Approach to Strongyloides prevention for asymptomatic individuals outside of endemic areas

PCR: polymerase chain reaction.

* Preventive treatment is warranted for organ transplant recipients if there is a positive serologic test for either the recipient or the donor.

¶ For living organ donors, some favor empiric ivermectin treatment in the absence of diagnostic screening.

Δ The optimal approach is uncertain and clinical practice varies based available resources.

◊ Stool microscopy is not sufficiently sensitive for screening asymptomatic individuals.

§ For asymptomatic individuals who are receiving immunosuppressive therapy, we favor a four-dose preventive treatment regimen (single dose administered on 2 consecutive days, then repeated after 1 autoinfection cycle) rather than a two-dose regimen, given the potentially devastating nature of Strongyloides infection in the setting of immunosuppression and the high tolerability of ivermectin; however, there is no clinical evidence to support this approach.