Conclusions
The first step to be done to guarantee an adequate management of infected patients is to avoid a delayed diagnosis. Unfortunately, lack of familiarity with strongyloidiasis by health care providers still seems to be the main cause of delay. A better diffusion of the available information is badly needed, and collaboration among different specialists (oncologists, rheumatologists…) is desirable in order to provide common and adequate protocols for screening and treatment of at – risk patients.
It is mandatory to treat patients in the chronic phase, before HS/DS develop. Patients with possible, previous exposure to the parasite should be screened with serology before corticosteroid treatment, chemotherapy or transplant. Considering the high tolerability of ivermectin, it would be probably worth treating high – risk patients irrespective of the result of the screening test, in order to avoid the potential consequences of a possible false negative result.
Ivermectin is currently the gold standard for treatment of strongyloidiasis, so it is simply no more ethical to use any other drug. Moreover, ivermectin is in the WHO model lists of essential medicines, so it should be registered and made available everywhere, particularly in endemic countries.