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The epidemiologic features of Strongyloides stercoralis infection in Kentucky were studied by an analysis of clinical cases at the University of Kentucky Medical Center (UKMC); by an analysis of parasitologic records of the Kentucky Bureau for Health Services (KBHS); and by a prospective stool survey of school children in Clay County, located in southeastern Kentucky, an area of the state previously found to be highly endemic for intestinal parasites. S. stercoralis was the most common parasitic infection diagnosed at UKMC. The patients were predominantly white male adults who were over 50 years old, had an associated chronic or debilitating medical illness, were of low socioeconomic background, and resided in southeastern Kentucky. S. stercoralis was a common parasitic infection at KBHS and the patients showed a similar geographic distribution. Of 561 Clay County children surveyed, 23.7% harbored one or more intestinal parasite pathogens and 3.0% had S. stercoralis. Thus, S. stercoralis remains highly endemic in Kentucky and may cause disease even in geriatric patients.