The infection may remain quiescent for years, lead to bothersome yet benign cutaneous findings (larva migrans), or escalate into a hyperinfection syndrome with massive increase in worm burden resulting in organ invasion, gram-negative sepsis, meningitis associated with intestinal bacteria, and death (mortality 70%-90%). This latter syndrome (hyperinfection) occurs in immunocompromised patients (corticosteroids, severe AIDS [T-cells less than 100 and often less than 50], malnutrition, malignancy, HTLV-1 infection).
Strongyloidiasis appears as single or multiple erythematous, linear, serpiginous, pruritic lesions usually located on the buttock or trunk region. Symptoms of pruritus alone may exist in this distribution without visual signs of the parasite. Symptoms of chronic infection may be specific (larva currens) or nonspecific (chronic abdominal pain, intermittent diarrhea, chronic urticaria / angioedema, nausea, constipation, coughing / wheezing, prurigo nodularis).
Risk factors include gardening, farming, having a psychiatric illness / being a long-term psychiatric patient (poor sanitation and pica), travel to hyperendemic areas, low socioeconomic status, being a prisoner of war, and walking barefoot outdoors.
Symptoms may persist from weeks to decades and may be frequent or lie quiescent for months at a time. The longest documented infection is 65 years.
B78.1 – Cutaneous strongyloidiasis
240855004 – Cutaneous strongyloidiasis
- Cutaneous larva migrans (CLM), also known as "creeping eruption" or animal hookworms, usually occurs on the distal lower extremities and often has a vesicular component. Unlike strongyloidiasis, the lesions of CLM only migrate 1-2 cm per day.
- Gnathostomiasis occurs most commonly in Southeast Asia and may be furuncular at times.
- Migratory myiasis causes wider lesions, migrates slowly, and often becomes furuncular.