Screening for parasitic infections: One doctor’s experience

Soin, et al, reported an interesting case of strongyloidiasis in a refugee in their Photo Rounds article, “Rash, diarrhea, and eosinophilia” (J Fam Pract. 2015;64:655-658). They mentioned the importance of having a high degree of suspicion for parasitic infections among refugees. Indeed, health screenings for refugees are necessary and should include testing for parasitoses. However, there are several other issues to consider.

First, a single screening may not be effective. Thus, results should be verified with repeat screening tests. In my experience in Thailand, a single screening of migrants from nearby Indochinese countries failed to detect several infectious cases, including tuberculosis, malaria, and intestinal parasite infections. To optimize early detection and infection control, a repeated check-up system is needed. It should be noted, however, that a false-negative result for strongyloidiasis is not common from a stool examination or immunological test.¹

Second, the mentioned symptoms of “rash, diarrhea, and eosinophilia” can be due to several etiologies and may have been caused by a completely separate illness. Or the findings might have been due to a forgotten condition, such as post-dengue infection illness.²

Finally, the existence of strongyloidiasis in the case presented by Soin, et al, could have been an incidental finding without a relationship to the exact pathology.

Viroj Wiwanitkit, MD
Bangkok, Thailand

Soin, et al, reported an interesting case of strongyloidiasis in a refugee in their Photo Rounds article, “Rash, diarrhea, and eosinophilia” (J Fam Pract. 2015;64:655-658). They mentioned the importance of having a high degree of suspicion for parasitic infections among refugees. Indeed, health screenings for refugees are necessary and should include testing for parasitoses. However, there are several other issues to consider.

First, a single screening may not be effective. Thus, results should be verified with repeat screening tests. In my experience in Thailand, a single screening of migrants from nearby Indochinese countries failed to detect several infectious cases, including tuberculosis, malaria, and intestinal parasite infections. To optimize early detection and infection control, a repeated check-up system is needed. It should be noted, however, that a false-negative result for strongyloidiasis is not common from a stool examination or immunological test.¹

Second, the mentioned symptoms of “rash, diarrhea, and eosinophilia” can be due to several etiologies and may have been caused by a completely separate illness. Or the findings might have been due to a forgotten condition, such as post-dengue infection illness.²

Finally, the existence of strongyloidiasis in the case presented by Soin, et al, could have been an incidental finding without a relationship to the exact pathology.

Viroj Wiwanitkit, MD
Bangkok, Thailand

Soin, et al, reported an interesting case of strongyloidiasis in a refugee in their Photo Rounds article, “Rash, diarrhea, and eosinophilia” (J Fam Pract. 2015;64:655-658). They mentioned the importance of having a high degree of suspicion for parasitic infections among refugees. Indeed, health screenings for refugees are necessary and should include testing for parasitoses. However, there are several other issues to consider.

First, a single screening may not be effective. Thus, results should be verified with repeat screening tests. In my experience in Thailand, a single screening of migrants from nearby Indochinese countries failed to detect several infectious cases, including tuberculosis, malaria, and intestinal parasite infections. To optimize early detection and infection control, a repeated check-up system is needed. It should be noted, however, that a false-negative result for strongyloidiasis is not common from a stool examination or immunological test.¹

Second, the mentioned symptoms of “rash, diarrhea, and eosinophilia” can be due to several etiologies and may have been caused by a completely separate illness. Or the findings might have been due to a forgotten condition, such as post-dengue infection illness.²

Finally, the existence of strongyloidiasis in the case presented by Soin, et al, could have been an incidental finding without a relationship to the exact pathology.

Viroj Wiwanitkit, MD
Bangkok, Thailand