Abstract
Background Strongyloides stercoralis, an intestinal parasitic nematode, infects more than 100 million people worldwide. Strongyloides are unique in their ability to exist as a free-living and autoinfective cycle. Strongyloidiasis can occur without any symptoms or as a potentially fatal hyperinfection or disseminated infection. The most common risk factors for these complications are immunosuppression caused by corticosteroids and infection with human T-lymphotropic virus or human immunodeficiency virus. Even though the diagnosis of strongyloidiasis is improved by advanced instrumentation techniques in isolated and complicated cases of hyperinfection or dissemination, efficient guidelines for screening the population in epidemiological surveys are lacking.Methodology and ResultsIn this review, we have discussed various conventional methods for the diagnosis and management of this disease, with an emphasis on recently developed molecular and serological methods that could be implemented to establish guidelines for precise diagnosis of infection in patients and screening in epidemiological surveys. A comprehensive analysis of various cases reported worldwide from different endemic and nonendemic foci of the disease for the last 40 years was evaluated in an effort to delineate the global prevalence of this disease. We also updated the current knowledge of the various clinical spectrum of this parasitic disease, with an emphasis on newer molecular diagnostic methods, treatment, and management of cases in immunosuppressed patients.ConclusionStrongyloidiasis is considered a neglected tropical disease and is probably an underdiagnosed parasitic disease due to its low parasitic load and uncertain clinical symptoms. Increased infectivity rates in many developed countries and nonendemic regions nearing those in the most prevalent endemic regions of this parasite and the increasing transmission potential to immigrants, travelers, and immunosuppressed populations are indications for initiating an integrated approach towards prompt diagnosis and control of this parasitic disease.
Highlights
Strongyloides stercoralis, one of the most common and globally distributed human pathogens of clinical importance, infects 30– 100 million people worldwide [1]
After its first report in 1876 from the feces of French soldiers with diarrhea who were returning from the old Indochina region, the disease was known for many years as ‘‘Cochin-China diarrhea’’ [5], which describes the most common gastrointestinal manifestations, such as epigastric pain and watery diarrhea, of this parasitic infection [6]
It took more than a century to trace most of the basic biology of this nematode and its extravagant ability to disseminate in host tissues, thereby leading to a spectrum of clinical complications
Summary
Strongyloides stercoralis, one of the most common and globally distributed human pathogens of clinical importance, infects 30– 100 million people worldwide [1]. Unique characteristics of this nematode are its immense ability to persist and replicate within a host for decades while producing minimal or no symptoms and its potential to cause lifethreatening infections by dissemination and hyperinfection in debilitated and immune-compromised patients [4]. It took more than a century to trace most of the basic biology of this nematode and its extravagant ability to disseminate in host tissues, thereby leading to a spectrum of clinical complications. Strongyloides stercoralis, an intestinal parasitic nematode, infects more than 100 million people worldwide. Strongyloidiasis can occur without any symptoms or as a potentially fatal hyperinfection or disseminated infection. Even though the diagnosis of strongyloidiasis is improved by advanced instrumentation techniques in isolated and complicated cases of hyperinfection or dissemination, efficient guidelines for screening the population in epidemiological surveys are lacking
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