Strongyloidiasis screening: Difference between revisions
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{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Most fatal infections caused by S.stercoralis can be prevented by early detection and treatment of asymptomatic chronic infections. Screening is highly recommended to detect latent S.stercoralis infection before the start of chemotherapy or immunosuppression/steroid therapy in patients at risk. Repeated stool examination for ova and parasites or agar culture of stool may be the most appropriate approach. | Most fatal infections caused by ''[[Strongyloides stercoralis|S.stercoralis]]'' can be prevented by early detection and treatment of [[asymptomatic]] [[chronic]] [[Infection|infections]]. Screening is highly recommended to detect latent [[Strongyloides stercoralis|''S.stercoralis'']] infection before the start of [[chemotherapy]] or [[immunosuppression]]/[[steroid therapy]] in patients at risk. Repeated [[stool examination]] for [[ova]] and [[parasites]] or [[agar]] culture of stool may be the most appropriate approach. | ||
==Screening== | ==Screening== | ||
*Most fatal infections caused by S.stercoralis can be prevented by early detection and treatment of asymptomatic chronic infections.<ref name="pmid22691685">{{cite journal |vauthors=Mejia R, Nutman TB |title=Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis |journal=Curr. Opin. Infect. Dis. |volume=25 |issue=4 |pages=458–63 |year=2012 |pmid=22691685 |pmc=3430846 |doi= |url=}}</ref><ref name="pmid19700900">{{cite journal |vauthors=Al Maslamani MA, Al Soub HA, Al Khal AL, Al Bozom IA, Abu Khattab MJ, Chacko KC |title=Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases |journal=Ann Saudi Med |volume=29 |issue=5 |pages=397–401 |year=2009 |pmid=19700900 |pmc=2860402 |doi= |url=}}</ref><ref name="urlCDC - Strongyloides">{{cite web |url=https://www.cdc.gov/parasites/strongyloides/ |title=CDC - Strongyloides |format= |work= |accessdate=}}</ref> | *Most fatal infections caused by ''[[Strongyloides stercoralis|S.stercoralis]]'' can be prevented by early detection and treatment of [[asymptomatic]] [[chronic]] [[infections]].<ref name="pmid22691685">{{cite journal |vauthors=Mejia R, Nutman TB |title=Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis |journal=Curr. Opin. Infect. Dis. |volume=25 |issue=4 |pages=458–63 |year=2012 |pmid=22691685 |pmc=3430846 |doi= |url=}}</ref><ref name="pmid19700900">{{cite journal |vauthors=Al Maslamani MA, Al Soub HA, Al Khal AL, Al Bozom IA, Abu Khattab MJ, Chacko KC |title=Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases |journal=Ann Saudi Med |volume=29 |issue=5 |pages=397–401 |year=2009 |pmid=19700900 |pmc=2860402 |doi= |url=}}</ref><ref name="urlCDC - Strongyloides">{{cite web |url=https://www.cdc.gov/parasites/strongyloides/ |title=CDC - Strongyloides |format= |work= |accessdate=}}</ref> | ||
*Screening is highly recommended to detect latent S.stercoralis infection before the start of chemotherapy or immunosuppression/steroid therapy in patients at risk.<ref name="urlDepartment of Health | Prevention of opportunistic infections in immunosuppressed patients in the tropical Top End of the Northern Territory of Australia">{{cite web |url=http://www.health.gov.au/internet/main/publishing.nsf/content/cda-pubs-cdi-2003-cdi2704-htm-cdi2704s.htm |title=Department of Health | Prevention of opportunistic infections in immunosuppressed patients in the tropical Top End of the Northern Territory of Australia |format= |work= |accessdate=}}</ref> | *Screening is highly recommended to detect latent [[Strongyloides stercoralis|''S.stercoralis'']] infection before the start of [[chemotherapy]] or [[immunosuppression]]/[[steroid therapy]] in patients at risk.<ref name="urlDepartment of Health | Prevention of opportunistic infections in immunosuppressed patients in the tropical Top End of the Northern Territory of Australia">{{cite web |url=http://www.health.gov.au/internet/main/publishing.nsf/content/cda-pubs-cdi-2003-cdi2704-htm-cdi2704s.htm |title=Department of Health | Prevention of opportunistic infections in immunosuppressed patients in the tropical Top End of the Northern Territory of Australia |format= |work= |accessdate=}}</ref> | ||
*Repeated stool examination for ova and parasites or agar culture of stool may be the most appropriate approach. | *Repeated [[stool examination]] for [[ova]] and [[parasites]] or [[agar]] culture of stool may be the most appropriate approach. | ||
==Population at risk== | ==Population at risk== | ||
*In the U.S., residents of the Southeast may be at risk for strongyloidiasis by growing up in an endemic area. | *In the U.S., residents of the Southeast may be at risk for strongyloidiasis by growing up in an endemic area. | ||
*Travelers and armed forces personnel may acquire infection during overseas trips to endemic areas (eg, southeast Asia, Central and South America, and Africa). | *Travelers and armed forces personnel may acquire [[infection]] during overseas trips to [[Endemic|endemic areas]] (eg, southeast Asia, Central and South America, and Africa). | ||
*Refugees and immigrants from endemic areas | *Refugees and immigrants from endemic areas | ||
*Immunocompromised patients, especially on corticosteroid therapy, are the most vulnerable population at risk for developing disseminated disease. | *[[Immunocompromised|Immunocompromised patients]], especially on [[Corticosteroid medications|corticosteroid therapy]], are the most vulnerable population at risk for developing disseminated disease. | ||
*Efforts to diagnose and screen individuals who harbor S.stercoralis should be made for patients who are candidates for immunosuppressive (eg, corticosteroid) therapy with relevant geographic history and peripheral eosinophilia. | *Efforts to diagnose and screen individuals who harbor [[Strongyloides stercoralis|''S.stercoralis'']] should be made for patients who are candidates for [[immunosuppressive]] (eg, [[corticosteroid]]) therapy with relevant geographic history and peripheral [[eosinophilia]]. | ||
==Screening modalities== | ==Screening modalities== | ||
===Microscopic evaluation=== | ===Microscopic evaluation=== | ||
At least three ova and parasite examinations should be performed on separate days. | * At least three ova and parasite examinations should be performed on separate days. | ||
===Serology=== | ===Serology=== | ||
*An enzyme-linked immunosorbent assay (ELISA) for detecting serum IgG ( | *An [[Enzyme linked immunosorbent assay (ELISA)|enzyme-linked immunosorbent assay]] (ELISA) for detecting serum [[Immunoglobulin G|IgG]] (''[[Strongyloides]]'' [[antibody]]) against a crude extract of the filariform larvae of ''[[Strongyloides stercoralis|S.stercoralis]]'' is available and should be used as a screening test for strongyloides infection. | ||
*However, because of cross-reactivity with other antigens, definitive diagnosis must also include identification of ova and parasites in stool specimens. | *However, because of cross-reactivity with other antigens, definitive diagnosis must also include identification of ova and parasites in [[Stool examination|stool specimens]]. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 06:31, 23 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Most fatal infections caused by S.stercoralis can be prevented by early detection and treatment of asymptomatic chronic infections. Screening is highly recommended to detect latent S.stercoralis infection before the start of chemotherapy or immunosuppression/steroid therapy in patients at risk. Repeated stool examination for ova and parasites or agar culture of stool may be the most appropriate approach.
Screening
- Most fatal infections caused by S.stercoralis can be prevented by early detection and treatment of asymptomatic chronic infections.[1][2][3]
- Screening is highly recommended to detect latent S.stercoralis infection before the start of chemotherapy or immunosuppression/steroid therapy in patients at risk.[4]
- Repeated stool examination for ova and parasites or agar culture of stool may be the most appropriate approach.
Population at risk
- In the U.S., residents of the Southeast may be at risk for strongyloidiasis by growing up in an endemic area.
- Travelers and armed forces personnel may acquire infection during overseas trips to endemic areas (eg, southeast Asia, Central and South America, and Africa).
- Refugees and immigrants from endemic areas
- Immunocompromised patients, especially on corticosteroid therapy, are the most vulnerable population at risk for developing disseminated disease.
- Efforts to diagnose and screen individuals who harbor S.stercoralis should be made for patients who are candidates for immunosuppressive (eg, corticosteroid) therapy with relevant geographic history and peripheral eosinophilia.
Screening modalities
Microscopic evaluation
- At least three ova and parasite examinations should be performed on separate days.
Serology
- An enzyme-linked immunosorbent assay (ELISA) for detecting serum IgG (Strongyloides antibody) against a crude extract of the filariform larvae of S.stercoralis is available and should be used as a screening test for strongyloides infection.
- However, because of cross-reactivity with other antigens, definitive diagnosis must also include identification of ova and parasites in stool specimens.
References
- ↑ Mejia R, Nutman TB (2012). "Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis". Curr. Opin. Infect. Dis. 25 (4): 458–63. PMC 3430846. PMID 22691685.
- ↑ Al Maslamani MA, Al Soub HA, Al Khal AL, Al Bozom IA, Abu Khattab MJ, Chacko KC (2009). "Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases". Ann Saudi Med. 29 (5): 397–401. PMC 2860402. PMID 19700900.
- ↑ "CDC - Strongyloides".
- ↑ "Department of Health | Prevention of opportunistic infections in immunosuppressed patients in the tropical Top End of the Northern Territory of Australia".