Management of Strongyloidiasis

There are many conditions that produce similar symptoms, including causes of acute and chronic diarrhea and malabsorption, other causes of eosinophilia, and other causes of severe Gram-negative septicemia. The following should be considered in the differential diagnosis:

• Intestinal infections—amebiasis, bacterial colitis, Shigella, Campylobacter, Yersinia, Clostridium difficile; see the WGO Global Guideline on Acute Diarrhea.
• Non-human hookworm infection, producing cutaneous larva migrans—distinguished from the larva currens caused by S. stercoralis by the absence of scabbing, rapid migration, perianal involvement and wide band of urticaria in larva currens.
• Inflammatory bowel disease.
• Irritable bowel syndrome.
• Functional abdominal disorders.
• Drugs—nonsteroidal anti-inflammatory drugs (NSAIDs) and many others—are possible causes of eosinophilia.

The key diagnostic element is to think of strongyloidiasis as a possible diagnosis and identify the parasite directly and/or through serologic/molecular tests.