{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:14:59Z","timestamp":1791976499131,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T00:00:00Z","timestamp":1564531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (<jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>) have increased infection rates. <jats:italic>Strongyloides<\/jats:italic>, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious <jats:italic>Strongyloides<\/jats:italic> infection with <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> dosed for rheumatologic disease is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a systematic literature review searching <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content>, Medline and Web of Science databases. All studies reporting humans exposed to <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> and tested for <jats:italic>Strongyloides<\/jats:italic> were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> exposure completed &gt;1\u00a0year prior to clinically apparent <jats:italic>Strongyloides<\/jats:italic> disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest had a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low\u2010dose <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>; 75% high\u2010dose <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>). Death occurred in 34% of cases (19% low\u2010dose <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>; 75% high\u2010dose <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>,<jats:italic> P<\/jats:italic>\u00a0&lt;\u00a00.01). All eight patients on high\u2010dose <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> received other immunosuppressants. Corticosteroids were taken in 18\/21 patients on low\u2010dose <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>. One of the three patients on <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> monotherapy had hyperinfection syndrome. None had disseminated <jats:italic>Strongyloides<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Serious <jats:italic>Strongyloides<\/jats:italic> infection can occur with low\u2010dose <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low\u2010 to middle\u2010income countries will increase the exposure of individuals prescribed <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> (with or without corticosteroids) to <jats:italic>Strongyloides<\/jats:italic>. <jats:italic>Strongyloides<\/jats:italic> screening and treatment should be considered for individuals receiving low\u2010dose <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> therapy, particularly if combined with additional immunosuppression.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13288","type":"journal-article","created":{"date-parts":[[2019,7,14]],"date-time":"2019-07-14T10:08:27Z","timestamp":1563098907000},"page":"1032-1041","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Methotrexate exposure and risk of 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