Editorial Strongyloides stercoralis Hyperinfection Syndrome: How Often is it Missed?

There has recently been an increase in awareness that infection with the intestinal helminth Strongyloides stercoralis can proceed to chronicity. Several reports have recorded infection lasting for 40 years or more in men who were formerly prisoners of war in south-east Asia during World War II [1-3]. In many members of this group, the infection is still present in 1987. 5. stercoralis is a small nematode occurring primarily in tropical and subtropical locations (especially west Africa, the Caribbean and south-east Asia); however it is also widely dis-tributed in eastern Europe, including Hungary, Romania, and southern areas of Poland and the USSR. A recent report of infection in a young woman at Nottingham strongly suggests that the parasite was acquired in a local recreational park [4]. Human infection is usually by penetration of intact skin by the filariform larvae which survive in moist soil contaminated with human faeces; this mode of transmission is exactly comparable with that of the hookworms Ankylostoma duodenale and Necator americanus [5, 6]. Infection by the faecal-oral route is also possible. Following a complex life-cycle in which the larvae migrate successively from the circulation to the lungs, trachea, and pharynx, they are swallowed and thence enter the small intestine where maturation to adult worms takes place whilst they are embedded in th