Rapid development of migratory, linear, and serpiginous lesions in association with immunosuppression - 14/05/14
Abstract |
Key teaching points |
• | Strongyloides is a genus of obligate gastrointestinal nematodes (roundworms) of vertebrates. The species stercoralis, the usual cause of human infection, has the potential for autoinfection and multiplication in human beings. |
• | Peripheral eosinophilia without a known cause may represent chronic, persistent infection with Strongyloides stercoralis. |
• | Undiagnosed disease is prevalent, especially among immigrants and military veterans who served in highly endemic areas in the tropics and subtropics. |
• | Immunosuppression of individuals with persistent Strongyloides stercoralis infection can lead to hyperinfection syndrome or disseminated infection, which can be fatal in up to 90% of cases. |
• | First-line therapy for acute and chronic strongyloidiasis is ivermectin, 200 μg/kg orally in a single daily dose for 1 to 2 days. Treatment of hyperinfection syndrome includes reduction of immunosuppression, if possible, and administration of ivermectin (200 μg/kg daily) until larvae are no longer detected in stool for at least 2 weeks.3 , 17 The spectrum of clinical disease is wide, however, and shorter courses of ivermectin may be sufficient. |
• | Larva currens is a hypersensitivity reaction that refers to the cutaneous manifestation of Strongyloides and should be distinguished from cutaneous larva migrans, which is caused by abortive human infection with an animal hookworm. |
Key words : autoinfection, hyperinfection, immunosuppression, ivermectin, larva currens, larva migrans, nematode, roundworm, Strongyloides stercoralis, strongyloidiasis
Plan
Supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. |
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Conflicts of interest: None declared. |
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Reprints not available from the authors. |
Vol 70 - N° 6
P. 1130-1134 - juin 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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