Pre-Immunosuppression Strongyloides — SCE Infectious Diseases MCQ

Correct answer: E — Treat with ivermectin before immunosuppression because negative stool microscopy does not exclude persistent infection after reassessment

The best answer is “Treat with ivermectin before immunosuppression because negative stool microscopy does not exclude persistent infection after reassessment”. Serology plus epidemiology identifies clinically important latent infection; immunosuppression can precipitate fatal hyperinfection even when stool sensitivity is low. “Wait for three positive stool samples before treating” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Treat only if eosinophilia develops” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Observe because asymptomatic infection cannot hyperinfect” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Use single-dose albendazole as the preferred eradication regimen” is less appropriate because it conflicts with the clinical discriminator or cited guidance.

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