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Posttraumatic stress disorder — USMLE Step 2 CK MCQ

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HardPsychiatryPosttraumatic stress disorderUSMLE Step 2 CK

A man from rural Cambodia receiving high-dose glucocorticoids develops abdominal pain, diffuse pulmonary infiltrates and gram-negative bacteremia. Larvae are seen in sputum and stool, confirming Strongyloides hyperinfection. What is the preferred antiparasitic strategy?

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Correct answer: B — Give daily ivermectin until stool and sputum are negative for 2 weeks

Glucocorticoids can trigger accelerated autoinfection with disseminated Strongyloides, carrying enteric bacteria across the gut and causing pneumonia or sepsis. CDC recommends ivermectin 200 micrograms/kg daily in hyperinfection or dissemination until stool and sputum examinations are negative for 2 weeks; immunosuppression should be reduced or stopped if feasible, and bacterial complications treated. Single-dose regimens are for uncomplicated infection, albendazole is less effective, praziquantel targets other parasites, and treatment cannot wait for bacterial clearance.

Reference: CDC: Clinical care of Strongyloides. https://www.cdc.gov/strongyloides/hcp/clinical-care/index.html