A Public Awareness Campaign

Strongyloidiasis in the U.S.

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Strongyloidiasis is Under-Diagnosed & Potentially Fatal

The following resources have been compiled for informational purposes only and do not constitute medical advice. If you or someone you know are experiencing symptoms that resemble Strongyloidiasis, consult your healthcare provider as soon as possible. Consider bringing a printed copy of “References for Healthcare Providers” with you to give to your physician.

Annotated Reference List for Healthcare Providers and free downloadable PDF here:

And more info about Strongyloidiasis below

Strongyloidiasis:

Causes & Symptoms

Strongyloidiasis is caused by the parasitic nematode Strongyloides stercoralis. This soil-transmitted helminth is prevalent in tropical and subtropical areas, but it can also occur in temperate regions (Boulware et al., 2004). Notably, strongyloidiasis is prevalent in parts of Texas and the southern United States, highlighting the need for awareness in these regions (Echidna et al., 2020).

The infection typically occurs when larvae penetrate the skin after contact with contaminated soil or ingestion of contaminated food or water. Symptoms of strongyloidiasis vary from mild to severe and can include gastrointestinal issues such as abdominal pain and diarrhea, as well as respiratory and dermatological symptoms due to larval migration (Yang et al., 2024). In chronic cases, symptoms may be subtle, leading to underdiagnosis. In some cases, the parasite can penetrate the intestinal wall and migrate to other organs, leading to disseminated strongyloidiasis, which can be fatal if untreated (Greaves et al., 2013; Mejia & Nutman, 2012). In immunocompromised individuals, the infection can lead to hyperinfection syndrome, which is also life-threatening (Hall et al., 2024).

Why isn’t it Diagnosed?

Despite its global prevalence, strongyloidiasis is frequently overlooked or misdiagnosed, leading to delayed treatment and potentially severe consequences. One primary reason for underdiagnosis is the lack of awareness and understanding among healthcare providers, especially in non-endemic regions (Buonfrate et al., 2021; Siddiqui & Berk, 2001). Notably, U.S. physicians-in-training were far less familiar with typical presentation and significantly more likely to misdiagnose than their international peers (Boulware et al., 2004).

The asymptomatic nature of many infections and the non-specific clinical manifestations contribute to this oversight (Yang et al., 2024). The diagnosis is challenging due to the intermittent and low-level shedding of the parasite in stool samples, leading to false negatives (Buonfrate et al., 2021; Nutman, 2017). Additionally, the non-specific symptoms associated with strongyloidiasis can be mistaken for other gastrointestinal or respiratory conditions (Nutman, 2017; Siddiqui & Berk, 2001). Physicians' lack of awareness and training further exacerbates the issue, particularly in non-endemic areas (Boulware et al., 2004).

The US Misinformed Medical System

The challenges in diagnosing and managing strongyloidiasis are exacerbated by the shortcomings of the US medical system. Many healthcare providers lack the necessary knowledge to recognize and treat this infection (Mejia & Nutman, 2012; Siddiqui & Berk, 2001; Marcos & Terashima, 2007). This knowledge gap can lead to incorrect diagnoses and suboptimal treatments. Additionally, the healthcare system's reliance on standardized guidelines may not fully account for the complexities of strongyloidiasis (Mejia & Nutman, 2012; Buonfrate et al., 2021). Socioeconomic and demographic factors, such as poverty and immigration status, also contribute to underdiagnosis and are often overlooked (Boatin et al., 2012; Siddiqui & Berk, 2001).

The medical system in the United States lacks adequate training and awareness regarding strongyloidiasis. This gap in knowledge is evident among physicians-in-training, many of whom fail to recognize the need for screening in at-risk populations (Boulware et al., 2004). A recent study found that demographic predictors of at-risk populations were not reliable indicators and targeted screening is ineffective (Telchik et al., 2025). The reliance on insufficient diagnostic tools and the absence of comprehensive guidelines further contribute to misdiagnosis and inadequate treatment (Boulware et al., 2004).

Dangers of Missed and Mis-diagnosis & Sub-therapeutic Treatment

Failure to properly diagnose and manage strongyloidiasis can have severe consequences, especially in immunocompromised patients who are at risk for hyperinfection syndrome (Hall et al., 2024). Missed or misdiagnosis can lead to the progression of the infection, potentially resulting in disseminated strongyloidiasis, a life-threatening condition (Mejia & Nutman, 2012; Siddiqui & Berk, 2001; Marcos & Terashima, 2007). Incorrect or sub-therapeutic dosing of ivermectin, the primary treatment, can lead to treatment failures and persistent infections, leading to chronic infection and drug resistance (Buonfrate et al., 2019; Marti et al., 1996; Suputtamongkol et al., 2011, Buonfrate et al., 2022). Missed diagnoses can also have significant economic and social implications, with prolonged illness and the need for more complex treatments placing a substantial burden on individuals and the healthcare system (Buonfrate et al., 2021; Siddiqui & Berk, 2001). Ensuring appropriate dosing and considering alternative treatments like moxidectin are crucial, as highlighted in comparative studies (Henriquez-Camacho et al., 2024).

References

1. ::Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey (Boulware et al. 2004):: - This study provides insights into the challenges faced by physicians-in-training in diagnosing and treating strongyloidiasis. It highlights the need for improved education and awareness among healthcare professionals, particularly in non-endemic areas, to prevent misdiagnosis and related complications.

Boulware, D. R., et al. (2004). Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey. /American Journal of Medicine/, 122(5), 487-488. https://doi.org/10.1016/j.amjmed.2006.05.072

2. ::A research agenda for helminth diseases of humans: towards control and elimination (::::Boatin et al. 2012):: - a comprehensive review of recent helmintiasis research to identify research gaps and develop future goals for R&D to achieve Health Development goals and outline salient funding needs.

Boatin, B. A., et al. (2012). A research agenda for helminth diseases of humans: towards control and elimination. /PLoS Neglected Tropical Diseases/, 6(4), e1547. https://doi.org/10.1371/journal.pntd.0001547

3. ::Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment (Buonfrate et al. 2022):: - This article discusses current treatment strategies and the complications involved in managing strongyloidiasis. It highlights the importance of proper dosing and explores alternative treatments, providing a valuable reference for optimizing therapeutic approaches.

Buonfrate, D., et al. (2022). Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment. /Expert Opinion on Pharmacotherapy/. https://doi.org/10.1080/14656566.2022.2114829

4. ::The Global Prevalence of Strongyloidiasis: A Systematic Review and Meta-analysis (Buonfrate et al., 2021):: - This systematic review and meta-analysis provide valuable insights into the global burden of strongyloidiasis, highlighting the significant underestimation of the disease's prevalence. It underscores the importance of increased surveillance and improved diagnostic techniques to better understand the true impact of this neglected tropical disease.

Buonfrate, D., et al. (2021). The global prevalence of strongyloidiasis: a systematic review and meta-analysis. /PLoS Neglected Tropical Diseases/, 15(2), e0008909. https://doi.org/10.1371/journal.pntd.0008909

5. ::Severe Strongyloidiasis: A Systematic Review of Case Reports (Buonfrate et al., 2019):: - This systematic review of case reports on severe strongyloidiasis, including hyperinfection syndrome and disseminated infections, offers healthcare providers a deeper understanding of the clinical presentation, risk factors, and management of these life-threatening manifestations of the disease.

Buonfrate, D., Requena-Mendez, A., Angheben, A., Muñoz, J., Gobbi, F., Van Den Ende, J., & Bisoffi, Z. (2019). Severe strongyloidiasis: a systematic review of case reports. /BMC Infectious Diseases/, 19(1), 1–12. https://doi.org/10.1186/s12879-019-3980-x

6. ::Strongyloides stercoralis in Texas and the southern United States (Echidna et al. 2020):: discusses the prevalence and implications of Strongyloides stercoralis infections in Texas and the southern United States, highlighting the need for increased awareness and diagnostic efforts in these regions.

Echidna, A., et al. (2020). Strongyloides stercoralis in Texas and the southern United States. /American Journal of Tropical Medicine and Hygiene/. https://doi.org/10.4269/ajtmh.19-0915

7. ::Strongyloides stercoralis infection (Greaves et al. 2013):: - provides a comprehensive overview of Strongyloides stercoralis infection, including its clinical presentation, diagnosis, treatment options, and the importance of recognizing this neglected tropical disease in affected populations.

Greaves, D., Coggle, S., Pollard, C., Aliyu, S. H., & Moore, E. M. (2013). Strongyloides stercoralis infection. /BMJ/, 347, f4610. https://doi.org/10.1136/bmj.f4610

8. ::Strongyloides Hyperinfection Syndrome and Disseminated Disease with Negative Serology (::::Hall et al. 2024::) - This case study emphasizes the diagnostic challenges of strongyloidiasis, particularly in immunocompromised patients. It underscores the importance of considering alternative diagnostic methods when serology is negative, thus offering practical insights for clinicians.

Hall, A. D., et al. (2024). Strongyloides Hyperinfection Syndrome and Disseminated Disease with Negative Serology. /American Journal of Tropical Medicine and Hygiene/. https://doi.org/10.4269/ajtmh.24-0460

9. ::Ivermectin vs moxidectin for treating Strongyloides stercoralis infection: a systematic review (Henriquez-Camacho et al. 2024):: - This systematic review compares the efficacy and safety of ivermectin and moxidectin, providing evidence for clinicians to make informed decisions about treatment options for strongyloidiasis.

Henriquez-Camacho, C., et al. (2024). Ivermectin vs moxidectin for treating Strongyloides stercoralis infection: a systematic review. /Parasitology/. https://doi.org/10.1017/S0031182024001215

10. ::Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection (Henriquez-Camacho et al., 2016):: - This review article provides guidance on the optimal dosing and duration of ivermectin treatment for strongyloidiasis, emphasizing the importance of ensuring adequate and appropriate treatment to prevent the development of drug resistance and poor clinical outcomes.

Henriquez-Camacho C, Gotuzzo E, Echevarria J, White AC Jr, Terashima A, Samalvides F, Pérez-Molina JA, Plana MN. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016 Jan 18;2016(1):CD007745. https://doi.org/10.1002/14651858.CD007745.pub3. PMID: 26778150; PMCID: PMC4916931.

11. ::Strongyloidiasis in the Immunocompromised Host: A Worm That Leaves No Stone Unturned (Marcos & Terashima, 2007):: - This article explores the unique challenges and management considerations for strongyloidiasis in immunocompromised individuals, such as those with HIV/AIDS, organ transplant recipients, and patients receiving immunosuppressive therapies.

Marcos, L. A., & Terashima, A. (2007). Strongyloidiasis in the immunocompromised host. /Current Infectious Disease Reports/, 9(1), 35-42. https://doi.org/10.1007/s11908-007-0027-9

12. ::A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children (Marti et al. 1996):: - presents a comparative trial evaluating the effectiveness of a single dose of ivermectin against a three-day regimen of albendazole for treating Strongyloides stercoralis and other soil-transmitted helminth infections in children. The study found that ivermectin was effective in treating these infections, demonstrating comparable efficacy to albendazole, while also highlighting the convenience of a single-dose treatment. The results suggest that ivermectin could be a practical alternative for managing these parasitic infections in pediatric populations.

Marti, H., et al. (1996). A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. /The American Journal of Tropical Medicine and Hygiene/, 55(5), 477-481. https://doi.org/10.4269/ajtmh.1996.55.477

13. ::Screening, Prevention, and Treatment for Hyperinfection Syndrome and Disseminated Infections Caused by Strongyloides stercoralis (Mejia & Nutman, 2012):: - This article focuses on the critical aspects of managing strongyloidiasis, particularly the prevention and treatment of life-threatening hyperinfection syndrome and disseminated infections. It emphasizes the need for early detection and appropriate treatment to avoid severe complications.

Mejia, R., & Nutman, T. B. (2012). Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. /Current Opinion in Infectious Diseases/, 25(4), 458–463. https://doi.org/10.1097/QCO.0b013e3283551dbd

14. ::Strongyloidiasis: A Neglected Tropical Disease (Nutman, 2017):: - This comprehensive review article provides an in-depth overview of the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of strongyloidiasis. It highlights the importance of increased awareness and improved diagnostic and management strategies among healthcare providers.

Nutman, T. B. (2017). Human infection with Strongyloides stercoralis and other related Strongyloides species. /Parasitology/, 144(3), 263–273. https://doi.org/10.1017/S0031182016000834

15. ::Chronic Strongyloidiasis – Don't look and you won't find. (Page & Speare, 2016):: – This article discusses the need for improved diagnostic techniques and increased awareness among healthcare providers to better manage and control this parasitic infection.

Page W, Speare R. Chronic strongyloidiasis - Don't look and you won't find. Aust Fam Physician. 2016 Jan-Feb;45(1):40-4. PMID: 27051986. https://www.racgp.org.au/afp/2016/januaryfebruary/chronic-strongyloidiasis-%E2%80%93-don%E2%80%99t-look-and-you-won%E2%80%99t-find/

16. ::Strongyloidiasis in the Immunocompromised Host (Ramanathan & Nutman, 2008):: - This article focuses on the unique challenges and management strategies for strongyloidiasis in immunocompromised patients, who are at a higher risk of developing severe and disseminated infections. It highlights the need for increased vigilance and proactive screening in this vulnerable population.

Ramanathan R, Nutman T. Strongyloides stercoralis infection in the immunocompromised host. Curr Infect Dis Rep. 2008 May;10(2):105-10. https://foi.org/10.1007/s11908-008-0019-6. PMID: 18462583; PMCID: PMC3401551.

17. ::Diagnosis of Strongyloides stercoralis Infection (Siddiqui & Berk, 2001):: - This article provides a comprehensive overview of the diagnostic challenges and strategies for strongyloidiasis, emphasizing the limitations of commonly used diagnostic methods and the importance of considering alternative testing approaches to improve detection.

Siddiqui, A. A., & Berk, S. L. (2001). Diagnosis of Strongyloides stercoralis infection. /Clinical Infectious Diseases/, 33(7), 1040-1047. https://doi.org/10.1086/322707

18. ::Efficacy and safety of single-dose ivermectin versus seven-day high dose albendazole for chronic strongyloidiasis (Suputtamongkol et al. 2011):: - compares the efficacy and safety of a single dose of ivermectin to a seven-day course of high-dose albendazole for treating chronic strongyloidiasis. The results indicate that ivermectin is as effective as albendazole in eliminating the infection, with a favorable safety profile. The findings support the use of ivermectin as a viable treatment option for chronic strongyloidiasis.

Suputtamongkol, Y., et al. (2011). Efficacy and safety of single-dose ivermectin versus seven-day high dose albendazole for chronic strongyloidiasis. /The American Journal of Tropical Medicine and Hygiene/, 84(5), 722-726. https://doi.org/10.4269/ajtmh.2011.10-0691

19. ::Human Strongyloides stercoralis infection: Review of epidemiology, diagnosis, and management (Yang et al. 2024):: - This review article covers the comprehensive aspects of Strongyloides stercoralis infection, from its epidemiology and pathophysiology to the latest diagnostic and treatment strategies. It serves as an essential resource for medical professionals seeking to update their knowledge on this neglected tropical disease.

Yang, R., et al. (2024). Human Strongyloides stercoralis infection: Review of epidemiology, diagnosis, and management. /Journal of Microbiology, Immunology, and Infection/. https://doi.org/10.1016/j.jmii.2024.07.01

No Morgellons: A Public Awareness Campaign is a not for profit effort by private citizens. While we have academic training, we are not medical professionals and nothing on this page should be taken in place of the advice of a licensed medical professional.