[Parasite screening for immunosuppressed traveler]

Area of Science:

• Tropical medicine
• Infectious disease screening
• Immunosuppression management

Background:

• Immunosuppressive therapy necessitates screening for latent infections like tuberculosis and parasitic diseases (amoebiasis, echinococcosis, strongyloidiasis, American trypanosomiasis).
• Specific patient exposures (travel, origin) guide the necessity for parasitic infection screening.

Purpose of the Study:

• To present an algorithm developed by the Geneva University Hospitals for recommending appropriate screening based on patient exposure.
• To analyze the practice of this screening algorithm and identify the most frequently detected latent diseases.

Main Methods:

• Development of a clinical algorithm to guide screening for latent tuberculosis and parasitic infections.
• Analysis of screening data to determine the prevalence of detected latent diseases.
• For strongyloidiasis, combining serological antibody testing with parasitological (Baermann, culture) and molecular (PCR) stool testing due to reduced serological sensitivity under immunosuppression.

Main Results:

• Tuberculosis was the most frequently detected latent disease.
• Strongyloidiasis was the second most common latent disease identified.
• The algorithm effectively guides screening practices in a clinical setting.

Conclusions:

• Pre-immunosuppression screening is vital for managing latent infections.
• Tuberculosis and strongyloidiasis are the most prevalent latent diseases requiring screening.
• An exposure-based algorithm aids in identifying necessary screenings, with specific methods required for strongyloidiasis diagnosis in immunosuppressed patients.