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Evidence-Based Guidelines for Screening and Management of Strongyloidiasis in Non-Endemic Countries

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  • 1 Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain;
  • | 2 Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy;
  • | 3 Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Universita Degli Studi di Firenze, Florence, Italy

Strongyloidiasis is an intestinal parasitic infection becoming increasingly important outside endemic areas, not only because of the high prevalence found in migrant populations, but also because immunosuppressed patients may suffer a potentially fatal disseminated disease. The aim of these guidelines is to provide evidence-based guidance for screening and treatment of strongyloidiasis in non-endemic areas. A panel of experts focused on three main clinical questions (who should be screened and how, how to treat), and reviewed pertinent literature available in international databases of medical literature and in documents released by relevant organizations/societies. A consensus of the experts’ opinion was sought when specific issues were not covered by evidence. In particular, six systematic reviews were retrieved and constituted the main support for this work. The evidence and consensus gathered led to recommendations addressing various aspects of the main questions. Grading of evidence and strength of recommendation were attributed to assess the quality of supporting evidence. The screening of individuals at risk of the infection should be performed before they develop any clinical complication. Moreover, in immunosuppressed patients, the screening should be mandatory. The screening is based on a simple and widely accessible technology and there is now a universally accepted treatment with a high efficacy rate. Therefore, the screening could be implemented as part of a screening program for migrants although further cost-effectiveness studies are required to better evaluate this strategy from a public health point of view.

Author Notes

Address correspondence to Ana Requena-Méndez, Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Carrer Roselló 132, 4°, 08036, Barcelona, Spain. E-mail: ana.requena@isglobal.org

These authors contributed equally to this work.

Authors’ addresses: Ana Requena-Méndez and Joan Gomez-Junynent, Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain, Barcelona, Spain, E-mails: ana.requena@isglobal.org and joan.gomez@isglobal.org. Dora Buonfrate and Zeno Bisoffi, Sacro Cuore Don Calabria Hospital, Centre for Tropical Diseases, Negrar, Verona, Italy, E-mails: dora.buonfrate@sacrocuore.it and zeno.bisoffi@sacrocuore.it. Lorenzo Zammarchi, Dipartimento di Medicina Sperimentale e Clinica, Clinica Malattie Infettive, Università di Firenze, Florence, Italy, E-mail: lorenzo.zammarchi@unifi.it. José Muñoz, Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain, E-mail: jose.munoz@isglobal.org.

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