Lifecycle

• Larvae penetrates skin

• Autoinfection: complete life-cycle in human (larvae hatch in intestine, penetrate intestinal mucosa and migrate to other organs e.g. lung)

• Infection may persist lifelong

Clinical features

• May be asymptomatic

• Larva currens

• Loffler's

• GI upset: diarrhoea, pain, nausea, anaemia

Hyperinfection syndrome (in immunosuppressed, or even small dose of corticosteroids [caution re COVID-19] or other immunosupressive)

• Pneumonia, meningitis, necrotising enterocolitis (severe diarrhoea, sepsis, death (60%)

• Eosinophilia may be absent

• Consider screening before giving steroids, treat with single dose of Ivermectin

Diagnosis

• Faecal OCP

• Eosinophila (may be absent)

• Larvae in sputum/tissues (hyperinfection)

• Serology: can cross-react with others e.g. Hookworm?

Management

• Ivermectin (caution re Loa Loa endemic areas)

• Review immunosupp drugs

Prevention

• Sanitation, shoes

• MDA

• Treat and treat before immunosuppression

Historical aspects

• Observed in British soldiers who presented later in life with hyperinfection syndrome

Small intestine: all stages, adults, larvae, eggs