Abstract:
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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. |