Strongyloides

Overview

Strongyloides stercoralis is a soil-transmitted helminth with a unique ability to cause autoinfection, allowing it to persist for decades in the host. This makes it particularly important to diagnose and treat in refugees.

Why It Matters

Strongyloides can cause hyperinfection syndrome and disseminated disease in immunocompromised patients (especially those on corticosteroids), which has high mortality.

Screening

• Strongyloides serology is recommended
• Stool examination has low sensitivity
• Eosinophilia may be present but is not always seen

Treatment

Ivermectin is the treatment of choice:

• 200 mcg/kg daily for 2 days
• Repeat in 2 weeks for immunocompromised patients

Before starting immunosuppression: Always screen for and treat strongyloides in patients from endemic areas before initiating corticosteroids or other immunosuppressive therapy.