Diagnostic Yield of Strongyloides stercoralis Screening in Immunocompromised Patients and Those with Anticipated Immunocompromise in a Dutch Tertiary Hospital: A Retrospective Cohort Study

Abstract

Strongyloidiasis is a parasitic infection caused by the intestinal helminth Strongyloides stercoralis (S. stercoralis). It is prevalent in tropical and subtropical regions but increasingly diagnosed in nonendemic countries because of migration and travel. In immunocompromised patients, infection with S. stercoralis can lead to a potentially lethal hyperinfection syndrome. Consequently, several guidelines recommend screening immunocompromised patients for S. stercoralis IgG. We aimed to assess the yield of this screening in our tertiary hospital in the Netherlands, a nonendemic country. We performed a retrospective cohort study, in which we identified all immunocompromised patients and those expected to be immunocompromised who were tested for S. stercoralis IgG between January 2010 and April 2022. For these patients, we collected demographic and clinically relevant data from electronic patient files. Strongyloides stercoralis IgG test results were positive in 17/379 patients (4.5%), all of whom were born in an endemic country. Eosinophilia was present in 7/17 patients (41.2%). Over the years, the number of diagnostic tests performed for S. stercoralis IgG has increased significantly, but the number of positive test results per year has not. Focusing screening on patients who have lived in endemic regions and less on travelers will improve diagnostic yield. We recommend screening all immunocompromised patients from high-endemic countries and highly immunocompromised patients with relevant travel history. For less severely immunocompromised patients, screening should be individualized based on travel characteristics.