Should prospective renal transplant recipients be screened for Strongyloides stercoralis?

Strongyloides stercoralis infection in the United Kingdom: a systematic review and meta-analysis of published cases

Strongyloidiasis is a helminth infection where symptoms vary, and asymptomatic presentation is common. Chronic strongyloidiasis can cause a high mortality 'hyper-infection' in immunocompromised states. Understanding at risk populations and symptomology can guide screening and early treatment to reduce hyper-infection risk. A systematic review of studies describing patients in the United Kingdom with strongyloidiasis a pooled total of 1308 patients. Weighted pooled prevalence (WPP) of asymptomatic cases was 27.7% (95%CI 17.1-39.5%,I2 = 92%,p<0.01]. At risk populations included migrants, returning travellers and armed forced personnel. The most common symptoms reported were abdominal pain (WPP 32.1%,[95%CI 20.5-44.8%],I2 = 93%,p<0.01), rashes (WPP 38.4%,[95%CI 13.1-67.7%],I2 = 99%, p<0.01) and diarrhoea (WPP 12.6% [95%CI 6.7-19.9%],I2=70%,p=0.03). Symptomatology varied with cohort characteristics. Although asymptomatic presentation is common, patients may present with abdominal pain, diarrhoea, or rashes. A low threshold for screening symptomatic individuals in at-risk groups is required.