Background/Purpose: Strongyloides Stercoralis is a helminthic infection that is usually chronic and asymptomatic and may persist undiagnosed for decades. Patients from strongyloides endemic areas (tropics and subtropics) on immunosuppression are at risk for disseminated disease that carries a high morbidity and mortality. Our aim is to prospectively evaluate the prevalence of Strongyloides infection in immunocompromised immigrant patients with rheumatic diseases.

Methods: A single center, prospective, pilot study was conducted at an urban safety net hospital caring for a large immigrant population from September 2016 to June 2017. Inclusion criteria included subjects with rheumatologic diagnosis who are from strongyloides endemic areas on immunosuppressant drugs. A strongyloides screening questionnaire was developed in collaboration with the infectious disease division. Patients were interviewed to obtain medical history, demographic, and social variables. Strongyloides serology was performed with ELISA at the medical center. If there was a positive or indeterminate test, treatment protocol was initiated in parasitology clinic. Statistical analysis was performed using SPSS. Institutional IRB approval was obtained.

Results: A total of 101 patients were screened. The most frequent diagnosis was lupus (39%) followed by rheumatoid arthritis (32%). Most of the patients immigrated from South America (62.6%) and rest of the population was from Asia and Africa. The majority of the patients were female (83.8%). A total of 88 patients completed strongyloides screening and out of which four (4.5%) had positive tests and three (3.4%) had an indeterminate tests. In terms of the socioeconomic conditions, 90.7 % had a bathroom in the house in their home country, 86.6% had running water in the house, 36.1% responded that they swam in fresh water and 43.3% had their home situated in the country side. Over half (56.3%) of the patients were on steroids, (9% on prednisone 15 mg and above), 15.4% of the patients were on biologic DMARDS and 72.5% were on non-biologic DMARDs.

Conclusion: We found 7.95% of patients were strongyloides positive or indeterminate. This is likely an underestimate of the true prevalence of stronglyloides infection in this population as our population may be representing a higher socioeconomic status (SES) than the general immigrant population as over 90.7% of patients had bathrooms in their home country and 86.6% had running water which is a surrogate marker of higher SES. Further investigation into larger cohorts may be required to quantify the true incidence and prevalence of strongyloides in this population. Given the magnitude of the morbidity and mortality that strongyloides can cause in immunocompromised patients, health care providers should consider strongyloides screening in their immunocompromised patients. As the exposure may be remote and patients are asymptomatic, increased awareness among physicians is critical in identifying and treating high risk populations to prevent the occurrence of severe strongyloides infection. To our knowledge, this is one of the few studies to evaluate prospectively for strongyloides infection in high risk individuals and the only one in patients with rheumatic disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/strongyloides-screening-in-immunocompromised-immigrant-rheumatology-patients/