Screening for Strongyloides infection among the institutionalized mentally disabled

Strongyloidiasis is an intestinal helminthic infection common among the mentally disabled population and can cause persistent occult infection before resulting in disseminated, possibly fatal disease.

Two cases of strongyloidiasis are described. The literature was searched using the key words "Strongyloides" and "mass screening."

Strongyloidiasis is clinically important and well documented in the mentally disabled populations both in endemic and nonendemic regions of North America. It has a substantial latent phase during which screening can be conducted, and its treatment with thiabendazole is convenient, effective, and reasonably well tolerated. Although strongyloidiasis is usually incidentally detected by findings of eosinophilia during routine blood screening, peripheral eosinophilia occurs only in 50% to 80% of infected persons and is extremely nonspecific for Strongyloides infection. Given the high cost of critical care for a patient with disseminated disease, screening mentally disabled populations in institutional settings for strongyloidiasis by administering the Strongyloides stercoralis antibody ELISA appears justifiable, particularly if risk factors for hyperinfection syndrome are used to select a subpopulation to be screened.