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Strongyloides stercoralis

Summary of Strongyloides stercoralis
Strongyloides stercoralis, thread worm, is a human pathogenic parasitic nematode (roundworm) causing the disease strongyloidiasis. The adult parasitic stage lives in tunnels in the mucosa of the small intestine and is contracted from larvae in the soil that penetrate the skin. Symptoms include vomiting, diarrhea, and a peptic ulcer-like pain epigastric pain. The drugs of choice are the benzimidazoles or ivermectin.

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Strongyloides stercoralis

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Strongyloides stercoralis

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or ivermectin are the first-line treatments for Strongyloides stercoralis.

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A 14-year-old girl comes to the office because of fatigue, anxiety, and balding for a month. Her parents are missionaries and note that her appetite has been odd roughly since they returned to the United States from a trip abroad. Among her odd behaviors, she has a new found craving for all things made of ice and the other day they say they caught her eating dirt. When questioned about her behavior the girl expresses shame but states that she does these things "almost compulsively." Examination shows a non-tender abdomen with areas of diffuse fullness, and palpebral pallor. Peripheral smear shows anisocytic, microcytic, hypochromic red blood cells. Eosinophilia and lymphocytosis are also shown. Iron studies show decreased transferrin, and decreased ferritin levels. A trichobezoar is retrieved on upper endoscopy. Which of the following is the most appropriate next step in treatment?

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