Infectious diseases: Strongyloides hyperinfection: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: Strongyloides hyperinfection

Sample item

A 58-year-old farmer from an endemic area has been on prednisolone 60 mg daily for four weeks for an autoimmune disease. He develops abdominal pain, diarrhoea, cough and fever, and then gram-negative septicaemia. Stool and sputum show filariform larvae. Which drug is the treatment of choice?

APraziquantelBAlbendazole aloneCDiethylcarbamazineDIvermectin

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Ivermectin

Corticosteroids impair immunity and allow autoinfection by Strongyloides stercoralis to escalate into hyperinfection, with larvae carrying gut bacteria into the blood and causing sepsis or meningitis. Ivermectin is the drug of choice, usually with immunosuppression reduced where possible and antibiotics for bacteraemia. Patients from endemic areas should be screened or treated before immunosuppression.

Option by option

A. Praziquantel
Praziquantel treats schistosomiasis and tapeworms and not Strongyloides.
B. Albendazole alone
Albendazole is less effective than ivermectin for strongyloidiasis.
C. Diethylcarbamazine
Diethylcarbamazine treats lymphatic filariasis and loiasis.
D. Ivermectin (correct)
Ivermectin is the most effective drug for strongyloidiasis, including hyperinfection.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Ivermectin. Corticosteroids impair immunity and allow autoinfection by Strongyloides stercoralis to escalate into hyperinfection, with larvae carrying gut bacteria into the blood and causing sepsis or meningitis.

Why is "Praziquantel" not the answer?

Praziquantel treats schistosomiasis and tapeworms and not Strongyloides.

Why is "Albendazole alone" not the answer?

Albendazole is less effective than ivermectin for strongyloidiasis.

Why is "Diethylcarbamazine" not the answer?

Diethylcarbamazine treats lymphatic filariasis and loiasis.

What concept does this question test?

It tests Infectious diseases: Strongyloides hyperinfection in General Medicine. Ivermectin is the drug of choice, usually with immunosuppression reduced where possible and antibiotics for bacteraemia. Patients from endemic areas should be screened or treated before immunosuppression.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: Strongyloides hyperinfection?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.