Infection with soil borne nematodes of the genus Strongyloides, considered to be a parthenogenetic parasitic female. Larvae passed to the soil develop through four larval instars to form free-living adults or develop from first and second free-living stages into infective third-stage strongyliform or filariform larvae, which penetrate the skin or enter the buccal mucosa through drinking water. Infection can occur by larvae of a new generation developed in the soil (indirect cycle), by infective larvae developed without an intervening adult stage (direct cycle), or by larvae that develop directly in the feces within the intestine of the host, penetrate the mucosa, and pass by blood/lung sputum migration back to the intestine (autoreinfection); most serious human infections and nearly all fatalities result from autoreinfection and subsequent disseminated infection, which commonly follow immunosuppression by steroids, adrenocorticotropic, or other immunosuppressive agents. Autoreinfection also may develop in patients with AIDS.
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