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Strongyloidiasis
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of strongyloidiasis are prepared by our editorial team based on guidelines from the National Institutes of Health (NIH 2024), the Center for Disease Control (CDC 2020), the Infectious Diseases Society of America (IDSA 2018), and the Barcelona Institute for Global Health (BIGH 2017).
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Screening and diagnosis
Screening, indications
As per BIGH 2017 guidelines:
Obtain routine screening for strongyloidiasis in immunocompetent patients at high risk of exposure to Strongyloides stercoralis infection.
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Obtain routine screening for strongyloidiasis in immunosuppressed patients and candidates for immunosuppression at high or intermediate risk of exposure to Strongyloides stercoralis.
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Screening (choice of test)
Diagnostic investigations
Stool examination: as per CDC 2020 guidelines, obtain serial stool examinations as the gold standard for the diagnosis of Strongyloides infection.
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Serology
Diagnostic procedures
Endoscopy and biopsy: as per CDC 2020 guidelines, recognize that duodenal aspirate is more sensitive than stool examination, and duodenal biopsy may reveal parasites in the gastric crypts, in the duodenal glands, or eosinophilic infiltration in the lamina propria. Recognize that larvae can frequently be seen by a simple wet-mount in fluid from a bronchoalveolar lavage.
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Medical management
Specific circumstances
Patients with COVID-19 infection: as per NIH 2024 guidelines, consider administering prophylactic treatment with ivermectin in patients receiving a combination of dexamethasone and tocilizumab, coming from areas where strongyloidiasis is endemic, because the combination of dexamethasone and tocilizumab may increase the risk of opportunistic infections or reactivation.
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Patients with neurocysticercosis