STRONGYLOIDES The clinical disease may be classified as cutaneous, pulmonary and intestinal. The overwhelming severe disease seen in the immunocompromised is known as hyperinfection. Cutaneous There may be a dermatitis, with erythema and itching at the site of penetration of the filariform larvae, paicularly when large numbers of larvae enter the skin. In those sensitised by prior infection, there may be an allergic response. This may prevent circulation in the blood of the larvae, which may instead migrate in skin, leading to a form of creeping eruption or larva migrans. Pulmonary During escape of the larvae from the pulmonary capillaries into the alveoli, small haemorrhages occur, along with cellular infiltration into alveoli and bronchioles. Larvae may be found in the sputum. Intestinal The symptoms may resemble those of peptic ulcer or of malabsorption syndrome. Mucus diarrhoea is often present. In heavy infection, the mucosa may be honeycombed with the worm and there may be extensive sloughing, causing dysenteric stools. Hyperinfection In debilitated individuals, and paicularly in those with cellular immune defects, extensive internal reinfection takes place, leading to enormous numbers of adult worms in the intestines and lungs, and larvae in various tissues and organs. This is known as hyperinfection. Severe malnutrition, lepromatous leprosy, lymphoreticular malignancies, AIDS, immunosuppressive drugs and other situations in which cellmediated immunity is defective, predispose to this condition. Hyperinfection is an impoant hazard of steroid therapy and other instances of prolonged immunosuppression as in tansplant patients. Manifestations depend on the sites affected. Brain abscess, meningitis and peritonitis are major fatal complications. TEXTBOOK OF MEDICAL PARASITOLOGY;CKJ PANIKER;6TH EDITION;PAGE NO 173