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Strongyloidiasis before immunosuppression — RACP Adult Medicine MCQ

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HardInfectious diseasesStrongyloidiasis before immunosuppressionRACP Adult Medicine

A 63-year-old man from rural northern Queensland is due to start high-dose corticosteroids for vasculitis. He has intermittent eosinophilia and vague abdominal symptoms. Strongyloides serology is positive. What is the most appropriate management?

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Correct answer: E — Treat with ivermectin before or with immunosuppression where feasible

Strongyloides can cause fatal hyperinfection with corticosteroids, so ivermectin treatment is required when infection is detected or strongly suspected. A single negative stool test does not exclude infection. Waiting for hyperinfection, withholding treatment or using praziquantel is unsafe.

Reference: Therapeutic Guidelines (eTG) Antibiotic; Australian immigrant/refugee health guidance