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Ethiopian refugees are receiving presumptive treatment with ivermectin for Strongyloides infection. See additional information on Loa loaincluding treatment. See additional information on Giardiaincluding treatment. Presumptive therapy is not recommended for any infant less than 12 months of age. While the infection itself does not pose a particular pregnancy risk, if a pregnant woman with strongyloidiasis receives immunosuppressive drugs e.
Therefore, treatment of strongyloidiasis with ivermectin during pregnancy is recommended Taenia brain cysts neurocysticercosis may cause seizures or other neurologic disorders.
In these cases, ivermectin may precipitate encephalopathy. The majority of resettling populations receive pre-departure albendazole, making stool testing or treatment for STH unnecessary for most refugees. Most refugees from SSA have been presumptively treated for schistosomiasis with praziquantel; therefore, domestic testing and treatment for schistosomiasis are not necessary for most refugees from SSA.
Nearly all refugees regardless of country of origin are at risk for Strongyloides and should be tested and treated with ivermectin, if not previously pretreated. However, refugees from areas of SSA endemic for Loa loa deserve special attention. These refugees should have serologic testing for Strongyloides parasites and if positive, high-burden Loa loa parasitemia should be ruled out before treatment is initiated.
Ivermectin given in the setting of high-burden Loa loa infection may result in encephalopathy. Screening for high-burden Loa loa parasitemia may be achieved by collecting a daytime 10 a. If the thin and thick blood smear is negative, it is safe to treat the Strongyloides infection with ivermectin, Album). If the daytime thin and thick blood smear is positive, contact CDC for further guidance regarding workup and management.
Detailed information regarding overseas presumptive treatment, including regions and countries where presumptive treatment has been implemented, can be found on the CDC Immigrant, Refugee, and Migrant Health Album). Pre-departure presumptive treatment for strongyloidiasis will likely be expanded to other refugee populations in the future.
It is important to note that certain populations may receive incomplete or no pre-departure presumptive treatment. Specific individuals may not be eligible for certain pre-departure medications because of pregnancy, breastfeeding, young age, or other contraindications, such as known hypersensitivity, allergies, history of seizures, or known neurocysticercosis see Table 2.
Thus, post-arrival guidelines are designed to be flexible and are contingent upon whether the pre-departure presumptive treatment was received. Ideally, clinicians will have documentation of presumptive therapy received by each refugee at the time of post-arrival screening.
There have been substantial challenges in providing the records of presumptive parasite treatment for individual refugees to US clinicians at the time of their post-arrival medical examination. Therefore, individual refugee presumptive treatment records are made available in electronic and hard copy formats, and general information is provided on the CDC Immigrant, Refugee, and Migrant Health website. The following sections recommend approaches for evaluating refugees during the post-arrival domestic medical visit based on whether the refugee had documented or presumed pre-departure treatment.
For the purpose of post-arrival management of parasites, refugees may be divided into two groups—incomplete presumptive treatment and complete presumptive treatment. Refugees in this category received all recommended overseas presumptive treatment for parasites before departure.
These individuals require no further testing for these infections unless they have persistent eosinophilia or other signs or symptoms of infection 3 to 6 months after initial Ingesting Disease - Parasitic Ejaculation - Isolation (CD Figure 1. Persistent eosinophilia may indicate treatment failure or unidentified parasitic infection Table 3and follow-up is recommended Figure 1. In these cases, please consult a tropical medicine specialist.
View Text Description and Overview of Flowchart. If the initial eosinophil count is Album), repeat testing for eosinophilia in an asymptomatic person is not indicated. Although many parasites are associated with eosinophilia, others are not.
In addition, eosinophilia may also be associated with noninfectious disorders, and the broader differential diagnosis should be kept in mind Ingesting Disease - Parasitic Ejaculation - Isolation (CD 3.
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