Where is this Parasite Found? Tropical and Sub- tropcial regions Temperate regions Rural areas, institutional settings, and in lower socioeconomic groups Mostly found in warm moist areas that favor the survival of the juvenile stages
Geographic Distribution Currently, an estimated million people are infected worldwide in 70 countries In the US: Appalachians, especially in eastern Tennessee, Kentucky, and West Virginia. Internationally: Sub-Saharan Africa, South and Southeast Asia, Central America, and South America, and parts of Eastern Europe
Question #1 Name a state that has Strongyloides stercoralis?
General Things to Know Commonly called a Threadworm The smallest nematode parasites of humans Most Strongyloides and their eggs are found in the soil Infections are initiated when exposed skin contacts contaminated soil Autoinfection commonly occurs allowing infection to persist for decades More common in people who suffer from alcholism, who are caucasion, males, or have an occupation that involves soil contact Not likely to be transmitted through water
Hosts Definitive Humans Dogs Cats Other mammals Intermediate Hosts None There are 38 species of threadworms found in sheep, swine, goat, ox, deer, camel, rabbit, primates, dogs, and cats
Question #2 How many species of Strongyloides are there?
Egg stage Eggs are about 50 um to 68 um long and 30 um by 34 um wide. Females produce several dozen eggs and release them in to the gut lumen or submucosa Not normally diagnostic because eggs hatch before exiting the human host
Rhabditiform larvae stage (L1) Non infective stage Size ranges from microns in length and 60 microns in diameter Passed with feces
Filariform Stage (L3) Reside in the small intestine of the host They are about 650 microns long and 50 microns in length Have a long esophagus This is the infective stage of Strongyloidiasis
Filariform Stage (cont’d) Have a long non bulbous esophagus of about 2/5 of the length of the body Female filariform larvae are slender and faster moving than the rhabditiform stage Male filariform larvae are not parasitic, only the females are Filariform larvae penetrate the skin by releasing hydrolitic enzymes
Question #3 Name one of the three distinguishable characteristics of rhabditiform larvae from other species of nematodes?
Question #4 What larvae form is the infective stage?
Free living Females Have a rhabditiform esophagus Females are about 1 mm in length by um wide Contain embryonated eggs Females have a vulva that is about equatorial Females uteri contains more eggs than most parasitic females
Free living Males Have a rhabditiform esophagus Males are up to 0.9 mm long and 40um to 50 um wide Have two simple spicules and a gubernaculum Their pointed tail is a curved ventrad
Parthenogenetic females Parthenogenetic females reach a length of mm 1/3 of the worm is the esophagus Inhabit crypts of the small intestines Female is stout and has a vulva that is about equatorial Vulva is in the posterior third of the body The uteri carries only a few eggs at a time
Question #5 T/F The adult male is found in the definitive host.
Life Cycle Adults lay eggs in the intestines within the definitive host Rhabditiform larvae hatch from the eggs in the intestines Three possibilities from here –Free living adult worms (Heterogonic) –Filariform larvae (Homogenic - Parasitic Generation) –Autoinfection
Free living adult worms (Heterogonic) Rhabditiform larvae will be excreted in the stool In this developmental option, the rhabditiform will molt four times and will either become a female or male adult worm The free-living adults then mate and produce eggs The rhabditiform larvae then hatch from the eggs The larvae then can either produce a new generation of adults or become filariform larvae
Homogenic Life Cycle Rhaabditiform larvae will be excreted in the stool The rhabditiform larvae molt twice and develop into filariform larvae No adult stages outside of host with this life cycle
Autoinfection In this, the rhabditiform larvae develop into filariform larvae before they leave the hosts intestines The filariform larvae then penetrate the intestinal mucosa or perianal skin They then follow the life cycle in the host…to be explained next…
Parasite in the host Now, the filariform larvae from each cycle enter the circulatory system and travel to the heart They come out of the pulmonary artery and enter into the lungs Penetrate the alveolar spaces and are carried to the trachea and pharynx, swallowed, and make there way to the small intestines In the small intestines they molt twice and become adult female worms By parthenogenesis they produce eggs, yielding rhabditiform larvae The prepatent period lasts about 1 month Possible cycles start over again
Question #6 Name 1 of the 3 cycles that occurs with Strongyloides stercoralis?
Question #7 What larvae stage is excreted in the stool?
Transmission Through contaminated soil –Ingestion –Skin contact Autoinfection Transmammary infection (with dogs) –Presumably it can occur in humans
Symptoms Most Strongyloides infections are asymptomatic and can survive decades undiagnosed –The longest documented asymptomatic infection was more than 65 years Symptomatic infections typically manifest in gastrointestinal, pulmonary, and dermatologic systems In immunocompromised persons, symptomatic infections can be devastating and carry a 60-85% mortality rate Acute Infection Chronic infection Hyperinfection Disseminated Infection
Types of Infections Acute Infection Symptoms occur after a few weeks whether it is a cough, abdominal pain, diarrhea, and/or anorexia. Most likely detection of hundreds of larvae Chronic infection –manifested by epigastric pain, recurrent hives (urticaria) and transient red lines on the skin that appear and move rapidly (larva currens) and sporadic diarrhea Hyperinfection –Most patients that experience this are immunocompromised –Most likely from accelerated autoinfection –Large number of parasites present –Large numbers of larvae in stool and/or sputum Disseminated Infection –Migration of larvae to organs beyond the range of the pulmonary autoinfective cycle
Gastrointestinal Symptoms Bloating, distension Diffuse abdominal pain Diarrhea, typically nonbloody Anorexia, weight loss, nausea Malabsorption syndromes may occur in chronic infections
Question #8 T/F It can be transmitted by breast milk
Dermatologic Symptoms Ground itch - Papulovesicular pruritic rash, usually on the feet Cutaneous infection: Dermatitis is produced by migration of the infective juveniles through the skin Petechial/purpuric rash (with disseminated disease) Inflammation Slight hemorrhage and swelling Larva currens – Skin lesions, hives, or rash often on the trunk and buttocks (allergic response due to migrating larvae
Cardiopulmonary Symptoms Wheezing or coughing Mild to severe symptoms of pneumonia when worms are present in the lungs Hyperinfection syndrome –massive proliferation of larval forms Pulpatations Atriofibrillations Choking sensation
Diagnosis Examination of feces and duodenal contents Finding rhabdiform or filariform larvae in a fresh stool –If not in a fresh stool, may be misdiagnosed as hookworm Finding larvae in the sputum Culture techniques ELISA Immunodiagnosis by indirect immunofluorescence –Antigen: whole Strongyloides ratti larvae
Question #9 Name a way the parasite can be diagnosed?
Culture Technique Fairly new technique Movement of the larval forms can be seen Bacterial colonies of normal oral flora are formed along the moving trail Performed using a chocolate agar sputum culture
Treatment and Prevention Thiamendazole –Keeps nematode larvae from growing into adult forms Cambendazole Ivermection – 100% effective for clearing Strongyloides infection with no side effects
Control Proper hygiene Do not allow infected hosts to breast feed Do not walk barefoot in soil In Hospitals –Make sure you wear clean masks, gloves, and aprons –Wash hands frequently
Question #10 What drug is 100% effective against Strongyloidiasis?
Question #11 Are you more likely to get Strongyloidiasis by swimming in a lake or walking barefoot in the woods?
Works cited Schmidt, G., & Roberts, L. (2005). Foundations of Parasitology (7th ed.). New York, NY: McGraw-Hill Schmidt, G.S., and L.S. Roberts Chapter 25. Order Rhabditata: Pioneering Parasites. in Foundations of Parasitology. Times Mirror/Mosby College Publishing. St. Louis. 750 pages htm e%20Strongyloidiasis