Outside of the body Strongyloides resides in the soil, so walking barefoot is a strong risk factor for infection since larvae can directly penetrate exposed skin.

The parasite predominately causes a disease of the bowel but is also known to cause dermatological complications. 

Most infected people have no symptoms or signs, but some experience perianal pruritus and develop perianal excoriations from scratching. 

However the infection can become chronic through persitenct infection and mimicing peptic ulcer and gallbladder disease

Symptoms of chronic strongyloidiasis
  • Asymptomatic or vague abdominal discomfort (most patients)
  • Abdominal pain, burning, and cramping (sometimes worse after eating)
  • Intermittent diarrhea (eg, alternating with constipation
  • Occasional nausea and vomiting
  • Weight loss (if heavier infestation)
  • Recurrent maculopapular or serpiginous rashes (larva currens)

Disseminated strongyloidiasis

Disseminated strongyloidiasis occurs when patients with chronic strongyloidiasis become immunosuppressed. It presents with abdominal pain, distension, shock, pulmonary and neurologic complications and septicemia, and is potentially fatal.

Dissemination can occur many decades after the initial infection and has been associated with 

  • high dose corticosteroids
  • organ transplant
  • HIV
  • lepromatous leprosy 
  • tertiary syphilis 
  • aplastic anemia
  • malnutrition
  • tuberculosis 
  • radiation poisoning
Symptoms of severe strongyloidiasis
  • Insidious and occasionally abrupt onset
  • Nausea, vomiting, and severe abdominal pain
  • Diarrhea, occasionally bloody
  • Cough, hemoptysis, dyspnea, and wheezing
  • Stiff neck, headache, and confusion (if CNS involvement)
  • Rash
  • Fever, chills