When should a patient on steroid therapy be closely monitored for Strongyloides stercoralis reactivation?

Patients on steroid therapy should be closely monitored for Strongyloides stercoralis reactivation primarily before any immunosuppressive therapy is initiated. This is critical because Strongyloides stercoralis can remain dormant in its larvae stage within the host. When an individual undergoes immunosuppression—such as through the use of steroids—the immune system is compromised, leading to the potential for the dormant larvae to reactivate and cause a hyperinfection syndrome, which can be life-threatening.

The risk is particularly significant in individuals from areas where Strongyloides stercoralis is endemic, as they may harbor the organism in a dormant state. Monitoring before administering immunosuppressive therapy allows healthcare providers to assess for any pre-existing infection and possibly treat it before the patient's immune response is further compromised.

In contrast, while travel to endemic areas can increase exposure risk, it is the immunosuppressive state that directly causes the potential for reactivation. Awareness of gastrointestinal disturbances may signal an issue but does not focus on the proactive monitoring aspect that is crucial before initiating therapy. Therefore, close monitoring should be a priority before starting any form of immunosuppressive therapy to ensure the safety of the patient.