Strongyloides — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesStrongyloidesRACP Adult Medicine

A 35-year-old woman from Southeast Asia presents with fever, rash, arthralgia, and eosinophilia. She has recently migrated to Australia. Stool microscopy shows rhabditiform larvae. Her IgE is markedly elevated. What organism is most likely responsible?

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Correct answer: D — Strongyloides stercoralis

Strongyloides stercoralis infection is endemic in Southeast Asia, tropical Australia, and among Aboriginal communities. Unlike other helminths, it can cause autoinfection and persist for decades. Eosinophilia with rhabditiform larvae on stool microscopy is diagnostic. Screening is essential before immunosuppression (corticosteroids) as Strongyloides hyperinfection syndrome (disseminated disease with Gram-negative sepsis) can be fatal. Ivermectin 200 mcg/kg for 2 days is first-line treatment.

Reference: eTG – 2025 – Antibiotic Guidelines; CDNA – 2024 – Strongyloides Guidelines