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Strongyloides Pre-Steroid Eradication — SCE Infectious Diseases MCQ

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ModerateParasitologyStrongyloides Pre-Steroid EradicationSCE Infectious Diseases

A 50-year-old man with known Strongyloides stercoralis infection (from childhood in rural Brazil) is about to start Prednisolone 40 mg daily for an acute flare of Crohn disease. He has not received anti-helminthic treatment. What is the risk?

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Correct answer: E — Strongyloides hyperinfection syndrome — corticosteroids suppress the Th2 immune response that controls Strongyloides, allowing massive larval proliferation with dissemination to lungs, CNS, and bacteraemia from enteric organisms

Corticosteroids are the most common trigger of Strongyloides hyperinfection. They suppress the Th2/eosinophil-mediated immune response essential for controlling Strongyloides auto-infection. Even a short course of high-dose steroids can trigger hyperinfection with mortality >70%. This patient MUST receive Ivermectin (200 µg/kg daily for 2 days) to eradicate Strongyloides BEFORE starting Prednisolone. All patients from endemic areas should be screened (serology ± stool) before immunosuppressive therapy.

Reference: WHO 2022 – Strongyloides; ECIL 2019; BSR 2024 – Pre-immunosuppression screening