Abstract
In spite of recent advances with experiments on animal models, strongyloidiasis, an infection caused by the nematode parasite Strongyloides stercoralis, has still been an elusive disease. Though endemic in some developing countries, strongyloidiasis still poses a threat to the developed world. Due to the peculiar but characteristic features of autoinfection, hyperinfection syndrome involving only pulmonary and gastrointestinal systems, and disseminated infection with involvement of other organs, strongyloidiasis needs special attention by the physician, especially one serving patients in areas endemic for strongyloidiasis. Strongyloidiasis can occur without any symptoms, or as a potentially fatal hyperinfection or disseminated infection. Th2 cell-mediated immunity, humoral immunity and mucosal immunity have been shown to have protective effects against this parasitic infection especially in animal models. Any factors that suppress these mechanisms (such as intercurrent immune suppression or glucocorticoid therapy) could potentially trigger hyperinfection or disseminated infection which could be fatal. Even with the recent advances in laboratory tests, strongyloidiasis is still difficult to diagnose. But once diagnosed, the disease can be treated effectively with antihelminthic drugs like Ivermectin. This review article summarizes a case of strongyloidiasis and various aspects of strongyloidiasis, with emphasis on epidemiology, life cycle of Strongyloides stercoralis, clinical manifestations of the disease, corticosteroids and strongyloidiasis, diagnostic aspects of the disease, various host defense pathways against strongyloidiasis, and available treatment options.
Highlights
In United States, strongyloidiasis is the most important nematode infection in humans with a tendency towards chronic persistent infection and with special characteristic features of autoinfection, hyperinfection involving pulmonary and gastrointestinal systems, and disseminated infection involving other organs [1,2,3,4]
Strongyloidiasis is caused by a soil dwelling nematode helminth, Strongyloides stercoralis
It took nearly 50 years for the complete elucidation of the complex life cycle after the discovery of the parasite [4] because of the rare and characteristic feature of autoinfection that occurs in the life cycle
Summary
In United States, strongyloidiasis is the most important nematode infection in humans with a tendency towards chronic persistent infection and with special characteristic features of autoinfection, hyperinfection involving pulmonary and gastrointestinal systems, and disseminated infection involving other organs [1,2,3,4]. Type 2 T helper (Th2) cells that stimulate eosinophils, IgE production, mast cells, and goblet cells by producing IL-4, IL-5, IL-9 [91], IL-10 and IL-13, are important in the defense against strongyloides infection [1,81,84,91,92] This has been shown, for example, in people with coinfection with HTLV-1 which decreases Th2 cell-mediated immunity, thereby increasing the risk for hyperinfection syndrome or disseminated infection [94]. Neutrophils are important in immunity against infective larvae of Strongyloides stercoralis in mice [98,99] which could play a role in human strongyloidiasis They are shown to have a controversial effect through the ADCC mechanism with the help of IgG as mentioned earlier. More research is needed in this aspect before limiting the use of leukotriene synthesis inhibitors
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