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Peter F Weller, MD, MACP
Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Section Editor
Edward T Ryan, MD, DTMH
Deputy Editor
Elinor L Baron, MD, DTMH


Strongyloidiasis is caused by infection with Strongyloides stercoralis. Manifestations of infection can range from asymptomatic eosinophilia in the immunocompetent host to disseminated disease with septic shock in the immunocompromised host.


Strongyloidiasis is endemic in rural areas of tropical and subtropical regions and occurs sporadically in temperate areas (Appalachia and southern Europe) [1]. In tropical and subtropical regions, the overall regional prevalence may exceed 25 percent. The highest rates of infection in the United States are among residents of the southeastern states [2,3] and among individuals who have been in endemic areas (including immigrants, refugees, travelers, and military personnel) [4,5]. Transmission of strongyloidiasis in long-term care settings has also been described [3,6].

Immunosuppressed individuals are at risk for developing Strongyloides hyperinfection syndrome. In addition, solid organ transplant recipients receiving organs from donors with epidemiologic risk for latent Strongyloides infection are at risk for donor-derived strongyloidiasis [7,8]. (See 'Role of immunosuppression' below and 'Prevention' below.)


The infection begins when human skin contacts filariform larvae (the infective larval stage) of S. stercoralis, which are found in soil or other materials contaminated with human feces (figure 1) [9,10]. The filariform larvae penetrate the skin and migrate hematogenously to the lungs where they penetrate into the alveolar air sacs. The larvae then ascend the tracheobronchial tree and are swallowed.

The larvae mature into adult worms that burrow into the mucosa of the duodenum and jejunum. Adult worms may live for up to five years. The adult female produces eggs, from which noninfectious larvae (rhabditiform larvae) develop within the lumen of the gastrointestinal tract. The rhabditiform larvae are generally passed in the feces. The cycle from dermal penetration to appearance of larvae in the stool requires approximately three to four weeks.

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Literature review current through: Nov 2017. | This topic last updated: Jul 25, 2017.
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