0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50
Strongyloidiasis 1387enteric organisms, and CSF may show PMNs and culture gram neg-
ative organisms.
differential diagnosis
■Skin lesions mimic cutaneous larva migrans due to Ancylostoma of
dogs and cats. Intestinal symptoms are confused with ulcers, other
causes of diarrhea, enteritis, colitis. Eosinophilia and allergic symp-
toms may mimic noninfectious causes. In the hyperinfection state,
gram negative sepsis, shock, meningitis, and pulmonary infiltrates
direct attention away from a parasitic cause.management
What to Do First
■Correct any fluid and electrolyte problems. If a hyperinfection state
exists, sepsis and hypotension need treatment.General Measures
■Stabilization of patient. Identify source of infection.
specific therapy
Indications
■All patients should be treated since the infection does not heal spon-
taneously.
Treatment Options
■Ivermectin for 1 or 2 days
■Thiabendazole for 2–3 days
■Albendazole for 5–7 days
■It is probably best to repeat the treatment in a week, if tolerated. Iver-
mectin and thiabendazole are approximately equivalent in effective-
ness, curing about 90% with one course. Albendazole is a little less
effective.Side Effects & Complications
■Ivermectin: well tolerated, may be itching, light-headedness
■Thiabendazole: side effects common, consisting of dizziness, nau-
sea, vomiting, rash, occasionally Stevens-Johnson syndrome.
■Albendazole: well tolerated, may get mild intestinal complaints,
light-headedness, rash.
■Contraindications to treatment: absolute: First trimester pregnancy
in mild infection. Treat any stage in hyperinfection syndrome, where
Ivermectin is drug of choice.
■Contraindications to treatment:relative:none