Strongyloidiasis. The protean parasitic infection.

To turn a well-known phrase regarding history, those who forget to diagnose strongyloidiasis will be condemned to rediscover it. The often protean manifestations of this disease cannot be emphasized enough. The parasite's unique life cycle enables it to live for decades in an unsuspecting host, presenting with symptomatic disease only occasionally. Making a definitive diagnosis may be difficult and requires persistence. A good history should reveal whether a patient belongs to a high-risk group. The physician should strongly suspect the diagnosis when nonspecific cutaneous, pulmonary, and gastrointestinal symptoms coexist. Unexplained enteric bacteremia or meningitis may be important clues to diagnosing disseminated disease, which carries a high mortality rate. Therapy is available, and advances are being made to make it more tolerable. Follow-up for eradication is laborious yet essential: In patients at high risk for disseminated disease, invasive procedures may be warranted to prove eradication. Incomplete therapy puts the patient at further risk for significant complications in the future.