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Strongyloidiasis
Published in Peter D. Walzer, Robert M. Genta, Parasitic Infections in the Compromised Host, 2020
Robert M. Genta, Peter D. Walzer
Two types of cutaneous manifestations have been described in patients with chronic strongyloidiasis. Urticarial rashes, possibly indicating a sensitization to parasite antigens, which subsided after successful antiparasitic treatment, have been found sporadically in patients from all parts of the world (2,3,81,101). In contrast, a characteristic dermatitis caused by the subcutaneous migration of filariform larvae (named larva currens, after the swift linear progression of the migrating larvae) has been reported almost exclusively in Caucasian patients who acquired the infection in southeast Asia (210-214). In many of these patients, larva currens was the only sign of strongyloidiasis, and the demonstration of parasites in the stools was not always possible (100,102). However, therapy with thiabendazole caused the permanent disappearance of the dermatitis, and this was interpreted as evidence ex adjuvantibus of the parasitic nature of this ailment.
Ivermectin
Published in Sarah H. Wakelin, Howard I. Maibach, Clive B. Archer, Handbook of Systemic Drug Treatment in Dermatology, 2015
Francisco Vega-Lopez, Sara Ritchie
Relevant diagnostic investigations should be performed. Onchocerciasis is diagnosed on detecting microfilaria in skin snips, positive serology, eosinophilia and ocular manifestations in those with a history of exposure in endemic regions of the world. Patients usually have severe pruritus, which may be accompanied by a papular, lichenified dermatitis. Other findings include nodules (onchocercomata) on trunk and/or limbs and chronic pigmentary changes (patchy hyper- and hypopigmentation) particularly on the lower limbs. Elimination of Ascaris worms can be observed as a secondary effect of treatment with ivermectin.Cutaneous larva migrans is diagnosed clinically, according to a history of exposure, intense localized pruritus and a distinctive rash comprising an erythematous cutaneous larval track often with a positive ‘sign of the loop’. Eosinophilia and Loeffler’s syndrome have been described and the diagnosis relies upon a FBC (CBC) with differential white blood cell (WBC) and chest x-rays.Strongyloidiasis can be reliably diagnosed by an enzyme linked immunosorbent assay (ELISA) serological test and the adult worms can be detected in stools by several methods, though some of these have limitations in detecting the larval stages or particular species. Patients may manifest generalized pruritus, pruritus ani, urticaria and less commonly symptoms of larva currens.Scabies is usually diagnosed clinically and presents with an intensely pruritic papular eruption with small linear or s-shaped mite tracks (burrows) in the epidermis, which may be more easily visualized with dermoscopy. Vesicopustular and nodular lesions may predominate in children. Microscopic identification of a mite in skin scrapings from a burrow confirms the diagnosis, but is time consuming and not always practical in a busy clinical setting.
Strongyloidiasis hyperinfection after renal transplant presenting as diffuse alveolar hemorrhage with respiratory failure
Published in Baylor University Medical Center Proceedings, 2019
Imtiyaz Hakeem, Charles Moritz, Faiza Khan, Erin Garrett, Mohanram Narayanan
Chest x-ray/computed tomography showed bilateral infiltrates/ground glass appearance with worsening respiratory status requiring endotracheal intubation. Bronchoscopy with bronchoalveolar lavage showed diffuse alveolar hemorrhage, for which pulse steroids and plasmapheresis were initiated. Serologic evaluation and renal allograft biopsy were negative for vasculitis/lupus and rejection, respectively. A repeat bronchoalveolar lavage returned positive for the larval forms of Strongyloides (Figure 2). Due to concern that the purpuric skin rash may represent “larva currens,” a punch biopsy was done that revealed Strongyloides larvae in the skin (Figure 3). Blood cultures grew Enterococcus faecium. Stool for ova and parasites was positive for Strongyloides. Enzyme-linked immunosorbent assay for Strongyloides was equivocal to low.
Introduction to the special issue on gastroenterology
Published in Paediatrics and International Child Health, 2019
Strongyloides stercoralis can persist in the body for years. Clinical features include larva currens (skin disease), malabsorption and hyperinfection syndrome. Trichinella spiralis is contracted by eating undercooked pork. The small intestine phase (enteric) is associated with vomiting and abdominal pain and is followed by the migratory phase associated with severe local and systemic symptoms including cardiac and neurological disorders.