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DPDx

DPDx is an education resource designed for health professionals and laboratory scientists. For an overview including prevention and control visit www.cdc.gov/parasites/strongyloidiasis.

Strongyloidiasis

[Strongyloides stercoralis]

 Filariform (L3) larva of S. stercoralis in a sputum specimen, stained with Giemsa. Image taken at 200x magnification.

Filariform (L3) larva of S. stercoralis in a sputum specimen, stained with Giemsa. Image taken at 200x magnification.


Rhabdititoid larvae of S. stercoralis.

’Rhabditiform (L1) larva of S. stercoralis.

Causal Agents

The nematode (roundworm) Strongyloides stercoralis. Other Strongyloides include S. fülleborni, which infects chimpanzees and baboons and may produce limited infections in humans.


Life Cycle

Life cycle of Strongyloidiasis

The Strongyloides life cycle is more complex than that of most nematodes with its alternation between free-living and parasitic cycles, and its potential for autoinfection and multiplication within the host. Two types of cycles exist: Free-living cycle: The rhabditiform larvae passed in the stool The number 1 (see "Parasitic cycle" below) can either molt twice and become infective filariform larvae (direct development) The number 6 or molt four times and become free living adult males and females The number 2 that mate and produce eggs The number 3 from which rhabditiform larvae hatch The number 4. The latter in turn can either develop The number 5 into a new generation of free-living adults (as represented in The number 2 ), or into infective filariform larvae The number 6. The filariform larvae penetrate the human host skin to initiate the parasitic cycle (see below) The number 6. Parasitic cycle: Filariform larvae in contaminated soil penetrate the human skin The number 6, and are transported to the lungs where they penetrate the alveolar spaces; they are carried through the bronchial tree to the pharynx, are swallowed and then reach the small intestine The number 7. In the small intestine they molt twice and become adult female worms The number 8. The females live threaded in the epithelium of the small intestine and by parthenogenesis produce eggs The number 9, which yield rhabditiform larvae. The rhabditiform larvae can either be passed in the stool The number 1 (see "Free-living cycle" above), or can cause autoinfection The number 10. In autoinfection, the rhabditiform larvae become infective filariform larvae, which can penetrate either the intestinal mucosa (internal autoinfection) or the skin of the perianal area (external autoinfection); in either case, the filariform larvae may follow the previously described route, being carried successively to the lungs, the bronchial tree, the pharynx, and the small intestine where they mature into adults; or they may disseminate widely in the body. To date, occurrence of autoinfection in humans with helminthic infections is recognized only in Strongyloides stercoralis and Capillaria philippinensis infections. In the case of Strongyloides, autoinfection may explain the possibility of persistent infections for many years in persons who have not been in an endemic area and of hyperinfections in immunodepressed individuals.

Geographic Distribution

Tropical and subtropical areas, but cases also occur in temperate areas (including the South of the United States). More frequently found in rural areas, institutional settings, and lower socioeconomic groups.

Clinical Presentation

Frequently asymptomatic. Gastrointestinal symptoms include abdominal pain and diarrhea. Pulmonary symptoms (including Loeffler’s syndrome) can occur during pulmonary migration of the filariform larvae. Dermatologic manifestations include urticarial rashes in the buttocks and waist areas. Disseminated strongyloidiasis occurs in immunosuppressed patients, can present with abdominal pain, distension, shock, pulmonary and neurologic complications and septicemia, and is potentially fatal. Blood eosinophilia is generally present during the acute and chronic stages, but may be absent with dissemination.

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  • Page last reviewed November 29, 2013
  • Page last updated November 29, 2013
  • Content source: Global Health - Division of Parasitic Diseases and Malaria
  • Notice: Linking to a non-federal site does not constitute an endorsement by HHS, CDC or any of its employees of the sponsors or the information and products presented on the site.
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