Let’s See You Try And Wriggle Out Of This

Endemic describes an infection rate of 1-5% and hyperendemic an infection rate of over 5%. Strongyloides infection rates of over 25% have been seen in in some parts of tropical and sub-tropical indigenous Australia. It i also found in high rates in other countries in the same latitudes.

Strongyloides stercoralis is a parasitic roundworm. These worms are picked up when you come in contact with faeces or faecally contaminated soil. When these worms get on the skin they burrow in.

The larvae then move through the body and can end up in the lungs.

You cough, they end up in your mouth.

You swallow they end up in your gut, well, the small intestine where they can live happily ever after (up to 12 months).

From there they burrow into the mucosa and lay their eggs. The time taken from burrowing into the skin until the eggs hatch in the intestinal mucosa is about two weeks.

Some of these larvae when hatched are excreted where they can live for a few days outside the body. Others go through the cycle again to reach the small intestine and reproduce. The video shows where you find them in the small intestine.

They can be diagnosed from a blood test or an examination of a stool sample. Often it is high eosinophils can indicate their presence leading to further diagnostic tests. You can have them for years without knowing. However should your immune system falter they become a problem. This can be due to among other causes, a bacterial infection or doses of cortisone. Up to 60% of all deaths due to strongyloidiasis are because cortisone type drugs were given to patients with chronic strongyloidiasis.

Ivermectin is the best treatment with about an 80% cure rate if two treatments are given a week apart.

More information can be found at the Aboriginal Resource and Development Services website. A very readable pharmacy based article (as part of a larger pdf file) written by pharmacist Lindy Swain can be found in the May 2008 edition of the Rural Pharmacy magazine.

Disclaimer:The above information is of a general nature only. 341 words where I could have used a thousand. Also, please do not try to take a biopsy of your own small intestine – or anyone else’s!

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Robbo is a pharmacist working with a very remote Aboriginal Health Service in the deserts of Western Australia. + Andrew Robbo Roberts

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