Biologic therapies are frequently utilised in the management of chronic inflammatory dermatological conditions. As with any immunosuppressive treatment, there are risks associated with reactivation or dissemination of underlying infections. Routine screening prior to commencing immunosuppression is important to identify any underlying viral, bacterial or parasitic infections that may result in serious morbidity and potentially mortality if left untreated. Preventative measures involve screening for common opportunistic infections including Strongyloides stercoralis, the persistent roundworm causing strongyloides.

Strongyloides is caused by the persistent roundworm, Strongyloides stercoralis, that is endemic in tropical and subtropical regions of the world. In Australia, it is common amongst Aboriginal and Torres Strait Islander communities, immigrants and returning travellers with a prevalence of between five to 60% on serology tests in the Northern Territory and an average prevalence of 1.97% in Queensland. Chronic strongyloidiasis can often go undiagnosed, however can lead to fatal hyperinfection, particularly if untreated in patients commencing immunosuppression. This is particularly important in patients requiring IL-4 and IL-13 blockade through Dupilumab, the proposed parasitic defence system, which is considered high risk for progressive strongyloides infection.

We present an overview of the incidence of strongyloidiasis in a large cohort of dermatological patients receiving biological therapy in a regional setting (Sunshine Coast, Queensland). Preliminary data identified approximately 3 % of patients with positive strongyloides serology prior to commencing biologic therapy, some of which had already received other immunosuppressive medications. Review of the treatment and outcomes of patients has been undertaken as part of this study.