Strongyloidiasis

Strongyloidiasis is an infection with Strongyloides, a parasitic worm that lives in soil. It’s sometimes called Strongy. The worm gets into your body through your skin and makes its way to your lungs and intestines, where it matures and reproduces.

Strongyloidiasis can cause skin or digestive symptoms that come and go, or no symptoms at all. If you have a weakened immune system, strongyloidiasis can be life-threatening.

Strongyloides can reinfect you repeatedly, either from inside your body or through your skin (autoinfection). This cycle can cause chronic strongyloidiasis, which can last for years without treatment.

Strongyloides worms exist all over the world, but they’re more commonly found in warmer climates and rural or economically disadvantaged areas. In the U.S., Strongyloides has been found in rural areas of the South and Southeast, especially Appalachia. But most cases in the U.S. are in people who were infected in other areas of the world.

Symptoms of strongyloidiasis

The most common symptoms of strongyloidiasis include:

• Raised, red, itchy rash (larva currens), often between your butt cheeks, on your thighs or on your wrists
• Nausea
• Diarrhea
• Upper abdominal pain that can be similar to heartburn or an ulcer
• Bloating
• Cough or scratchy throat (less common)

Most people don’t have symptoms, or their symptoms come and go.

Strongyloidiasis causes

Several types of Strongyloides, parasitic worms that live in soil (dirt), cause strongyloidiasis. They’re more common in warm climates (tropical and subtropical regions) and areas where poop is more likely to contaminate the soil.

Young Strongyloides worms get into your body through your skin, usually through your feet. You don’t need to have a cut or break in your skin for this to happen. The worms can cause an itchy rash as they move through your skin.

Once inside your body, they move into your bloodstream to reach your lungs. There, they grow into adults. They sometimes lay eggs and reproduce in your lungs, causing a cough or scratchy throat.

You can cough up and swallow the adult worms into your stomach and digestive tract. There, they lay eggs in your intestines, which hatch and grow into more worms. This can cause digestive symptoms, like nausea, diarrhea or stomach pain.

The worms can leave your body in your poop, which spreads the infection. They can also reinfect you from inside your body or through your skin.

Is strongyloidiasis contagious?

Strongyloidiasis isn’t usually contagious. Most people get it from contact with contaminated soil. Rarely, people have been infected by other people or transplanted organs.

Risk factors

Having a weakened immune system puts you at higher risk for strongyloidiasis and severe complications. You’re especially at risk if you:

• Take high doses of corticosteroids
• Have an HLTV-1 infection
• Have a disease that affects your blood or bone marrow, including leukemia or lymphoma
• Have had an organ or stem cell transplant

You’re also at higher risk if you’re in an area where Strongyloides live and you:

• Walk barefoot in soil
• Have a job that puts you in contact with soil that could be contaminated, like farming or coal mining
• Don’t have adequate sanitation

Complications

If you have a weakened immune system, Strongyloides can cause serious damage. The worms can:

• Reinfect you and reproduce more quickly, causing many parasites in your lungs and GI tract at once (hyperinfection)
• Invade other parts of your body (disseminated strongyloidiasis), causing severe inflammation
• Bring bacteria into your bloodstream

These conditions can lead to life-threatening complications, like sepsis and pneumonia.

How doctors diagnose strongyloidiasis

To diagnose strongyloidiasis, a healthcare provider will need to test one or more body fluids to look for Strongyloides. This could include blood, poop (stool) and sputum (mucus coughed up from your lungs). They may look for rashes on your body, including on your wrists, thighs or between your butt cheeks.

How is strongyloidiasis treated?

Antiparasitic medications treat strongyloidiasis. Ivermectin, sometimes given with albendazole, is the most effective treatment. You usually have to take medications for two to 14 days or longer.

If you’re on immunosuppressive medications, your provider may temporarily reduce the amount of immunosuppressants you take. Even if you don’t have symptoms, it’s very important to treat a Strongyloides infection to lower your risk of hyperinfection.

When should I see my healthcare provider?

See a healthcare provider if:

• You have symptoms of strongyloidiasis.
• You have a weakened immune system and have concerns about Strongyloides infections.
• You’re traveling to an area where Strongyloides is common, especially if you have a weakened immune system. Talk to your provider about preventing infections.
• You’re going to have a treatment or procedure that’ll weaken your immune system. A provider may test you for infections before starting treatment.

Go to the ER if you have any symptoms of serious illnesses, including:

• High fever (103 degrees Fahrenheit /39.4 degrees Celsius)
• Confusion or other mental changes
• Low blood pressure
• Trouble breathing or shortness of breath while sitting still
• New or worsening chest pain
• Not peeing or peeing very little

What can I expect if I have strongyloidiasis?

If you have a weakened immune system, you should immediately start treatment for a Strongyloides infection. You may need to be hospitalized or treated multiple times to get rid of the infection.

If you don’t have a compromised immune system, antiparasitic medications can often successfully eliminate the infection. You’ll need to follow up with your provider after treatment to make sure all the worms are gone.

Can strongyloidiasis be cured?

Yes, antiparasitic treatments can cure strongyloidiasis, especially in people without any immune system issues. Hyperinfections have life-threatening complications that are harder to treat.

Can strongyloidiasis be prevented?

Some ways you can reduce your risk for strongyloidiasis include:

• Wear protective clothing when you’re around soil in areas where Strongyloides live. This includes shoes and gloves.
• Be especially cautious in areas with inadequate sanitation. This increases the risk of Strongyloides contaminating the soil.
• If you’re going to have a procedure or start medication that will weaken your immune system, ask your provider about testing for infections. If they diagnose you with strongyloidiasis, you can treat it first to prevent hyperinfection.