CATMAT statement on disseminated strongyloidiasis: Prevention, assessment and management guidelines

Boggild, Andrea K.; Libman, Michael; Greenaway, Christina; McCarthy, Anne; Travel,

doi:10.14745/ccdr.v42i01a03

Cited by 71 publications

(134 citation statements)

References 25 publications

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“…Strongyloides infections can disseminate following immunosuppression and cause a severe and frequently fatal disease [94]. Screening for Strongyloides is now recommended prior to initiating immunosuppressive medications in patients who have spent significant time in endemic countries [95]. Similarly, neurocysticercosis should be considered in those with seizure disorders from endemic countries, even if they have not visited an endemic region in many years.…”

Section: Clinical Implications Of Infections Transmitted Via Air Travelmentioning

confidence: 99%

Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel

Findlater

Bogoch

2018

Trends in Parasitology

239

168

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Greater human mobility, largely driven by air travel, is leading to an increase in the frequency and reach of infectious disease epidemics. Air travel can rapidly connect any two points on the planet, and this has the potential to cause swift and broad dissemination of emerging and re-emerging infectious diseases that may pose a threat to global health security. Investments to strengthen surveillance, build robust early-warning systems, improve predictive models, and coordinate public health responses may help to prevent, detect, and respond to new infectious disease epidemics.

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Section: Clinical Implications Of Infections Transmitted Via Air Travelmentioning

confidence: 99%

Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel

Findlater

Bogoch

2018

Trends in Parasitology

239

168

View full text Add to dashboard Cite

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“…No studies describing empiric prophylaxis for Strongyloides were identified in our review. Several organisations including the Brazilian Society of Rheumatology, the Centres for Disease Control and Prevention and the Canadian Committee to Advise on Tropical Medicine and Travel recommend screening and considering empiric prophylaxis prior to immunosuppressive therapy for patients residing in endemic areas or returned travellers with potential Strongyloides exposure . This is particularity relevant if there are clinical manifestations such as unexplained eosinophilia, urticarial or serpiginous skin lesions, pulmonary or gastrointestinal symptoms, or if additional corticosteroids or other immunosuppressive agents are indicated urgently.…”

Section: Discussionmentioning

confidence: 99%

Methotrexate exposure and risk of strongyloidiasis

Richards

Penner

Colmegna

et al. 2019

Tropical Med Int Health

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Objective Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (MTX) have increased infection rates. Strongyloides, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious Strongyloides infection with MTX dosed for rheumatologic disease is unknown. Methods We performed a systematic literature review searching EMBASE, Medline and Web of Science databases. All studies reporting humans exposed to MTX and tested for Strongyloides were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and MTX exposure completed >1 year prior to clinically apparent Strongyloides disease. Results After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest had a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low‐dose MTX; 75% high‐dose MTX). Death occurred in 34% of cases (19% low‐dose MTX; 75% high‐dose MTX, P < 0.01). All eight patients on high‐dose MTX received other immunosuppressants. Corticosteroids were taken in 18/21 patients on low‐dose MTX. One of the three patients on MTX monotherapy had hyperinfection syndrome. None had disseminated Strongyloides. Conclusions Serious Strongyloides infection can occur with low‐dose MTX particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low‐ to middle‐income countries will increase the exposure of individuals prescribed MTX (with or without corticosteroids) to Strongyloides. Strongyloides screening and treatment should be considered for individuals receiving low‐dose MTX therapy, particularly if combined with additional immunosuppression.

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“…An alternative to ivermectin is albendazole; however, efficacy may be lower for this agent 16. In patients with disseminated infection, treatment guidelines recommend prolonged courses of ivermectin alone17 or in conjunction with albendazole18 until symptoms resolve and serial stool examinations return negative. In immunocompromised hosts, treatment may require prolonged courses of ivermectin 12 19.…”

Section: Discussionmentioning

confidence: 99%

Strongyloides hyperinfection syndrome in an immunocompetent host resulting in bandemia and death

et al. 2017

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infection is usually asymptomatic but can result in a hyperinfection syndrome, most commonly triggered by acquired or iatrogenic immunosuppression. Here, we present a case of a man aged 60 years originally from a strongyloides endemic area with a medical history of alcohol abuse who presents with strongyloides hyperinfection syndrome (SHS) complicated by partial small bowel obstruction, pulmonary haemorrhage, large bandemia without eosinophilia and cardiac arrest resulting in death. This case is notable for the presence of bandemia and absence of eosinophilia, lack of historical risk factors for hyperinfection, specifically corticosteroid immunosuppressants, and dramatic decline in clinical status which ultimately resulted in the patient's death. Clinicians should suspect SHS in immunocompetent patients who are from an endemic area and who have persistent gastrointestinal and/or pulmonary manifestations in the absence of a clear cause.

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CATMAT statement on disseminated strongyloidiasis: Prevention, assessment and management guidelines

Abstract: Background: Strongyloides stercoralis is a parasitic nematode found in humans, with a higher prevalence in tropical and sub-tropical regions worldwide. If untreated, the infection can progress to disseminated strongyloidiasis, a critical illness which may be fatal.

Cited by 71 publications

References 25 publications

Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel

Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel

Methotrexate exposure and risk of strongyloidiasis

Strongyloides hyperinfection syndrome in an immunocompetent host resulting in bandemia and death

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