Strongyloidiasis is infection with the roundworm Strongyloides stercoralis. It is unusual among human helminths because it can complete its entire life cycle inside one host, a process called autoinfection. Untreated infection can therefore persist for decades — cases have been documented in veterans more than 50 years after exposure. Ivermectin is the FDA-approved first-line treatment.
Because of autoinfection, strongyloidiasis does not clear on its own. If the host becomes immunosuppressed — most notably by corticosteroids, but also by HTLV-1 infection, transplantation or chemotherapy — the cycle can accelerate catastrophically into hyperinfection syndrome and disseminated strongyloidiasis, in which larvae spread throughout the body and carry Gram-negative bacteria with them. Mortality in disseminated disease is very high.
This is why screening and eradication before starting steroids or immunosuppressive therapy is standard practice in anyone with a plausible exposure history, and why complete clearance rather than symptom improvement is the treatment goal.
The approved regimen for uncomplicated intestinal strongyloidiasis is 200 micrograms per kilogram once daily for two consecutive days. Some clinicians repeat the course at two weeks to cover the autoinfection cycle. Hyperinfection and disseminated disease require prolonged daily therapy under specialist supervision until larvae are undetectable.
Comparative trials and systematic reviews consistently favour ivermectin. Ivermectin achieves parasitological cure in roughly 80 to 95 percent of cases, while albendazole performs considerably less well in this particular infection, with cure rates frequently reported below 50 percent. Ivermectin is therefore recommended as first-line by CDC, WHO and infectious disease guidelines, with albendazole reserved as an alternative.
Cure is confirmed by serology, which should decline substantially over 6 to 12 months, and by repeated stool examination. Because larval shedding is intermittent and often scanty, a single negative stool sample does not exclude infection — this is a common reason infections are missed.
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View products and pricingYes. Intestinal strongyloidiasis is one of the two FDA-approved human indications for oral ivermectin, alongside onchocerciasis.
Yes, clearly so for this infection. Ivermectin achieves parasitological cure in roughly 80 to 95 percent of cases against frequently under 50 percent for albendazole, and is recommended first-line by CDC and WHO.
Because of autoinfection, decades. Documented cases include veterans diagnosed more than 50 years after their original exposure. The infection does not self-clear, which is why treatment is recommended even in people without symptoms.