Strongyloidiasis in a Rural Setting — Southeastern Kentucky, 2013

Strongyloidiasis is caused by Strongyloides stercoralis, a parasitic nematode (worm). Initial symptoms can include abdominal pain, diarrhea, or rash. Infection is often asymptomatic in the chronic phase but can be life-threatening in immunosuppressed persons. Transmission typically occurs when larvae from stool-contaminated soil penetrate skin; intraintestinal autoinfection is also possible, sometimes allowing infection to persist for decades. Serologic studies are often used in prevalence estimates because intermittent shedding can make stool-based testing insensitive. Strongyloidiasis is most common in tropical and subtropical environments with poor sanitation. In the United States, it is commonly reported among refugees and immigrants; in the 1980s, studies in the rural southeastern United States also reported prevalence estimates ranging from 1.2%-6.1%. Prevalence might have since decreased because of investments in sanitation; however, no recent studies have been done, and strongyloidiasis is not a reportable disease in any state.