On arrival, they still complained of itching, episodes of cough, and weakness. P.F. also showed transient urticaria. Eosinophilia was still present (absolute count 8,270 mm−3, 55% for S.F. and 8,700 mm−3, 60% for P.F.). Rhabditoid larvae of S stercoralis were found in one of five stool samples provided click here by S.F. but in none of the five samples provided by P.F. (using

Ritchie’s fecal enrichment technique). Serology (an in-house IFAT for S stercoralis, with 97.4% sensitivity and 97.9% specificity),6 was positive, at minimum titer (ie, 1/20), only for S.F., whereas P.F. had a negative result. Fecal culture for S stercoralis resulted positive for both. Patients were treated with ivermectin, 200 µg/kg/d for 2 days, repeated after 1 month. All clinical signs disappeared. After 6 months, both patients were asymptomatic, with normal eosinophil count. Serology was found positive at minimum titer (1/20 ) in both patients 1 month after discharge and resulted

negative 3 and 6 months after treatment. We describe here the clinical and biological characteristics of acute strongyloidiasis, in a couple of travelers. This early invasive phase of human strongyloidiasis has never been reported in clinical settings, to our knowledge. Our two patients give the opportunity to more precisely describe this phase of the disease. Strongyloidiasis was probably acquired in Thailand Quizartinib where the disease prevalence, depending on the diagnostic technique and population under study, ranges from 2.3 to 19.2% (respectively in schoolchildren from West-Central Thailand and Thai workers who pursue overseas employment).7,8 Patients did not visit any other disease-endemic country before. We identified Koh Samui Island as the most likely site of infection. Indeed no bare skin exposure to humid soil was reported by the patients in Apulia where they came Protein kinase N1 from or during travel in Malaysia, Singapore, and Bangkok where the patients always wore shoes. In contrast, during the last 4 days spent in the tourist resort in Koh Samui Island, they reported walking barefoot on the

grass around the bungalow. As Koh Samui is a very important touristic place, we may assume that other exposed travelers could have similarly acquired strongyloidiasis, an infection which goes largely under-reported. Little is known about the clinical manifestations of acute strongyloidiasis. Freedman gives a description of experimental infections in humans.9 Interestingly, he noticed a transient skin reaction at the site of larval entry that appears almost immediately after exposure to the larvae and lasted 1 to 21 days depending on the study. Within 10 days after exposure, a larval migration syndrome or Loeffler’s-like syndrome with pulmonary symptoms (cough, tracheal irritation, and asthma) and skin signs (acute urticaria and itching) may occur.