COMPLICATION

·         Gastrointestinal

·         GI hemorrhage

·         Malabsorption

·         Intestinal obstruction

·         Peritonitis

·         Appendicitis

·         Obstructive jaundice

·         Ileus

·         Pneumatosis intestinalis

·         Intestinal perforation

·         Intestinal infarction

·         Diarrhea

·         Pruritus

·         Ascites

·         Respiratory

·         Asthma or exacerbation of preexisting obstructive pulmonary disease

·         Pneumonitis

·         Respiratory failure⁸

·         Acute respiratory distress syndrome

·         Alveolar hemorrhage

·         Pleural effusion

·         Granulomatous lung disease

·          Pulmonary eosinophilia(Loeffler’s Syndrome)

·         Bronchospasm

·         Dermatologic

·         Larva currens

·         Purpura of the trunk and proximal extremities

·         Chronic urticaria

·         Neurologic

·         Meningitis due to enteric bacteria

·         Brain abscess

·         Vascular - Hyperinfection syndrome presenting as bacteremia (occasionally recurrent) due to enteric microorganisms (eg, E coli, Klebsiella pneumoniae, Enterococcus species including vancomycin-resistantEnterococcus faecium, Streptococcus bovis)

·         Renal -Nephrotic syndrome (rare)

·         Musculoskeletal -Reactive arthritis (rare)

·         Death

·         Anemia

MANAGEMENT

TREATMENT

Medical Care

• Administer anthelmintic therapy.
• Provide supportive treatment as indicated (eg, intravenous fluids if volume depletion, blood transfusion if gastrointestinal or alveolar haemorrhage, mechanical ventilation if respiratory failure).
• Provide antibiotic therapy directed toward enteric pathogens if bacteremia or meningitis is present or suggested.
• Reduce immunosuppression, if possible.

Surgical Care

Perform surgery in patients with acute abdominal symptoms (peritonitis due to bowel perforation or infarction) in the context of severe strongyloidiasis.

Medication

The goal of therapy in strongyloidiasis is eradication of the parasite by using anthelmintic drugs.

Anthelmintics

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Ivermectin (Stromectol, Mectizan)

DOC for acute and chronic strongyloidiasis, hyperinfection syndrome, and disseminated strongyloidiasis. Binds selectively to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver.

Albendazole (Albenza, Eskazole, Valbazen, Zentel)

Alternative to ivermectin for treatment of acute and chronic strongyloidiasis. Decreases ATP production in worm, causing energy depletion, immobilization, then death. To avoid inflammatory response in CNS, administer with anticonvulsants and high-dose glucocorticoids.

Thiabendazole (Mintezol)

Alternative to ivermectin for acute and chronic strongyloidiasis, hyperinfection syndrome, and disseminated infection. For mixed helminthic infections; inhibits helminth-specific mitochondrial fumarate reductase.

Prevention

Good personal hygiene can reduce the risk of strongyloidiasis.

Adequate public health services and sanitary facilities provide good control of infection