Clinical Characteristics of Patients Diagnosed with Strongyloidiasis in a United States Urban Outpatient Dermatology Department: A Case Series

Main Article Content

Jacqueline Watchmaker
Sean Legler
Dianne de Leon
Vanessa Pascoe
Robert Stavert


strongyloidiasis, eosinophilia, serology, parasite, pruritus


Background: Although considered a tropical disease, strongyloidiasis may be encountered in non-endemic regions, primarily amongst immigrants and travelers from endemic areas.  Chronic strongyloides infection may be under-detected owing to its non-specific cutaneous presentation and the low sensitivity of commonly used screening tools.

Methods: 18 consecutive patients with serologic evidence of strongyloides infestation who presented to a single urban, academic dermatology clinic between September 2013 and October 2016 were retrospectively included.  Patient age, sex, country of origin, strongyloides serology titer, absolute eosinophil count, presenting cutaneous manifestations, and patient reported subjective outcome of pruritus after treatment were obtained via chart review. 

Results: Of the 18 patients, all had non-specific pruritic dermatoses, 36% had documented eosinophila and none were originally from the United States. A majority reported subjective improvement in their symptoms after treatment.

Conclusion:  Strongyloides infection and serologic testing should be considered in patients living in non-endemic regions presenting with pruritic dermatoses and with a history of exposure to an endemic area.

Key Points:

  • Chronic strongyloidiasis can be encountered in non-endemic areas and clinical manifestations are variable
  • Eosinophilia was not a reliable indicator of chronic infection in this case series 
  • Dermatologists should consider serologic testing for strongyloidiasis in patients with a history of exposure and unexplained pruritus


1. Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, et al. Soil transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367:1521-1532.

2. Puthiyakunnon S, Boddu S, Li Y, et al. Strongyloidiasis-An Insight into Its Global Prevalence and Management. PLoS Negl Trop Dis. 2014;8:3018.

3. Genta RM. Global prevalence of strongyloidiasis: critical review with epidemiologic insights into the prevents of disseminated disease. Rev Infect Dis. 1989;11:755-767.

4. Montes M, Sawhney C, Barros N. Strongyloides stercoralis: there but not seen. Curr Opin Infect Dis. 2010;23:500-504.

5. Einsiedel L, Spelman D. Strongyloides stercoralis: risks posed to immigrant patients in an Australian tertiary referral centre. Intern Med J. 2006 Oct;36:632-7.

6. Grove D. Human strongyloidiasis. Adv Parasitol. 1996;38:251-309.

7. DeMessias IT, Telles FQ, Boaretti AC, et al: Clinical, immunological and epidemiological aspects of strongyloidiasis in an endemic area of Brazil . Allergol Immunopathol. 1987;15:37-41.

8. Corsini AC. Strongyloidiasis and chronic urticarial. Postgrad Med J. 1982;58:247-248.

9. Nielsen PB, Mojon M. Improved diagnosis of strongyloides stercoralis by seven consecutive stool specimens. Sentralbl Bakeriol Mikrobiol Hyg. 1987;263:616-618.

10. Loutfy M, Wilson M, Keystone J, Kain K. Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area. Am J Trop Med Hyg. 2002;66:749-752.

11. Payne M, Osgood R, Brown A. An unexpected epidemic: schistosomiasis and strongyloides infections detected in an academic urban community GI practice. A case series of 104 patients. J Gastroenterol Hepatol. 2013;1:76-86.

12. Grove DI. Strongyloidiais: a major roundworm infection of man. London, UK: Taylor and Francis; 1989.