymptomatic, but in patients with clinical disease [[gastrointestinal]] and [[cutaneous]] manifestations are the most common.
*[[Chronic]] [[strongyloidiasis]] is generally [[asymptomatic]], but in patients with clinical disease, [[gastrointestinal]] and [[cutaneous]] manifestations are the most common.
*The [[gastrointestinal]] symptoms include [[epigastric]] pain, [[postprandial]] fullness, [[heartburn]], and brief episodes of intermittent [[diarrhea]] and [[constipation]].
*The [[gastrointestinal]] symptoms include [[epigastric]] pain, [[postprandial]] fullness, [[heartburn]], and brief episodes of intermittent [[diarrhea]] and [[constipation]].
*Less commonly, patients may present with [[fecal occult blood]], or massive [[Colon (anatomy)|colonic]] and [[Hemorrhage|gastric hemorrhage]].
*Less commonly, patients may present with [[fecal occult blood]], or massive [[Colon (anatomy)|colonic]] and [[Hemorrhage|gastric hemorrhage]].
*Presentations resembling [[inflammatory bowel disease]], specifically [[ulcerative colitis]], are rare. Also rare, but documented, are endoscopic exams revealing pathology similar to pseudopolyposis.
*Presentations resembling [[inflammatory bowel disease]], specifically [[ulcerative colitis]], are rare. Also rare, but documented, are [[endoscopic]] exams revealing pathology similar to pseudopolyposis.
*[[Cutaneous]] symptoms include [[Urticaria|chronic urticaria]] and the pathognomonic [[larva currens]] - a recurrent serpiginous [[maculopapular]] or [[Rash|urticarial rash]] along the buttocks, [[perineum]], and thighs due to repeated [[autoinfection]].  
*[[Cutaneous]] symptoms include [[Urticaria|chronic urticaria]] and the [[pathognomonic]] [[larva currens]], a recurrent [[serpiginous]] [[maculopapular]] or [[Rash|urticarial rash]] along the buttocks, [[perineum]], and thighs due to repeated [[autoinfection]]. The rash has been described as advancing as rapidly as 10 cm/hr.  
*It has been described as advancing as rapidly as 10 cm/hr.
*Rarely, patients with [[chronic]] [[strongyloidiasis]] have complained of [[arthritis]], [[Cardiac arrhythmia|cardiac arrhythmias]], and signs and symptoms consistent with [[chronic]] [[malabsorption]], [[Obstruction|duodenal obstruction,]] [[nephrotic syndrome]], and recurrent [[asthma]].
*Rarely, patients with chronic [[strongyloidiasis]] have complained of [[arthritis]], [[Cardiac arrhythmia|cardiac arrhythmias]], and signs and symptoms consistent with chronic [[malabsorption]], [[Obstruction|duodenal obstruction,]] [[nephrotic syndrome]], and recurrent [[asthma]].
*Up to 75% of people with [[chronic]] [[strongyloidiasis]] have mild peripheral [[eosinophilia]] or elevated [[IgE]] levels.
*Up to 75% of people with chronic [[strongyloidiasis]] have mild peripheral [[eosinophilia]] or elevated [[IgE]] levels.


===Hyperinfection syndrome and disseminated strongyloidiasis===
===Hyperinfection syndrome and disseminated strongyloidiasis===
*Hyperinfection syndrome and disseminated [[strongyloidiasis]] are most frequently associated with subclinical infection in patients receiving high-dose [[corticosteroids]] for the treatment of [[asthma]] or [[chronic obstructive pulmonary disease]] ([[COPD]]) exacerbations.
*Hyperinfection syndrome and disseminated [[strongyloidiasis]] are most frequently associated with [[subclinical infection]] in patients receiving high-dose [[corticosteroids]] for the treatment of [[asthma]] or [[chronic obstructive pulmonary disease]] ([[COPD]]) exacerbations.
*Subsequent impaired host immunity leads to accelerated [[autoinfection]] and an overwhelming number of migrating larvae.
*Subsequent impaired host immunity leads to accelerated [[autoinfection]] and an overwhelming number of migrating larvae.
*Whereas in chronic [[strongyloidiasis]] and in hyperinfection syndrome the larvae are limited to the [[GI tract]] and the [[lungs]], in disseminated [[strongyloidiasis]] the larvae invade numerous organs.  
*While in [[chronic]] [[strongyloidiasis]] and hyperinfection syndrome, the larvae are limited to the [[GI tract]] and the [[lungs]], in disseminated [[strongyloidiasis]], the larvae invade numerous organs.  
*Left untreated, the [[Mortality rate|mortality]] rates of hyperinfection syndrome and disseminated [[strongyloidiasis]] can approach 90%.
*Left untreated, the [[Mortality rate|mortality]] rates of hyperinfection syndrome and disseminated [[strongyloidiasis]] can approach 90%.
The following are signs and symptoms that can be seen with hyperinfection syndrome and disseminated strongyloidiasis:
The following are signs and symptoms that can be seen with hyperinfection syndrome and disseminated strongyloidiasis:


'''Gastrointestinal manifestations'''
{| class="wikitable"
!Organ involved
!Symptoms
|-
|Gastrointestinal
|
*[[Abdominal pain]]
*[[Abdominal pain]]
*[[Nausea]] and [[vomiting]]
*[[Nausea]] and [[vomiting]]
*[[Diarrhea]]
*[[Diarrhea]]
*[[Ileus]]
*[[Ileus]]
*[[Bowel edema]]
*Bowel [[edema]]
*Intestinal [[obstruction]]
*Intestinal [[obstruction]]
*[[Mucosal ulceration]]
*[[Mucosal]] [[ulceration]]
*[[Massive hemorrhage]]
*[[Massive hemorrhage]]
*[[Peritonitis]]
*[[Peritonitis]]
*[[Sepsis|Bacterial sepsis]]
*[[Sepsis|Bacterial sepsis]]
'''Pulmonary manifestations and findings'''
|-
*[[Cough]], [[wheezing]], [[dyspnea]], [[hoarseness]], [[pneumonitis]], [[hemoptysis]], [[respiratory failure]], diffuse interstitial [[infiltrates]] or [[Consolidation (medicine)|consolidation]] on chest radiographs
|Pulmonary  
'''Neurologic findings'''
|
*[[Cough]]
*[[Wheezing]]
*[[Dyspnea]]
*[[Hoarseness]]
*[[Pneumonitis]]
*[[Hemoptysis]]
*[[Respiratory failure]]
*Diffuse interstitial infiltrates  
|-
|CNS
|
*[[Aseptic]] or [[Meningitis|gram-negative meningitis]]
*[[Aseptic]] or [[Meningitis|gram-negative meningitis]]
*Larvae have been reported in the [[CSF]], meningeal vessels, [[dura]], [[epidural]], [[Subdural empyema|subdural]], and [[Subarachnoid space|subarachnoid spaces]].
*Larvae have been reported in:
'''Systemic symptoms'''
**[[CSF]], [[Meninges|meningeal]] vessels, [[dura]], [[epidural]], [[Subdural empyema|subdural]], and [[Subarachnoid space|subarachnoid spaces]]
|-
|Systemic
|
*Peripheral [[edema]] and [[ascites]] secondary to [[hypoalbuminemia]] from [[protein losing enteropathy]]
*Peripheral [[edema]] and [[ascites]] secondary to [[hypoalbuminemia]] from [[protein losing enteropathy]]
*Recurrent gram negative [[bacteremia]]/[[sepsis]] from larvae carrying bacteria that penetrate [[mucosal]] walls
*Recurrent [[gram negative]] [[bacteremia]]/[[sepsis]] from larvae carrying bacteria that penetrate [[mucosal]] walls
*[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate secretion of anti-diuretic hormone]] ([[SIADH]])
*[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate secretion of anti-diuretic hormone]] ([[SIADH]])
*Peripheral [[eosinophilia]] is frequently absent
*Peripheral [[eosinophilia]] is frequently absent
'''Cutaneous manifestations'''
|-
*Recurrent [[maculopapular]] or [[Urticaria|urticarial rash]] most commonly found along the [[buttocks]], [[perineum]], and thighs due to repeated [[autoinfection]], but can be found anywhere on the skin.
|Skin
*[[Larva currens|Larva curren<nowiki/>s]] - pathognomonic [[serpiginous]] or urticarial [[rash]] that advances as rapidly as 10 cm/hr.
|
*Recurrent [[maculopapular]] or [[Urticaria|urticarial rash]] most commonly found along the [[buttocks]], [[perineum]], and thighs due to repeated [[autoinfection]], but can be found anywhere on the [[skin]]
*[[Larva currens|Larva currens]], a [[pathognomonic]] [[serpiginous]] or urticarial [[rash]] that advances as rapidly as 10 cm/hr
|}


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}
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[[Category:Disease]]
[[Category:Emergency mdicine]]
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[[Category:Infectious disease]]
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Latest revision as of 00:19, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Strongyloides infection can present in various forms. The majority of people infected with Strongyloides are asymptomatic. The symptomatic spectrum of strongyloidiasis ranges from subclinical in acute and chronic infection to severe and fatal in hyper infection syndrome. On acquiring the infection, there may be respiratory symptoms (Löffler's syndrome). The infection may progress to chronic stage with mainly digestive symptoms. On reinfection there may be respiratory, skin, and digestive symptoms. Finally, hyper infection syndrome sets in and cause symptoms in many organ systems, including the central nervous system.

History

The significant information that needs to be focused on in the history of the patient includes:

  • History of travel to the endemic areas
  • History of exposure to individuals with similar complaints

Symptoms

The majority of people infected with strongyloides are asymptomatic. The symptomatic spectrum of strongyloidiasis ranges from subclinical in acute and chronic infection to severe and fatal in hyperinfection syndrome and disseminated strongyloidiasis, which have case-fatality rates that approach 90%. In either case, patients’ symptoms are a result of the parasite’s larval form migrating through various organs of the body. Those who do develop symptoms tend to have non-specific, or generalized complaints. Some patients develop abdominal pain, bloating, heartburn, intermittent episodes of diarrhea and constipation, a dry cough, and rashes.[1][2]

Acute strongyloidiasis

Chronic strongyloidiasis

Hyperinfection syndrome and disseminated strongyloidiasis

The following are signs and symptoms that can be seen with hyperinfection syndrome and disseminated strongyloidiasis:

Organ involved Symptoms
Gastrointestinal
Pulmonary
CNS
Systemic
Skin

References

  1. Montes M, Sawhney C, Barros N (2010). "Strongyloides stercoralis: there but not seen". Curr. Opin. Infect. Dis. 23 (5): 500–4. doi:10.1097/QCO.0b013e32833df718. PMC 2948977. PMID 20733481.
  2. Marcos LA, Terashima A, Dupont HL, Gotuzzo E (2008). "Strongyloides hyperinfection syndrome: an emerging global infectious disease". Trans. R. Soc. Trop. Med. Hyg. 102 (4): 314–8. doi:10.1016/j.trstmh.2008.01.020. PMID 18321548.

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