Management of Strongyloides stercoralis: a puzzling parasite

Strongyloides stercoralis is one of the common parasites in tropical areas. It can result in severe clinical syndromes, hyperinfection syndrome or disseminated strongyloidiasis in immunocompromised patients. The treatment of strongyloidiasis is a challenge for clinicians in clinical practice. Failure of treatment is due to autoinfection caused by the parasite life cycle and impairment of host immunity. Ivermectin currently is the treatment of choice. When compared with thiabendazole, it has shown a similar efficacy with better tolerability. However, there is neither consensus in duration of treatment nor in repetition of doses. The keys for management of this tough parasite include proper evaluation and prevention. Stool examination with high sensitivity techniques such as Baermann technique, filter-paper culture and agar-plate culture and specific IgG serology should be used in evaluation for 1 to 2 years. Screening, both stool examination and serology, before patients have immunosuppressive treatment is needed to prevent the severe form of strongyloidiasis.