GeneHealth - Your precision medicine

Strongyloidiasis

Disease Details

Family Health Simplified

Buy Membership

Description: Strongyloidiasis is a parasitic infection caused by the nematode Strongyloides stercoralis, leading to a range of symptoms from mild gastrointestinal issues to severe, life-threatening complications.
Type: Strongyloidiasis is a parasitic infection caused by the nematode (roundworm) Strongyloides stercoralis. It is not transmitted genetically; rather, it is acquired through contact with contaminated soil, primarily when larvae penetrate the skin.
Signs And Symptoms: Strongyloides infection occurs in five forms. As the infection continues and the larvae matures, 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) from the skin to the lungs and finally to the small intestine, there may be respiratory, skin and digestive symptoms. Finally, the hyperinfection syndrome causes symptoms in many organ systems, including the central nervous system.
Prognosis: The prognosis for strongyloidiasis varies depending on the patient’s immune status and the timeliness of treatment. In immunocompetent individuals, the prognosis is usually good with appropriate antihelminthic therapy, typically resulting in complete eradication of the parasite. However, in immunocompromised patients, especially those on corticosteroids or undergoing chemotherapy, the infection can become severe and disseminate, leading to a life-threatening condition known as hyperinfection syndrome. Early detection and prompt treatment are crucial for improving outcomes in these cases.
Onset: Onset: The onset of strongyloidiasis can range from days to several weeks after exposure to the parasite. The time it takes for symptoms to appear varies widely depending on the individual's immune response and the parasite load.

Nan: Strongyloidiasis is caused by the parasitic roundworm Strongyloides stercoralis. The term "nan" might be used in various contexts, but if it refers to "not a number," additional context or clarification may be needed to provide a specific answer. If you meant something else by "nan," please provide more details.
Prevalence: The prevalence of strongyloidiasis is not precisely known but is estimated to affect 30-100 million people globally. It is more common in tropical and subtropical regions, as well as in areas with inadequate sanitation.
Epidemiology: Low estimates postulate it to affect 30–100 million people worldwide, mainly in tropical and subtropical countries, while higher estimates conservatively extrapolate that infection is upwards to or above 370 million people. It belongs to the group of neglected tropical diseases, and worldwide efforts are aimed at eradicating the infection.
Intractability: Strongyloidiasis can be challenging to treat and manage, particularly if not diagnosed early. The infection is caused by the parasitic nematode Strongyloides stercoralis. While most cases can be effectively treated with appropriate antiparasitic medications such as ivermectin or albendazole, chronic or hyperinfective cases can prove more intractable, especially in immunocompromised patients. Early diagnosis and timely treatment are critical to prevent complications and manage the disease more effectively.
Disease Severity: Strongyloidiasis can range from asymptomatic or mild symptoms to severe and life-threatening. In immunocompromised individuals, the disease can become hyperinfection syndrome or disseminated strongyloidiasis, both of which can be fatal if not treated promptly.
Healthcare Professionals: Disease Ontology ID - DOID:10955
Pathophysiology: Strongyloidiasis is caused by the parasitic nematode Strongyloides stercoralis. The pathophysiology involves several stages:

1. **Infection**: Infective filariform larvae in contaminated soil penetrate human skin, typically through bare feet.
2. **Migration**: After penetrating the skin, the larvae enter the bloodstream and are carried to the lungs.
3. **Pulmonary Phase**: In the lungs, the larvae migrate into the alveoli, ascend the bronchial tree, and are swallowed to reach the gastrointestinal tract.
4. **Intestinal Phase**: In the small intestine, the larvae mature into adult female worms, which reproduce by parthenogenesis. These adults lay eggs within the intestinal wall.
5. **Autoinfection**: Some rhabditiform larvae (hatched from eggs) are excreted in stool, while others become filariform larvae, penetrate the intestinal mucosa or perianal skin, and begin a new cycle within the host (internal autoinfection).
6. **Dissemination**: In immunocompromised individuals, the autoinfection cycle can become uncontrolled, leading to hyperinfection syndrome and widespread dissemination of larvae throughout the body.

The clinical manifestations of strongyloidiasis may vary from asymptomatic infection to severe, life-threatening disease, particularly in immunocompromised hosts.
Carrier Status: Strongyloidiasis occurs due to infection with the parasitic roundworm *Strongyloides stercoralis*. Here is the information requested:

- **Carrier Status:** Humans can act as carriers of *Strongyloides stercoralis* without showing symptoms, a condition known as asymptomatic strongyloidiasis. The parasite can persist in the host's body for many years due to its ability to autoinfect the host.

- **Nan:** This term is vague in the context of strongyloidiasis. If it refers to detection or measurement, nanotechnology is not typically used in standard clinical diagnostics for strongyloidiasis. Standard diagnostic methods include stool examination, serologic tests, and sometimes molecular techniques like PCR. If "nan" has a different intended meaning, please provide more context.
Mechanism: Strongyloidiasis is caused by the parasitic nematode Strongyloides stercoralis. The mechanism of infection typically begins when infective larvae penetrate the skin, typically through contact with contaminated soil. The larvae then migrate through the bloodstream to the lungs, where they ascend the trachea and are swallowed. They reach the small intestine, mature into adult worms, and begin laying eggs. The eggs hatch into larvae within the intestine, which can either be excreted in stool or cause autoinfection by penetrating the intestinal mucosa or perianal skin, leading to a persistent infection.

At the molecular level, Strongyloides stercoralis releases several molecules that facilitate its survival and immune evasion. These include:

1. Proteases: The parasite secretes excretory/secretory (ES) proteins, including proteases, which degrade host tissues and aid in skin penetration and tissue migration.

2. Immunomodulatory factors: Strongyloides produces molecules such as thioredoxin peroxidase and glutathione peroxidase that modulate host immune responses, suppressing effective immune attacks and promoting chronic infection.

3. Molecular mimicry: Some parasitic proteins mimic host proteins, which can impede the host's ability to recognize and mount an effective immune response against the parasite.

Understanding these mechanisms helps in developing targeted treatments and interventions to manage strongyloidiasis effectively.
Treatment: The consensus drug of choice for the treatment of uncomplicated strongyloidiasis is ivermectin. However, even if it is considered the main drug of choice, recent studies have illustrated the challenges in ivermectin curing strongyloidiasis. Ivermectin does not kill the Strongyloides larvae, only the adult worms, therefore repeat dosing may be necessary to properly eradicate the infection. There is an auto-infective cycle of roughly two weeks during which ivermectin should be re-administered; however, additional dosing may still be necessary as it will not kill Strongyloides in the blood or larvae deep within the bowels or diverticula. Other drugs that can be effective are albendazole and thiabendazole (25 mg/kg twice daily for 5 days—400 mg maximum (generally)). All patients who are at risk of disseminated strongyloidiasis should be treated. The optimal duration of treatment for patients with disseminated infections is not clear.Treatment of strongyloidiasis can be difficult and if ceasing treatment before being entirely cleared Strongyloides via the autoinfective cycle has been known to live in individuals for decades; even after initial or inadequate sustained treatment. Continued treatment, blood and stool monitoring thus may be necessary even if symptoms temporarily resolve. As cited earlier, due to the fact that some infections are insidiously asymptomatic, and relatively expensive bloodwork is often inconclusive via false-positives or false-negatives, just as stool samples can be unreliable in diagnoses, there is yet unfortunately no real gold standard for proof of cure, mirroring the lack of an efficient and reliable methodology of diagnosis. An objective eradication standard for strongyloidiasis is elusive given the high degree of suspicion needed to even begin treatment, the sometimes difficulty of the only definitive diagnostic criteria of detecting and isolating larvae or adult Strongyloides, the importance of early diagnosis, particularly before steroid treatments, and the very wide variability and exclusion/inclusion of differing collections of diffuse symptoms. Disregarding mis-ascribing bonafide delusional parasitosis disorders, strongyloidiasis should be more well known among medical professionals and have serious consideration for broad educational campaigns in effected geographic locales both within the semi-tropical developed world and otherwise, as well as in the tropical developing world where, among many other neglected tropical diseases, it is endemic.Government programs are needed to help decontaminate endemic areas and to help effected populations from infection. Furthermore, progress is required in establishing financial support to facilitate and cover affordable medications for individuals in effected at-risk regions and communities to help continuing treatments.There are conflicting reports on effective drug treatments. Ivermectin ineffectiveness and rising drug resistance has been documented. Albendazole is noted by the WHO as being the least effective. Thiabendazole can have severe side effects and is unavailable in many countries. Major inroads are required to advance the development of successful medications and drug protocols for strongyloidiasis and other neglected tropical diseases.Contagiousness via textiles, unlike Enterobius vermicularis, is unfounded. As is, generally speaking, person to person contagiousness of asymptomatic and disseminated infection. It has rarely been transmitted through organ transplantation. Married Vietnam War veterans who were infected, yet never developed significant hyperinfection, lived for multiple decades with non-debilitating disseminated infection, without treatment, with wives who failed to ever contract infection. Contraction occurs overwhelmingly from skin exposure to any contaminated soil, contaminated potting soil, contaminated waters, lack of sanitation, or environmental factors as potential vectors. Nearly never to extraordinarily very rarely documented is transmission from person to person (besides from infected male homosexual sex), other than closeness of contact to the productive coughing of a very ill hyperinfected individual. It has been shown possible to occur in that situation, or potentially other similar scenarios, it is speculated via pulmonary secretions of a direly hyperinfected individual. In which case treatment for others may be indicated, if deemed necessary by proximity, symptoms, precautions, probable exposures to the same vectors, or through screening of serology and stool samples, until infection is eradicated.Before administering steroids at least somewhat screening for infection in even remotely potentially susceptible individuals in order to prevent escalating the infection is advised. As not doing so in certain cohorts can have extremely high mortality rates from inadvertently caused hyperinfection via immunosuppression of application of certain steroids. Thus extreme caution with respect to iatrogenic risks is crucial to avoiding deaths or other adverse consequences in treatment, that of course prefigures a correct diagnosis. People with high exposure to Strongyloides stercoralis may mitigate the risk of strongyloidiasis hyperinfection associated with corticosteroid treatment, with the presumptive use of ivermectin. Such hyperinfection has been a particular concern during the COVID-19 pandemic because of the use of corticosteroids for treatment of COVID-19 symptoms. The CDC and other international bodies recommend the use of ivermectin for refugees from areas which have a risk of strongyloidiasis.During the 1940s, the treatment of choice was enteric coated tablets of 60 mg gentian violet, three times daily, for 16 days. The cure rate was reported to be only about 50 to 70 percent, requiring repeat courses. It is possible the cure rate was even less than that published in the literature, due to the difficulty in positively diagnosing infection.
Compassionate Use Treatment: For strongyloidiasis, traditional first-line treatments include ivermectin and albendazole. However, in situations where these treatments are ineffective or unavailable, certain compassionate use, off-label, or experimental treatments may be considered. These include:

1. **Moxidectin**: Primarily used for veterinary purposes, moxidectin is being explored in clinical trials as a potential treatment for strongyloidiasis in humans.

2. **Tribendimidine**: Originally developed to treat other parasitic infections, tribendimidine is undergoing research to assess its efficacy against Strongyloides stercoralis.

3. **Nitazoxanide**: Primarily used for protozoal infections, nitazoxanide has shown some potential as an off-label treatment for strongyloidiasis, though it is not a first-line option.

It is important to consult a healthcare professional for appropriate treatment options tailored to the individual patient's condition.
Lifestyle Recommendations: Strongyloidiasis is an infection caused by the parasitic worm Strongyloides stercoralis. Lifestyle recommendations to help manage and prevent strongyloidiasis include:

1. **Avoiding contact with contaminated soil:** Minimize walking barefoot in areas where the parasite might be present, particularly in tropical or subtropical regions.

2. **Good hygiene practices:** Wash hands thoroughly with soap and water after contact with soil, before eating, and after using the bathroom.

3. **Proper sanitation:** Ensure that sanitation facilities are available and use them properly. Dispose of human waste safely to prevent soil contamination.

4. **Safe food practices:** Consume only well-cooked food and clean drinking water to reduce the risk of ingesting larvae.

5. **Wear protective clothing:** Use gloves and shoes when handling soil or working in gardens.

6. **Treat infections promptly:** If diagnosed with strongyloidiasis, follow the medical treatment plan strictly to eradicate the infection.

Implementing these practices can significantly reduce the risk of acquiring and spreading strongyloidiasis.
Medication: For strongyloidiasis, the primary medication used is Ivermectin. Albendazole is an alternative option, although it is generally considered less effective than Ivermectin.
Repurposable Drugs: For strongyloidiasis, repurposable drugs include ivermectin and albendazole. These medications can be used effectively to treat the infection caused by the parasitic roundworm Strongyloides stercoralis.
Metabolites: In strongyloidiasis, the most relevant metabolic interactions are related to the immune response and the survival of the larval stages of *Strongyloides stercoralis* in the human host. While there hasn't been a detailed profiling of metabolites specifically related to the disease, typical metabolic changes include elevated levels of certain immune signaling molecules and alterations in gut microbiota. The disease itself does not have specific metabolic byproducts that are regularly used for diagnosis or monitoring; instead, clinical diagnosis often relies on stool sample analysis and serological tests.
Nutraceuticals: Strongyloidiasis is primarily treated with antiparasitic medications such as ivermectin or albendazole. There is limited scientific evidence supporting the use of nutraceuticals for treating this parasitic infection. It's essential to consult healthcare providers for appropriate diagnosis and treatment.
Peptides: Strongyloidiasis is a parasitic disease caused by the nematode *Strongyloides stercoralis*. There is limited specific information regarding the use of peptides or nanotechnology in treating strongyloidiasis. The primary method of treatment typically involves antiparasitic medications such as ivermectin or albendazole. However, research in parasitic diseases is ongoing, and advancements in these areas may emerge in the future.