Warm/temperate regions including southeast US, tropics/subtropics including Asia/Southeast Asia
Larvae enter thru feet/skin if walk barefoot in soil w/infected feces→ enter skin, where they can cause itching→ travel to lung→ penetrate alveoli and travel up trachea→ cough and then swallowed→ travel to and live in small intestine
Risk Factors
Visit to/living in endemic region: Asia, Southeast Asia, Caribbean (tropics/subtropics), Southeast US
Symptoms
Most carry life-long w/o any sx
Non-compromised hosts can have vague sx including cough, epigastic pain, nausea, vomiting, weakness, watery diarrhea, constipation, malabsorption, headache/meningitis-like sx, weight loss, sub-acute wasting
Can cause life threatening hyper-infxn syndrome w/systemic symptoms if compromised from glucocorticoids, malignancy, HTLV-1 or organ transplant
Physical Exam Findings
Sometimes serpiginous red erruption from migrating larva under skin