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Lung Apr 2022Strongyloidiasis has been estimated to affect over 600 million people worldwide. It is caused by Strongyloides stercoralis, a roundworm endemic to the tropics and... (Review)
Review
Strongyloidiasis has been estimated to affect over 600 million people worldwide. It is caused by Strongyloides stercoralis, a roundworm endemic to the tropics and subtropics, especially areas where sanitation is suboptimal Autochthonous transmission has been documented in rural areas of the USA and Europe. Humans are infected when larvae penetrate the skin or are ingested. Autoinfection, in which larvae generated in the host go on to re-infect the host, leads to a state of chronic asymptomatic infection often with eosinophilia. Hyperinfection syndrome may develop when patients develop immune suppression, due to medications such as corticosteroids or following solid-organ transplantation. Hyperinfection is characterized by exponential increase in parasitic burden, leading to tissue invasion and life-threatening disease and associated bloodstream infections due to enteric organisms. Cases following use of corticosteroids for COVID-19 pneumonia have been described. Strongyloidiasis can be diagnosed by direct visualization of larvae in stool or other body fluids, or by serology. Ivermectin is highly effective in treating the disease. Patients with exposure to endemic areas and those expected to become immune suppressed should be screened and treated before starting immune suppressive agents. Empiric treatment should be considered when timely testing is not readily available.
Topics: Animals; COVID-19; Eosinophilia; Humans; Sepsis; Strongyloides stercoralis; Strongyloidiasis
PubMed: 35396957
DOI: 10.1007/s00408-022-00528-z -
Infectious Disease Clinics of North... Mar 2019Most of the 30 to 100 million people infected with Strongyloides stercoralis have subclinical (or asymptomatic) infections. These infections are commonly chronic and... (Review)
Review
Most of the 30 to 100 million people infected with Strongyloides stercoralis have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. The use of corticosteroids and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses that are like other nematodes. Definitive diagnosis of S stercoralis infection is based on stool examinations for larvae. S stercoralis remains largely neglected.
Topics: Animals; Antiparasitic Agents; Asymptomatic Infections; Clinical Trials as Topic; Disease Management; Humans; Immunoassay; Ivermectin; Molecular Diagnostic Techniques; Neglected Diseases; Soil; Strongyloidiasis
PubMed: 30712758
DOI: 10.1016/j.idc.2018.10.006 -
Parasitology Mar 2017
Topics: Animals; Humans; Strongyloides; Strongyloidiasis
PubMed: 27759560
DOI: 10.1017/S0031182016001773 -
Strongyloidiasis Hyperinfection Syndrome in COVID-19 Positive Migrants Treated with Corticosteroids.Journal of Immigrant and Minority Health Dec 2022The aim of this study is to highlight the potentially fatal risk of Strongyloidiasis Hyperinfection Syndrome for hospitalized immigrant patients with moderate to severe... (Review)
Review
The aim of this study is to highlight the potentially fatal risk of Strongyloidiasis Hyperinfection Syndrome for hospitalized immigrant patients with moderate to severe COVID-19 disease and undiagnosed Strongyloidiasis. We reviewed electronic medical records of immigrants from 2010 to 2022 and extracted the number of patients with eosinophilia, strongyloidiasis and COVID-19 infection, outpatient and hospitalized. While 885 outpatients were diagnosed with eosinophilia, only 356 (40.2%) were tested for strongyloidiasis and 160 (44.9%) yielded a reactive serology. COVID-19 infection was reported in 6,412 patients. 1135 (17.7%) of these patients sought hospital care. Patients with undiagnosed strongyloidiasis are at risk for a potentially fatal parasitosis if treated with systemic corticosteroids for COVID-19. This supports clinical guidelines in hospital settings for those with severe COVID-19. Strongyloidiasis should be considered by taking a thorough travel or migration history and testing before giving immunosuppressive drugs.
Topics: Animals; Humans; Strongyloidiasis; Strongyloides stercoralis; Transients and Migrants; COVID-19; Eosinophilia; Adrenal Cortex Hormones
PubMed: 35939223
DOI: 10.1007/s10903-022-01386-w -
The Lancet. Global Health Feb 2019Global migration from regions where strongyloidiasis and schistosomiasis are endemic to non-endemic countries has increased the potential individual and public health... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Global migration from regions where strongyloidiasis and schistosomiasis are endemic to non-endemic countries has increased the potential individual and public health effect of these parasitic diseases. We aimed to estimate the prevalence of these infections among migrants to establish which groups are at highest risk and who could benefit from screening.
METHODS
We did a systematic review and meta-analysis of strongyloidiasis and schistosomiasis prevalence among migrants born in endemic countries. Original studies that included data for the prevalence of Strongyloides or Schistosoma antibodies in serum or the prevalence of larvae or eggs in stool or urine samples among migrants originating from countries endemic for these parasites and arriving or living in host countries with low endemicity-specifically the USA, Canada, Australia, New Zealand, Israel, and 23 western European countries-were eligible for inclusion. Pooled estimates of the prevalence of strongyloidiasis and schistosomiasis by stool or urine microscopy for larvae or eggs or serum antibodies were calculated with a random-effects model. Heterogeneity was explored by stratification by age, region of origin, migrant class, period of study, and type of serological antigen used.
FINDINGS
88 studies were included. Pooled strongyloidiasis seroprevalence was 12·2% (95% CI 9·0-15·9%; I 96%) and stool-based prevalence was 1·8% (1·2-2·6%; 98%). Migrants from east Asia and the Pacific (17·3% [95% CI 4·1-37·0]), sub-Saharan Africa (14·6% [7·1-24·2]), and Latin America and the Caribbean (11·4% [7·8-15·7]) had the highest seroprevalence. Pooled schistosomiasis seroprevalence was 18·4% (95% CI 13·1-24·5; I 97%) and stool-based prevalence was 0·9% (0·2-1·9; 99%). Sub-Saharan African migrants had the highest seroprevalence (24·1·% [95% CI 16·4-32·7]).
INTERPRETATION
Strongyloidiasis affects migrants from all global regions, whereas schistosomiasis is focused in specific regions and most common among sub-Saharan African migrants. Serological prevalence estimates were several times higher than stool estimates for both parasites. These data can be used to inform screening decisions for migrants and support the use of serological screening, which is more sensitive and easier than stool testing.
FUNDING
None.
Topics: Africa South of the Sahara; Australia; Canada; Caribbean Region; Emigrants and Immigrants; Endemic Diseases; Europe; Asia, Eastern; Feces; Humans; Israel; Latin America; Mass Screening; New Zealand; Pacific Islands; Prevalence; Schistosomiasis; Seroepidemiologic Studies; Serologic Tests; Strongyloidiasis; United States
PubMed: 30683241
DOI: 10.1016/S2214-109X(18)30490-X -
Infectious Diseases of Poverty May 2021Strongyloidiasis is the most neglected of the neglected tropical diseases (NTDs). The aim of this commentary is to describe the possible reasons why strongyloidiasis is...
BACKGROUND
Strongyloidiasis is the most neglected of the neglected tropical diseases (NTDs). The aim of this commentary is to describe the possible reasons why strongyloidiasis is so overlooked in Ethiopia, and shed light on better ways of control and elimination of the disease.
MAIN BODY
This commentary highlights three points why strongyloidiasis is the most neglected of the NTDs in Ethiopia. Firstly, lack of clear category within the NTDs resulted in omission of the disease from reports, intervention programs, and preventive chemotherapy guidelines. Secondly, magnitude of the disease is underestimated due to paucity of studies and low sensitivity of diagnostic methods coupled with asymptomatic nature of most of the infections. Finally, ivermectin (the drug of choice for treatment of strongyloidiasis) is not in use for control of the other soil-transmitted helminthiasis, nor is there ivermectin mass drug administration for control of strongyloidiasis. This might have created gap in control and elimination of the disease in Ethiopia and possibly elsewhere.
CONCLUSION
Strongyloidiasis appears to be the most neglected of the NTDs mainly due to nature of the infection, low sensitivity of the routine diagnostic tools and it's exclusion from strategic plans and intervention programs. Moreover, studies on strongyloidiasis should use sensitive diagnostic tools. Strongyloidiasis control and elimination programs should be based on reliable evidence of epidemiology of the disease in Ethiopia.
Topics: Ethiopia; Helminthiasis; Humans; Neglected Diseases; Strongyloidiasis; Tropical Medicine
PubMed: 33962697
DOI: 10.1186/s40249-021-00851-2 -
PLoS Neglected Tropical Diseases Aug 2014Strongyloides stercoralis, an intestinal parasitic nematode, infects more than 100 million people worldwide. Strongyloides are unique in their ability to exist as a... (Review)
Review
BACKGROUND
Strongyloides stercoralis, an intestinal parasitic nematode, infects more than 100 million people worldwide. Strongyloides are unique in their ability to exist as a free-living and autoinfective cycle. Strongyloidiasis can occur without any symptoms or as a potentially fatal hyperinfection or disseminated infection. The most common risk factors for these complications are immunosuppression caused by corticosteroids and infection with human T-lymphotropic virus or human immunodeficiency virus. Even though the diagnosis of strongyloidiasis is improved by advanced instrumentation techniques in isolated and complicated cases of hyperinfection or dissemination, efficient guidelines for screening the population in epidemiological surveys are lacking.
METHODOLOGY AND RESULTS
In this review, we have discussed various conventional methods for the diagnosis and management of this disease, with an emphasis on recently developed molecular and serological methods that could be implemented to establish guidelines for precise diagnosis of infection in patients and screening in epidemiological surveys. A comprehensive analysis of various cases reported worldwide from different endemic and nonendemic foci of the disease for the last 40 years was evaluated in an effort to delineate the global prevalence of this disease. We also updated the current knowledge of the various clinical spectrum of this parasitic disease, with an emphasis on newer molecular diagnostic methods, treatment, and management of cases in immunosuppressed patients.
CONCLUSION
Strongyloidiasis is considered a neglected tropical disease and is probably an underdiagnosed parasitic disease due to its low parasitic load and uncertain clinical symptoms. Increased infectivity rates in many developed countries and nonendemic regions nearing those in the most prevalent endemic regions of this parasite and the increasing transmission potential to immigrants, travelers, and immunosuppressed populations are indications for initiating an integrated approach towards prompt diagnosis and control of this parasitic disease.
Topics: Animals; Female; Humans; Male; Prevalence; Serologic Tests; Strongyloides; Strongyloidiasis
PubMed: 25121962
DOI: 10.1371/journal.pntd.0003018 -
Internal Medicine (Tokyo, Japan) Sep 2000Strongyloidiasis is an intestinal parasitic disease caused by Strongyloides stercoralis. Basically, detecting larvae of S. stercoralis in feces makes definitive... (Review)
Review
Strongyloidiasis is an intestinal parasitic disease caused by Strongyloides stercoralis. Basically, detecting larvae of S. stercoralis in feces makes definitive diagnosis. The ordinary agar plate culture method developed at our department is much simpler to handle and much more sensitive than the conventional filter paper culture method. It is considered to be the most useful method in the diagnosis of strongyloidiasis and in evaluation of the eradicating effect. Among chemotherapeutic agents, thiabendazole representing the benzimidazole compounds is most effective. However, it has a problem in safety, since its adverse effects and liver dysfunction occur with a high incidence, and it can be severe. Regarding the effects of mebendazole, albendazole and ivermectin, a study was conducted which included many patients. A high incidence of liver dysfunction was observed with mebendazole, and eradicating effect was not sufficient with albendazole. Ivermectin is different from benzimidazole compounds in a pharmacokinetic profile. However, ivermectin showed a strong anthelmintic effect with the least toxicity. We therefore consider ivermectin is the most useful drug for the treatment of strongyloidiasis.
Topics: Antiprotozoal Agents; Humans; Intestinal Diseases, Parasitic; Ivermectin; Strongyloidiasis
PubMed: 10969899
DOI: 10.2169/internalmedicine.39.695 -
International Journal of Environmental... May 2016Strongyloidiasis is a disease caused by soil transmitted helminths of the Strongyloides genus. Currently, it is predominately described as a neglected tropical disease.... (Review)
Review
Strongyloidiasis is a disease caused by soil transmitted helminths of the Strongyloides genus. Currently, it is predominately described as a neglected tropical disease. However, this description is misleading as it focuses on the geographical location of the disease and not the primary consideration, which is the socioeconomic conditions and poor infrastructure found within endemic regions. This classification may result in misdiagnosis and mistreatment by physicians, but more importantly, it influences how the disease is fundamentally viewed. Strongyloidiasis must be first and foremost considered as a disease of disadvantage, to ensure the correct strategies and control measures are used to prevent infection. Changing how strongyloidiasis is perceived from a geographic and clinical issue to an environmental health issue represents the first step in identifying appropriate long term control measures. This includes emphasis on environmental health controls, such as better infrastructure, sanitation and living conditions. This review explores the global prevalence of strongyloidiasis in relation to its presence in subtropical, tropical and temperate climate zones with mild and cold winters, but also explores the corresponding socioeconomic conditions of these regions. The evidence shows that strongyloidiasis is primarily determined by the socioeconomic status of the communities rather than geographic or climatic conditions. It demonstrates that strongyloidiasis should no longer be referred to as a "tropical" disease but rather a disease of disadvantage. This philosophical shift will promote the development of correct control strategies for preventing this disease of disadvantage.
Topics: Animals; Humans; Prevalence; Social Class; Strongyloides stercoralis; Strongyloidiasis
PubMed: 27213420
DOI: 10.3390/ijerph13050517 -
Revista Da Sociedade Brasileira de... 2022
Topics: Animals; Colitis; Gastritis; Humans; Leprosy; Strongyloides stercoralis; Strongyloidiasis
PubMed: 36134864
DOI: 10.1590/0037-8682-0189-2022