Editing Strongyloidiasis (section)

==Signs and symptoms==
[[File:Strongyloides Storcoralis Lifecycle Diagram.jpg|alt=Diagram depicting the life cycle of Strongyloides Stercoralis|thumb|350x350px|''Strongyloides'' life cycle]]
''Strongyloides'' infection occurs in five forms. As the infection continues and the larvae mature, there may be respiratory symptoms ([[Löffler's syndrome]]). The infection may then become chronic with mainly digestive symptoms. There may be respiratory, skin, and digestive symptoms of reinfection (when larvae migrate through the body) from the skin to the lungs and finally to the small intestine. Finally, the hyperinfection syndrome causes symptoms in many organ systems, including the [[central nervous system]].<ref name=Montes>{{cite journal | vauthors = Montes M, Sawhney C, Barros N | title = Strongyloides stercoralis: there but not seen | journal = Current Opinion in Infectious Diseases | volume = 23 | issue = 5 | pages = 500–4 | date = October 2010 | pmid = 20733481 | pmc = 2948977 | doi = 10.1097/QCO.0b013e32833df718 }}</ref><ref name=Marcos>{{cite journal | vauthors = Marcos LA, Terashima A, Dupont HL, Gotuzzo E | title = Strongyloides hyperinfection syndrome: an emerging global infectious disease | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 102 | issue = 4 | pages = 314–8 | date = April 2008 | pmid = 18321548 | doi = 10.1016/j.trstmh.2008.01.020 }}</ref>

===Uncomplicated disease===
Frequently [[asymptomatic]]. [[Gastrointestinal system]] [[symptom]]s include abdominal [[pain]] and [[diarrhea]] and/or conversely [[constipation]].  [[Lungs|Pulmonary]] symptoms (including [[Löffler's syndrome]]) can occur during pulmonary migration of the filariform larvae.  [[Pulmonary infiltrate]] may be present through radiological investigation.  [[Dermatology|Dermatologic]] manifestations include [[urticaria]]l [[rash]]es in the buttocks and waist areas as well as [[larva currens]].<ref name=pmid13558704>{{cite journal | vauthors = Arthur RP, Shelley WB | title = Larva currens; a distinctive variant of cutaneous larva migrans due to Strongyloides stercoralis | journal = A.M.A. Archives of Dermatology | volume = 78 | issue = 2 | pages = 186–90 | date = August 1958 | pmid = 13558704 | doi = 10.1001/archderm.1958.01560080044007 }}</ref>  [[Eosinophilia]] is generally present. Strongyloidiasis can become chronic and then become completely asymptomatic.{{citation needed|date=May 2021}}

===Disseminated disease===
Disseminated strongyloidiasis occurs when patients with chronic strongyloidiasis become [[immunosuppression|immunosuppress]]ed. There is a distinction to be made between dissemination and hyperinfection. It is mainly a semantic distinction. There can be mild dissemination where the worm burden is relatively lower yet causes insidious symptoms, or extreme dissemination that the term hyperinfection is used to describe.  Thus hyperinfection of varying levels of severe dissemination may present with abdominal pain, distension, [[Shock (circulatory)|shock]], pulmonary and neurologic [[complication (medicine)|complications]], [[sepsis]], [[haemorrhage]], [[malabsorption]], and depending on the combination, degree, number, and severity of symptoms, is potentially fatal.   The worms enter the bloodstream from the bowel wall, simultaneously allowing entry of bowel bacteria such as ''[[Escherichia coli]]''. This may cause symptoms such as [[sepsis]] (bloodstream infection),<ref>{{cite journal | vauthors = Ghoshal UC, Ghoshal U, Jain M, Kumar A, Aggarwal R, Misra A, Ayyagari A, Naik SR | title = Strongyloides stercoralis infestation associated with septicemia due to intestinal transmural migration of bacteria | journal = Journal of Gastroenterology and Hepatology | volume = 17 | issue = 12 | pages = 1331–3 | date = December 2002 | pmid = 12423282 | doi = 10.1046/j.1440-1746.2002.02750.x | s2cid = 10004323 }}</ref> and the bacteria may spread to other organs where they may cause localized infection such as [[meningitis]].<ref name=Graeff>{{cite journal | vauthors = Graeff-Teixeira C, da Silva AC, Yoshimura K | title = Update on eosinophilic meningoencephalitis and its clinical relevance | journal = Clinical Microbiology Reviews | volume = 22 | issue = 2 | pages = 322–48, Table of Contents | date = April 2009 | pmid = 19366917 | pmc = 2668237 | doi = 10.1128/CMR.00044-08 }}</ref>  Dissemination without hyperinfection may present to a lesser degree the above and many other symptoms.{{citation needed|date=May 2021}}

Dissemination can occur many decades after the initial infection<ref name=pmid15099996>{{cite journal | vauthors = Gill GV, Beeching NJ, Khoo S, Bailey JW, Partridge S, Blundell JW, Luksza AR | title = A British Second World War veteran with disseminated strongyloidiasis | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 98 | issue = 6 | pages = 382–6 | date = June 2004 | pmid = 15099996 | doi = 10.1016/j.trstmh.2003.11.002 }}</ref> and has been associated with high dose [[corticosteroids]], [[organ transplant]], any other instances and causes of immunosuppression, [[HIV]],<ref name="Kramer1990">{{cite journal | vauthors = Kramer MR, Gregg PA, Goldstein M, Llamas R, Krieger BP | title = Disseminated strongyloidiasis in AIDS and non-AIDS immunocompromised hosts: diagnosis by sputum and bronchoalveolar lavage | journal = Southern Medical Journal | volume = 83 | issue = 10 | pages = 1226–9 | date = October 1990 | pmid = 2218668 | doi = 10.1097/00007611-199010000-00024 }}</ref><ref name="Gompels1991">{{cite journal | vauthors = Gompels MM, Todd J, Peters BS, Main J, Pinching AJ | title = Disseminated strongyloidiasis in AIDS: uncommon but important | journal = AIDS | volume = 5 | issue = 3 | pages = 329–32 | date = March 1991 | pmid = 2059374 | doi = 10.1097/00002030-199103000-00015 }}</ref> lepromatous [[leprosy]], tertiary [[syphilis]], [[aplastic anemia]], malnutrition, advanced [[tuberculosis]] and [[radiation poisoning]].<ref>{{cite journal | vauthors = Purtilo DT, Meyers WM, Connor DH | title = Fatal strongyloidiasis in immunosuppressed patients | journal = The American Journal of Medicine | volume = 56 | issue = 4 | pages = 488–93 | date = April 1974 | pmid = 4818417 | doi = 10.1016/0002-9343(74)90481-1 }}</ref>  It is often recommended that patients being started on immunosuppression be screened for chronic strongyloidiasis; however, this is often impractical (screen tests are sometimes unavailable) and in developed countries, the prevalence of chronic strongyloidiasis is minimal, so screening is usually not cost-effective, except in endemic areas.  The reality of global travel and the need for modern advanced healthcare, even in the so-called "developed world", necessitates that in non-endemic areas there is easily accessible testing and screening for neglected tropical diseases such as strongyloidiasis.{{citation needed|date=May 2021}}

There is not necessarily any eosinophilia in the disseminated disease. The absence of eosinophilia in an infection limited to the gastrointestinal tract may indicate a poor prognosis.<ref>{{cite journal |doi=10.5001/omj.2010.47 |first1=Uday A. |last1=Gokhale |first2=G. Rajasekharan |last2=Pillai |first3=Said |last3=Al-Mammari |first4=Dhia |last4=Al-Layla |title=Hyperinfection by Strongyloides Stercoralis |journal=Oman Medical Journal |year=2010  |volume=25 |issue=2 |pages=163–6 |url= http://www.omjournal.org/CaseReports/FullText/201004/HyperinfectionbyStrongyloidesStercoralis.html |doi-broken-date=1 November 2024 }}</ref> Eosinophilia is often absent in disseminated infection. Steroids will also suppress eosinophilia while leading to dissemination and potential hyperinfection.{{citation needed|date=May 2021}}

Escalated disseminated infections caused by immunosuppression can result in a wide variety and variable degree of disparate symptoms depending on the condition and other biological aspects of the individual, that may emulate other diseases or diagnoses. In addition to the many palpable gastrointestinal and varied other symptoms drastic [[cachexia]] amidst lassitude is often present, although severe disseminated infections can occur in individuals without weight loss regardless of [[body mass index]].{{citation needed|date=November 2018}}