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Strongyloidiasis

Nature Reviews Disease Primers volume 10, Article number: 6 (2024) Cite this article

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Abstract

Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.

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Fig. 1: Life cycle of Strongyloides spp.
Fig. 2: Global distribution of Strongyloides stercoralis infection.
Fig. 3: Clinical images from patients with Strongyloides stercoralis infection.
Fig. 4: Differentiating between hookworm and Strongyloides stercoralis larvae based on morphology.

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Authors and Affiliations

  1. Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia

    Catherine A. Gordon

  2. Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia

    Catherine A. Gordon

  3. Swiss Tropical and Public Health Institute, Allschwil, Switzerland

    Jürg Utzinger, Sören L. Becker & Jennifer Keiser

  4. University of Basel, Basel, Switzerland

    Jürg Utzinger, Sören L. Becker & Jennifer Keiser

  5. Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia

    Stephen Muhi

  6. The University of Melbourne, Department of Microbiology and Immunology, Parkville, Victoria, Australia

    Stephen Muhi

  7. Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany

    Sören L. Becker

  8. National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia

    Virak Khieu

  9. Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia

    Darren J. Gray

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Introduction (C.A.G. and J.U.); Epidemiology (C.A.G. and J.U.); Mechanisms/pathophysiology (S.M. and S.L.B.); Diagnosis, screening, and prevention (C.A.G., S.M. and S.L.B.); Management (V.K., D.J.G., J.K. and S.L.B.); Quality of life (J.U. and D.J.G.); Outlook (C.A.G., J.U., V.K., D.J.G., S.M., J.K. and S.L.B.); Overview of the Primer (C.A.G.).

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Correspondence to Catherine A. Gordon.

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Nature Reviews Disease Primers thanks S. Babu, R. Gryschek, H. Maruyama and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Gordon, C.A., Utzinger, J., Muhi, S. et al. Strongyloidiasis. Nat Rev Dis Primers 10, 6 (2024). https://doi.org/10.1038/s41572-023-00490-x

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