CDC MMWR - An Increase in Strongyloidiasis Cases in LA

According to CDC's MMWR weekly report, there has been an increase in the number of cases of Strongyloidiasis in LA County, California.  While there were none in 2012, there were 14 cases in 2013 and 29 cases in 2014.

So what the heck is strongyloidiasis?  Just because you wanted to know.......

So, there you are out tending your garden (or whatever they do in LA where one has their hands in the soil), and this little parasitic worm burrows into your skin and then finds its way to your intestines where it creates a never-ending maternity ward for more parasitic worms.  Isn't that a pleasant thought.

Strongyloidiasis is a disease caused by a nematode, or a roundworm, in the genus Strongyloides. While there are a number of species of this roundworm that can infect birds, reptiles and such, Strongyloides stercoralis is the primary species that infects humans. The larvae are only about 1.5mm in length and are found in the soil. "When the larvae come in contact with skin, they are able to penetrate it and migrate through the body, eventually finding their way to the small intestine where they burrow and lay their eggs and these eggs hatch into larvae in the intestine. Most of these larvae will be excreted in the stool, but some of the larvae may molt and immediately re-infect the host either by burrowing into the intestinal wall, or by penetrating the perianal skin. This characteristic of Strongyloides is termed auto-infection. The significance of auto-infection is that unless treated for Strongyloides, persons may remain infected throughout their lifetime."
"The majority of people infected with Strongyloides are without symptoms. Those who do develop symptoms tend to have non-specific, or generalized complaints. Some people develop abdominal pain, bloating, heartburn, intermittent episodes of diarrhea and constipation, a dry cough, and rashes. Rarely people will develop arthritis, kidney problems, and heart conditions."

"In the United States, Strongyloides has classically been associated with uniformed-service veterans who returned from tropical regions such as Southeast Asia and the South Pacific during World War II. Small domestic studies have shown locations of infection in rural Appalachia. The highest rates in the United States have been documented in immigrant populations."



CDC - MMWR
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a8.htm?s_cid=mm6433a8_e
Increase in Reports of Strongyloides Infection — Los Angeles County, 2013–2014
Weekly
August 28, 2015 / 64(33);922-923
Curtis Croker, MPH1; Rosemary She, MD2

During the 1990s, reports of infection with the nematode (roundworm) Strongyloides stercoralis submitted to the Los Angeles County Department of Public Health (LACDPH) ranged from 40 to 50 per year, but by 2000, reports had decreased to five per year; in 2006, Strongyloides infection was removed from the LACDPH reportable disease list. Currently, it is only reported at the discretion of Los Angeles County clinicians and laboratories as an unusual disease occurrence. LACDPH currently only monitors case counts and does not investigate reported Strongyloides cases. During 2013–2014, an increase in Strongyloides cases occurred, with 43 cases reported.