Intended for healthcare professionals

Clinical Review

Strongyloides stercoralis infection

BMJ 2013; 347 doi: (Published 30 July 2013) Cite this as: BMJ 2013;347:f4610
  1. Daniel Greaves, registrar in infectious diseases and microbiology1,
  2. Sian Coggle, registrar in infectious diseases and microbiology1,
  3. Christopher Pollard, visiting fellow/research physician2,
  4. Sani H Aliyu, consultant in infectious diseases and microbiology3,
  5. Elinor M Moore, consultant in infectious diseases1
  1. 1Department of Infectious Diseases, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
  2. 2Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  3. 3Department of Microbiology, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to: D Greaves greaves{at}

Summary points

  • Strongyloidiasis is endemic in the tropics and subtropics and anyone who has travelled to, or lived in, these areas is at risk

  • Unlike most other intestinal parasite infections, strongyloidiasis may be life long

  • The infection is often asymptomatic and may only be indicated by a peripheral blood eosinophilia

  • Diagnosis is important as immunosuppression in patients with chronic infection can precipitate a life threatening hyperinfection syndrome

  • Serology is the investigation of choice for diagnosis and follow-up, as stool microscopy has a low sensitivity

  • Treatment is with 2×200 μg/kg doses of oral ivermectin given two weeks apart

Strongyloides stercoralis is an intestinal helminth that infects humans through contact with soil containing the larvae. Between 30 and 100 million people are infected worldwide.1 In the United Kingdom, strongyloidiasis is seen predominantly in migrants and returning travellers from endemic areas in the tropics and subtropics. Strongyloidiasis may present with cutaneous or gastrointestinal symptoms but is asymptomatic in over 60% of cases and only indicated by a raised blood eosinophil count.2 Diagnosis is important as the infection may persist for decades.3 Immunosuppressed patients with chronic strongyloidiasis are at high risk of developing strongyloides hyperinfection syndrome, a life threatening complication whereby larval proliferation leads to systemic sepsis and multiorgan failure. If strongyloidiasis is diagnosed early, however, it is easily treatable with oral antihelmintic drugs. In this article we review the epidemiology and common symptoms of strongyloidiasis and strongyloides hyperinfection syndrome, discuss the appropriate investigations, and summarise the evidence on treatment.

Sources and selection criteria

We performed a search of PubMed using the search term “Strongyloides stercoralis”, and included English language studies only. There is a paucity of randomised controlled trails investigating the treatment of strongyloides infection, and no Cochrane reviews have been published. Likewise there are no national or globally recognised guidelines for the investigation …

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