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Trop Dis Travel Med Vaccines. 2019 Apr 3;5:3. doi: 10.1186/s40794-019-0080-1. eCollection 2019.

Implementation and evaluation of a quality and safety tool for ambulatory strongyloidiasis patients at high risk of adverse outcome.

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1University of Toronto, 27 King's College Circle, Toronto, Ontario M5S1A1 Canada.
2Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada.
3McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8 Canada.
4Georgetown University, 3800 Reservoir Rd NW, Washington, DC 20007 USA.
5Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street 13EN-218, Toronto, Ontario M5G2C4 Canada.
6Public Health Ontario Laboratory, 661 University Avenue, Toronto, Ontario M5G1M1 Canada.
7Department of Medicine, University of Toronto, Toronto, Canada.



Strongyloidiasis is a common infection in Canadian migrants that can cause life-threatening hyperinfection in immunosuppressed hosts. We designed and implemented a safety tool to guide management of patients with Strongyloides in order to prevent adverse outcomes. Methods: Patients treated at our centre for strongyloidiasis from January 1, 2013 to December 31, 2015 were identified through our ivermectin access log. Patients were categorized into pre-implementation and post-implementation groups. A retrospective chart review for predefined variables was conducted.


Of 37 patients with strongyloidiasis, 26 were in the pre-implementation group and 11 were in the post-implementation group. Documented seroreversion (positive to negative) occurred in 42.1% of patients pre-implementation and 62.5% of patients post-implementation (p = 0.420). Documented stool clearance occurred in 80.0% of patients pre-implementation and 100.0% of patients post-implementation (p = 1.000). More patients were screened for HTLV-1 coinfection post-implementation (80.0%) versus pre-implementation (30.8%) (p = 0.011). Loss to follow-up after treatment occurred in 23.1% of patients pre-implementation and 20.0% of patients post-implementation (p = 1.000).


The safety tool may be useful in the treatment of patients with strongyloidiasis to improve documentation of patient outcomes and standardize care. Future research should include a powered prospective study.


Neglected tropical diseases; Patient safety; Quality improvement; Soil-transmitted helminths; Strongyloidiasis

Conflict of interest statement

None.Ethics approval and Institutional Review Board approval were granted by the University Health Network. The need for consent was waived.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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