Les formes graves de strongyloïdose

Strongyloidiasis is a helminthiasis spread in tropical and subtropical areas, which affects approximately 100 million people worldwide. In Europe where autochthonous cases are uncommon it is the most frequent imported intestinal helminthiasis. It has an original and complex cycle. Chronic infection is asymptomatic in about half of the cases and symptoms when present are non-specific. In specific situations, there is an acceleration of the autoinfection cycle resulting in hyper infection syndrome or disseminated infection. Main risk factors, often associated are: therapy with corticosteroid or other immunosuppressive drugs, organ or bone marrow transplants, hematologic malignancies, retroviral infections. Gastrointestinal and pulmonary manifestations are predominant but non-specific. Associated infections with enteric bacteria are common. Global fatality rate is high exceeding 60%. In contrast with chronic strongyloidiasis larvae are easily founded in stools but also in sputum, bronchoalveolar lavage fluid or other specimens. There is no defined treatment schedule for severe strongyloidiasis. Ivermectin is more effective than albendazole, and thiabendazole is not available anymore. Ivermectin dose and duration vary according to the different publications. Ivermectin was administered intravenously in a few observations. Because of the poor prognosis of severe strongyloidiasis, patient at risk should be systematically screened for the infection and treated if positive with a control of efficacy.