Strongyloides — SCE Infectious Diseases MCQ

Correct answer: C — Treat with ivermectin before or at the start of immunosuppression to prevent hyperinfection after review

The best answer is “Treat with ivermectin before or at the start of immunosuppression to prevent hyperinfection after review”. Strongyloides can persist through autoinfection for decades and corticosteroids can precipitate fatal dissemination; pre-emptive treatment is therefore critical. “Ignore the result because asymptomatic infection cannot persist” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use praziquantel because all helminths respond identically” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Wait for eosinophilia after corticosteroids before treating” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use metronidazole to eradicate autoinfection” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: WHO strongyloidiasis guideline: https://www.who.int/publications/i/item/9789240113930