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Strongyloidiasis in Veterans-Reply

Robert M. Genta, MD; Peter D. Walzer, MD; Robert E. Weesner, MD
JAMA. 1987;258(22):3259. doi:10.1001/jama.1987.03400220058032.
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In Reply.—  We agree with Byard and colleagues that the clinical manifestations of disseminated strongyloidiasis are helpful in suggesting the diagnosis. However, our study was designed to evaluate the usefulness of serology for the detection of chronic, nondisseminated infections, which often remain undiagnosed for a long time precisely because of their few and nonspecific manifestations.The high prevalence of larva currens found in British,1 Australian,2 and American3 former prisoners of war who worked on the Burma-Thai railroad contrasts with the virtual absence of this dermatitis in patients with documented S stercoralis infections presumably acquired on the American continent.4 We have suggested that the existence of separate geographic strains of the parasite may account for this difference,5 but further studies are needed to test this hypothesis.Based on their Tasmanian experience, Byard and colleagues correctly stress the importance of maintaining a high index of suspicion when


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