Parasitologists of MeFi: Has my friend had strongyloidiasis 40+ years?
October 2, 2023 10:29 AM   Subscribe

Friend's dad worked for the US state department; she spent a few years in Peru where she got infected with some kind of intestinal worm and stayed infected a long time. Now she has gastroparesis. Except... ...does she? Maybe she has lifelong strongyloidiasis. Is this totally improbable? Possible? Highly possible...? Should she pester her GP about it?

YANMD, TINMA, IANETPIQ, et al. (you are not my doctor; this is not medical advice; I am not even the patient in question; all other applicable disclaimer acronyms)

She apparently had this infection for years in Peru but nobody did anything about it until she'd been back stateside for a good long time because, as is apparently typical with Strongyloides stercoralis, there was nothing definite, just intermittent amorphous gastric symptoms and pronounced bloating.

NOTE: there is no confirmation that it was definitely Strongyloides stercoralis; it could've been pinworms or something. Friend, however, reports that, as a very young child in Peru, she noticed a tiny white worm on her hand attempting to burrow into the skin. She flicked it away and thought no more about it, but then years later when she got up to flush the toilet and was startled by the sight of a bunch of worms in her stool, she immediately remembered the worm attempting to tunnel into her hand because they appeared identical. That sequence would appear to suggest Strongyloides stercoralis, a freaky punkrock burrowing worm, not some rando snorefest ingested worm.

Friend is now ~fifty years old, and this all happened when she was very young. She'd've been wormed with whatever they were using in the 1970s. According to what I'm duckduckgo-ing, it's entirely possible they didn't do multiple post-treatment screenings to test to be sure it was effective. And screenings in the 70s were not failsafe. Screenings now apparently are not failsafe, though there are more and better options.

This article said "S. stercoralis is unique in its ability to replicate in the human host permitting ongoing cycles of autoinfection. Strongyloidiasis can consequently persist for decades without further exposure to exogenous infection." So if she was treated in the 1970s with something wimpy that knocked it back but didn't eliminate it entirely ("Albendazole at a dose of 10 mg/kg/d can be used as an alternative if nothing else is available as it has a lower efficacy [38–45%]"), perhaps she's had it this entire time just constantly getting autoinfected again and again and being rendered unable to digest anything and feeling sick a whole lot of the time. A lot of the symptoms of chronic strongyloidiasis look similar to those of gastroparesis: epigastric pain, postprandial fullness, heartburn, and brief episodes of intermittent diarrhea and constipation (emphasis added).

Before I start blabbing all this at her face and giving her a bunch of false hope/insurmountable horror (because really? intestinal worms...? This whole time???) is it even remotely possible this could be the case? And if it is, how does she go about getting screened and getting care?
posted by Don Pepino to Health & Fitness (4 answers total)
 
Yes, you can have a strongyloides infection that lasts indefinitely, because it reinfects you as it passes through your intestine or out of you (here's a case of a man infected for 75 years). The path to determine if a possible strongyloides infection is the cause of your friend's symptoms is to get a test and then get treated to see if it helps. The blood tests now are fairly accurate and the standard treatment is just a couple doses of ivermectin. This is not a big deal to test and treat and completely reasonable to ask for.

That said, strongyloides are very small (up to 1mm), which might not match your friend's memory as it is quite tiny. Gastroparesis is also very common.

Strongyloides is also common throughout the world and your friend could easily have been infected with it if they've ever been in Mexico or many other warm places.
posted by ssg at 10:58 AM on October 2, 2023 [1 favorite]


Another factor to consider is that the larval form that strongyloides takes when you excrete it is even smaller than 1mm (about a third of a mm), so it seems unlikely that this was what your friend saw in their feces. A larger worm seems like a more likely candidate.
posted by ssg at 1:21 PM on October 2, 2023


Epidemiologist here. It is trivial to test for and treat strongyloidiasis. Unless this person is somewhere that makes testing and treatment difficult, this is a good conversation for them to have with a physician. This probably isn't the easy answer for her clinical situation today, but, again, her medical team can and should hear any relevant concerns (especially as they relate to medical histories that may be a bit less common in an average GP's patient pool, like this person's story).
posted by late afternoon dreaming hotel at 1:32 PM on October 2, 2023 [8 favorites]


Response by poster: Okay, so it sounds like if she could actually see the worms, they couldn't have been Strongyloides. Dang. I was so hoping it would turn out she didn't have gastroparesis after all.
posted by Don Pepino at 7:48 PM on October 2, 2023


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