Evidence-Based Guidelines for Screening and Management of Strongyloidiasis in Non-Endemic Countries

Abstract

Strongyloidiasis is an intestinal parasitic infection becoming increasingly important outside endemic areas, not only because of the high prevalence found in migrant populations, but also because immunosuppressed patients may suffer a potentially fatal disseminated disease. The aim of these guidelines is to provide evidence-based guidance for screening and treatment of strongyloidiasis in non-endemic areas. A panel of experts focused on three main clinical questions (who should be screened and how, how to treat), and reviewed pertinent literature available in international databases of medical literature and in documents released by relevant organizations/societies. A consensus of the experts' opinion was sought when specific issues were not covered by evidence. In particular, six systematic reviews were retrieved and constituted the main support for this work. The evidence and consensus gathered led to recommendations addressing various aspects of the main questions. Grading of evidence and strength of recommendation were attributed to assess the quality of supporting evidence. The screening of individuals at risk of the infection should be performed before they develop any clinical complication. Moreover, in immunosuppressed patients, the screening should be mandatory. The screening is based on a simple and widely accessible technology and there is now a universally accepted treatment with a high efficacy rate. Therefore, the screening could be implemented as part of a screening program for migrants although further cost-effectiveness studies are required to better evaluate this strategy from a public health point of view.

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

“…Screening should also be considered in patients with unknown Strongyloides serology status undergoing augmentation of immunosuppression (in particular high‐dose steroids) for the treatment of acute rejection. Recently published evidence‐based guidelines for screening and management of strongyloidiasis in non‐endemic countries state that in immunosuppressed patients with epidemiological risk of exposure, the screening should be mandatory . Current guidelines of the American Society of Transplantation (AST) recommend evaluation for Strongyloides infection be strongly considered in transplant candidates and donors with epidemiologic risk factors, that is, born in or had traveled to a Strongyloides ‐endemic areas for any period of time or unexplained eosinophilia .…”

Post‐transplant liver graft schistosomiasis in a migrant from Sub‐Saharan Africa

“…We may speculate that following the “surgical trauma” related to the transplant intervention, the shed eggs produced by adult worms could have migrated in an unusual manner reaching the liver. The occurrence of schistosomiasis and other parasitic diseases such as strongyloidiasis and Chagas disease in non‐endemic areas warrants implementation of screening protocols for donors and recipients with a history of exposure in endemic areas …”

“…The occurrence of schistosomiasis and other parasitic diseases such as strongyloidiasis and Chagas disease in non-endemic areas warrants implementation of screening protocols for donors and recipients with a history of exposure in endemic areas. [14][15][16] Screening for schistosomiasis and strongyloidiasis in all immigrants from endemic to non-endemic countries is recommended from several guidelines independently on possible transplantation and other concurrent medical issues to early intercept the infection, treat it, and prevent possible complications. [17][18][19]…”

Decrease in eosinophilia as a marker of response to therapy in solid organ transplant candidates with Strongyloides infection: A single‐center experience

“…1 Solid organ transplant (SOT) patients are at risk for hyperinfection syndrome and disseminated infection with high mortality rates. 2,3 Pre-transplant screening is recommended in SOT candidates with epidemiological risk factors, and treatment indicated in those who test positive. 3,4 As of yet, there is no well-established objective means to assess treatment response in SOT candidates with Strongyloides infection in SOT candidates.…”

“…2,3 Pre-transplant screening is recommended in SOT candidates with epidemiological risk factors, and treatment indicated in those who test positive. 3,4 As of yet, there is no well-established objective means to assess treatment response in SOT candidates with Strongyloides infection in SOT candidates. The sensitivity of parasitological stool examination is low.…”