title: [Disseminated strongyloidiasis: diagnosis and treatment].
abstract: OBJECTIVE
  Disseminated strongyloidiasis is a clinical form of presentation associated with states of severe immunosuppression, as in AIDS, hematological malignancies and in treatment for immunosuppression (especially with high doses of corticosteroids). It usually mimics severe sepsis and still brings a significant challenge related to the diagnosis and treatment. Therefore exceedingly high mortality rates remain unchanged in the past decades. Initially, the diagnosis depends on the clinical suspicion and on the identification of the larva in an organic fluids or tissues. The cutaneous involvement, albeit rare, is typical and can provide an important clue for the diagnostic hypothesis. The emergence of ivermectin for oral use changed significantly the treatment for strongyloidiasis; however, there are still shortcomings for the utilization in critically ill patients. Shock, ileus and hypoperfusion states are associated with difficulties in the absorption that result in erratic systemic levels. Reports of good results with parenteral administration of ivermectin raised the prospect that this therapeutic modality be more effective. However, questions about dosage and safety remain unanswered. The aim of the present article is to review the medical literature on the clinical aspects of disseminated strongyloidiasis.
  
  
  BACKGROUND
  A systematic review of the literature was performed by searching the PubMed database within the last 30 years. Search terms were: disseminated strongyloidiasis, strongyloides and hyperinfection e ivermectin.
  
  
  CONCLUSIONS
  The article highlights the diagnostic and therapeutic aspects emphasizing the importance of the clinical suspicion for the institution of appropriated therapy.
authors.affiliation: Instituto de Assistência aos Servidores do Estado do Rio de Janeiro.
authors.forename: Olívia Barberi
authors.initials: OB
authors.lastname: Luna
authors.affiliation: Instituto de Assistência aos Servidores do Estado do Rio de Janeiro.
authors.forename: Rossana
authors.initials: R
authors.lastname: Grasselli
authors.affiliation: Centro de Tratamento Intensivo, Instituto Nacional de Câncer.
authors.forename: Marcio
authors.initials: M
authors.lastname: Ananias
authors.affiliation: Centro de Tratamento Intensivo, Instituto Nacional de Câncer.
authors.forename: Tatiana Soares
authors.initials: TS
authors.lastname: Pinto
authors.affiliation: AMIB.
authors.forename: Fernando Augusto
authors.initials: FA
authors.lastname: Bozza
authors.affiliation: Centro de Tratamento Intensivo, Instituto Nacional de Câncer.
authors.forename: Márcio
authors.initials: M
authors.lastname: Soares
authors.affiliation: Centro de Tratamento Intensivo, Instituto Nacional de Câncer.
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh