Screening for Strongyloides
Screening for Strongyloides
Background: Strongyloidiasis is an intestinal helminthic infection common among the mentally disabled population and can cause persistent occult infection before resulting in disseminated, possibly fatal disease.
Methods: Two cases of strongyloidiasis are described. The literature was searched using the key words "Strongyloides" and "mass screening."
Results and Conclusion: Strongyloidiasis is clinically important and well documented in the mentally disabled populations both in endemic and nonendemic regions of North America. It has a substantial latent phase during which screening can be conducted, and its treatment with thiabendazole is convenient, effective, and reasonably well tolerated. Although strongyloidiasis is usually incidentally detected by findings of eosinophilia during routine blood screening, peripheral eosinophilia occurs only in 50% to 80% of infected persons and is extremely nonspecific for Strongyloides infection. Given the high cost of critical care for a patient with disseminated disease, screening mentally disabled populations in institutional settings for strongyloidiasis by administering the Strongyloides stercoralis antibody ELISA appears justifiable, particularly if risk factors for hyperinfection syndrome are used to select a subpopulation to be screened.
Strongyloidiasis is an intestinal helminthic infection that is prevalent among the North American mentally disabled population, including among those living in institutional settings. It can cause persistent occult infection for decades before potentially resulting in disseminated, possibly fatal disease. The issue of systematic screening for this infection among this population has not been well addressed. Most clinicians stumble on asymptomatic strongyloidiasis as illustrated in the examples that follow. Family physicians often care for such populations of patients and are perhaps uniquely equipped to address issues of screening among them. Strongyloidiasis appears to be common enough to make screening worthwhile.
Background: Strongyloidiasis is an intestinal helminthic infection common among the mentally disabled population and can cause persistent occult infection before resulting in disseminated, possibly fatal disease.
Methods: Two cases of strongyloidiasis are described. The literature was searched using the key words "Strongyloides" and "mass screening."
Results and Conclusion: Strongyloidiasis is clinically important and well documented in the mentally disabled populations both in endemic and nonendemic regions of North America. It has a substantial latent phase during which screening can be conducted, and its treatment with thiabendazole is convenient, effective, and reasonably well tolerated. Although strongyloidiasis is usually incidentally detected by findings of eosinophilia during routine blood screening, peripheral eosinophilia occurs only in 50% to 80% of infected persons and is extremely nonspecific for Strongyloides infection. Given the high cost of critical care for a patient with disseminated disease, screening mentally disabled populations in institutional settings for strongyloidiasis by administering the Strongyloides stercoralis antibody ELISA appears justifiable, particularly if risk factors for hyperinfection syndrome are used to select a subpopulation to be screened.
Strongyloidiasis is an intestinal helminthic infection that is prevalent among the North American mentally disabled population, including among those living in institutional settings. It can cause persistent occult infection for decades before potentially resulting in disseminated, possibly fatal disease. The issue of systematic screening for this infection among this population has not been well addressed. Most clinicians stumble on asymptomatic strongyloidiasis as illustrated in the examples that follow. Family physicians often care for such populations of patients and are perhaps uniquely equipped to address issues of screening among them. Strongyloidiasis appears to be common enough to make screening worthwhile.
Source...