Strongyloides infection

The US Centers for Disease Control and Prevention (CDC) recommends screening for Strongyloides in the following: patients on, or about to start, immunosuppressants (including corticosteroids); patients with human T-cell lymphotropic virus type-1 (HTLV-1) infection, hematologic malignancies, or persistent peripheral or unexplained eosinophilia; patients who have had or are being considered for organ transplant; and patients with a recent or remote travel history to an endemic area.[36]Centers for Disease Control and Prevention. Parasites - strongyloides: resources for health professionals. Mar 2023 [internet publication].​ https://www.cdc.gov/parasites/strongyloides/health_professionals/index.html#tx ​​

Screening for intestinal parasites is recommended for people migrating from endemic areas and long-term expatriates. Initial screening is via three standard stool ova and parasite (O&P) examinations, collected on different days. Obtaining multiple specimens on different days can be cumbersome, expensive, and poorly achieved in reality, thus many experts obtain a single stool O&P sample coupled with serologic testing. Serologic strongyloides IgG testing is recommended in unexplained eosinophilia.

Refugees newly arriving in the US with unexplained eosinophilia are recommended to be screened for serologic strongyloides IgG, or receive empiric ivermectin. It is recommended that physicians also consider screening or empiric therapy for schistosomiasis in people migrating from sub-Saharan Africa with eosinophilia, because of the high prevalence of schistosomiasis in this group.[37]Centers for Disease Control and Prevention. Presumptive treatment and screening for strongyloidiasis, infections caused by other soil-transmitted helminths, and schistosomiasis among newly arrived refugees. Mar 2021 [internet publication]. https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites-domestic.html