Treatment strategies in controlling strongyloidiasis

Strongyloidiasis is an intestinal parasite infection caused by Strongyloides stercoralis. Spontaneous cure cannot be expected due to the unique life cycle of the parasite, termed autoinfection. The disease occurs worldwide, but especially in tropical and subtropical regions. Serious clinical problems with complications and refractory strongyloidiasis are observed, especially in immunocompromised patients, such as those infected with human T cell leukaemia virus Type 1 (HTLV-1) or HIV, or corticosteroid-treated patients. Thiabendazole is effective against S. stercoralis infection; however, serious side effects have been reported. Recently, ivermectin, which has been introduced for the treatment of human onchocerciasis, has been reported to be effective against strongyloidiasis, without serious side effects. The interval of administration is important for treatment, because if autoinfective migrating larvae are not eradicated, S. stercoralis will resume its life cycle and multiply again. To evaluate the results of treatment of S. stercoralis, stool examinations and S. stercoralis-specific antibody titres should be examined for at least 1 or 2 years if possible. This article provides a review of treatments and methods of evaluation of patients infected with S. stercoralis.