Special Issue "Prevalence of Strongyloidiasis and Schistosomiasis"

A special issue of Pathogens (ISSN 2076-0817).

Deadline for manuscript submissions: closed (30 April 2020).

Special Issue Editor

Dr. Ana Requena Mendez
E-Mail Website
Guest Editor
Barcelona Institute for Global Health, 08036 Barcelona, Spain
Interests: migrant health; imported diseases; schistosomiasis; strongyloidiasis

Special Issue Information

Dear Colleagues,

It is a pleasure to invite you to participate in this Special Issue, which aims to evaluate the prevalence of strongyloidiasis and schistosomiasis.

Both of these helminth infections are of particular importance. First, besides being as highly prevalent as other parasitic infections, they can cause long-term complications and severe consequences. Schistosomiasis is associated with chronic urogenital, hepato-intestinal, and central nervous system complications. St. stercoralis can manifest as a severe condition (disseminated infection or hyper infection) with fatal outcomes in immunosuppressed patients (e.g., transplant recipients, those on corticosteroid therapy, those with malignancies, or co-infections with human T-cell lymphotropic virus-1). Second, most infections are asymptomatic, and those that are infected are either unaware of their infection or have very mild unspecific symptoms. Third, both become chronic infections if untreated [1]. Schistosomiasis can remain as a sub-clinical infection for many years, and St. stercoralis replicates indefinitely inside the human host, causing lifelong infection if untreated [2].

Strongyloidiasis has worldwide distribution, although it is more prevalence in tropical and subtropical areas [3]. The current estimate of 30 to 100 million infected persons in the world dates back to review articles published between 1989 and 1996. However, global prevalence estimates should probably be revised, based on studies using diagnostic techniques that are better suited to S. stercoralis. In addition, few studies have been conducted to assess strongyloidiasis’ prevalence in non-endemic countries. On the other hand, schistosomiasis affects almost 240 million people worldwide, and more than 700 million people live in endemic areas [4]. The infection is prevalent in tropical and sub-tropical areas. The risk of schistosomiasis is more geographically specific, with adult migrants from sub-Saharan Africa at highest risk. In these settings, the proliferation of mass drug administration (MDA) programmes using the drug praziquantel results in substantial increases in the number of people receiving one or more treatments during their lifetimes [5]. This could decrease the burden of disease, as has been shown in some settings such as Zanzibar [6]. The Expert Committee on Prevention and Control of schistosomiasis and soil-transmitted helminthiasis has recently reviewed data on morbidity and mortality due to schistosomiasis in sub-Saharan Africa and endorsed new estimates.

Topics may include but are not limited to prevalence studies on strongyloidiasis and schistosomiasis, including studies on both endemic and non-endemic countries and also on high risk populations (e.g., immunosuppressed patients). 

Dr. Ana Requena Mendez
Guest Editor

References:

  1. Agbata, E.; Morton, R.L.; Bisoffi, Z.; Bottieau, E.; Greenaway, C.; Biggs, B.A.; Montero, N.; Tran, A.; Rowbotham, N.; Arevalo-Rodriguez, I.; et al. Effectiveness of screening and treatment approaches for schistosomiasis and strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review. Int. J. Environ. Res. Public Health 2018, 16, 11.
  2. Requena-Mendez, A; Buonfrate, D.; Gomez-Junyent, J.; Zammarchi, L.; Bisoffi, Z.; Munoz, J. Evidence-Based Guidelines for Screening and Management of Strongyloidiasis in Non-Endemic Countries. J. Trop. Med. Hyg. 2017, 97, 645–652.
  3. Asundi, A.; Beliavsky, A.; Liu, X.J.; Akaberi, A.; Schwarzer, G.; Bisoffi, Z.; Requena-Mendez, A.; Shrier, L.; Greenaway, C. Prevalence of strongyloidiasis and schistosomiasis among migrants: a systematic review and meta-analysis. Lancet Glob Health 2019; 7, e236–e248.
  4. Bisoffi, Z.; Buonfrate, D.; Montresor, A.; Requena-Mendez, A.; Munoz, J.; Krolewiecki, A.J.; Gotuzzo, E.; Mena, M.A.; Chiodini, P.L.; Anselmi, M.; et al. Strongyloides stercoralis: a plea for action. PLoS Negl. Trop. Dis. 2013, 7, e2214.
  5. Mutapi, F.; Maizels, R.; Fenwick, A.; Woolhouse, M. Human schistosomiasis in the post mass drug administration era. Lancet Infect Dis. 2017,17, e42–e48.
  6. Knopp, S.; Person, B.; Ame, S.M.; Mohammed, K.A.; Ali, S.M.; Khamis, I.S.; Rabone, M.; Allan, F.; Gouvras, A.; Blair, L.; et al. Elimination of schistosomiasis transmission in Zanzibar: baseline findings before the onset of a randomized intervention trial. PLoS Negl. Trop. Dis. 2013, 7, e2474.

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Keywords

  • Strongyloides
  • Schistosoma
  • Prevalence
  • Helminth infections
  • St. stercoralis

Published Papers (12 papers)

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Research

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Article
Strongyloidiasis in Southern Alicante (Spain): Comparative Retrospective Study of Autochthonous and Imported Cases
Pathogens 2020, 9(8), 601; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9080601 - 23 Jul 2020
Cited by 1 | Viewed by 689
Abstract
Background: Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. Methods: [...] Read more.
Background: Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. Methods: Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. Results: We included 36 patients (21 men) with a mean age of 60.8 years ±17.6; 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs. 53.3 years; p = 0.002), male sex (odds ratio (OR) 5.33; 95% confidence interval (CI) 1.15–24.68; p = 0.041), and agricultural activity (OR 13.5; 95% CI 2.4–73.7; p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs. 75%; p = 0.207), treatment received, or clinical response (85.7% vs. 88.9% cured; p = 1). Conclusion: In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
Asymptomatic Strongyloidiasis among Latin American Migrants in Spain: A Community-Based Approach
Pathogens 2020, 9(6), 511; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9060511 - 24 Jun 2020
Cited by 3 | Viewed by 867
Abstract
Strongyloides stercoralis infection is frequently underdiagnosed since many infections remain asymptomatic. Aim: To estimate the prevalence and characteristics of asymptomatic S. stercoralis infection in Latin American migrants attending a community-based screening program for Chagas disease in Spain. Methodology: Three community-based Chagas disease screening [...] Read more.
Strongyloides stercoralis infection is frequently underdiagnosed since many infections remain asymptomatic. Aim: To estimate the prevalence and characteristics of asymptomatic S. stercoralis infection in Latin American migrants attending a community-based screening program for Chagas disease in Spain. Methodology: Three community-based Chagas disease screening campaigns were performed in Alicante (Spain) in 2016, 2017, and 2018. Serological testing for S. stercoralis infection was performed using a non-automatized IVD-ELISA detecting IgG (DRG Instruments GmbH, Marburg, Germany). Results: Of the 616 migrants from Central and South America who were screened, 601 were included in the study: 100 children and adolescents (<18 years of age) and 501 adults. Among the younger group, 6 participants tested positive (prevalence 6%, 95% confidence interval [CI] 2.5% to 13.1%), while 60 adults did so (prevalence 12%, 95% CI 9.3% to 15.3%). S. stercoralis infection was more common in men than in women (odds ratio adjusted [ORa] 2.28, 95% CI 1.289 to 4.03) and in those from Bolivia (ORa 2.03, 95% CI 1.15 to 3.59). Prevalence increased with age (ORa 1.02, 95% CI 0.99 to 1.05). In contrast, a university education had a protective effect (ORa 0.29, 95% CI 0.31 to 0.88). Forty-one (41/66; 62.1%) of the total cases of S. stercoralis infection were treated at the health care center. Positive stool samples were observed in 19.5% of the followed-up positive cases. Conclusion: Incorporating serological screening for S. stercoralis into community-based screening for Chagas disease is a useful intervention to detect asymptomatic S. stercoralis infection in Central and South American migrants and an opportunity to tackle neglected tropical diseases in a transversal way. The remaining challenge is to achieve patients’ adherence to the medical follow-up. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
Clinical Features Associated with Strongyloidiasis in Migrants and the Potential Impact of Immunosuppression: A Case Control Study
Pathogens 2020, 9(6), 507; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9060507 - 23 Jun 2020
Cited by 2 | Viewed by 832
Abstract
Strongyloides stercoralis is a widely distributed nematode more frequent in tropical areas and particularly severe in immunosuppressed patients. The aim of this study was to determine factors associated with strongyloidiasis in migrants living in a non-endemic area and to assess the response to [...] Read more.
Strongyloides stercoralis is a widely distributed nematode more frequent in tropical areas and particularly severe in immunosuppressed patients. The aim of this study was to determine factors associated with strongyloidiasis in migrants living in a non-endemic area and to assess the response to treatment and follow-up in those diagnosed with the infection. We performed a multicenter case-control study with 158 cases and 294 controls matched 1:2 by a department service. Participants were recruited simultaneously at six hospitals or clinics in Spain. A paired-match analysis was then performed looking for associations and odds ratios in sociodemographic characteristics, pathological background, clinical presentation and analytical details. Cases outcomes after a six-month follow-up visit were also registered and their particularities described. Most cases and controls came from Latin America (63%–47%) or sub-Saharan Africa (26%–35%). The number of years residing in Spain (9.9 vs. 9.8, p = 0.9) and immunosuppression status (30% vs. 36.3%, p = 0.2) were also similar in both groups. Clinical symptoms such as diffuse abdominal pain (21% vs. 13%, p = 0.02), and epigastralgia (29% vs. 18%, p < 0.001); along with a higher eosinophil count (483 vs. 224 cells/mL in cases and controls, p < 0.001) and the mean total Immunoglobulin E (IgE) (354 U/L vs. 157.9 U/L; p < 0.001) were associated with having strongyloidiasis. Finally, 98.2% percent of the cases were treated with ivermectin in different schedules, and 94.5% met the cure criteria at least six months after their first consultation. Abdominal pain, epigastralgia, eosinophilia, increased levels of IgE and Latin American origin remain the main features associated with S. stercoralis infection, although this association is less evident in immunosuppressed patients. The appropriate follow-up time to evaluate treatment response based on serology titers should be extended beyond 6 months if the cure criteria are not achieved. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
The Global Prevalence of Strongyloides stercoralis Infection
Pathogens 2020, 9(6), 468; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9060468 - 13 Jun 2020
Cited by 43 | Viewed by 2977
Abstract
Strongyloidiasis is a common neglected tropical disease in tropical and sub-tropical climatic zones. At the worldwide level, there is high uncertainty about the strongyloidiasis burden. This uncertainty represents an important knowledge gap since it affects the planning of interventions to reduce the burden [...] Read more.
Strongyloidiasis is a common neglected tropical disease in tropical and sub-tropical climatic zones. At the worldwide level, there is high uncertainty about the strongyloidiasis burden. This uncertainty represents an important knowledge gap since it affects the planning of interventions to reduce the burden of strongyloidiasis in endemic countries. This study aimed to estimate the global strongyloidiasis prevalence. A literature review was performed to obtain prevalence data from endemic countries at a worldwide level from 1990 to 2016. For each study, the true population prevalence was calculated by accounting for the specificity and the sensitivity of testing and age of tested individuals. Prediction of strongyloidiasis prevalence for each country was performed using a spatiotemporal statistical modeling approach. The country prevalence obtained from the model was used to estimate the number of infected people per country. We estimate the global prevalence of strongyloidiasis in 2017 to be 8.1% (95% CI: 4.2–12.4%), corresponding to 613.9 (95% CI: 313.1–910.1) million people infected. The South-East Asia, African, and Western Pacific Regions accounted for 76.1% of the global infections. Our results could be used to identify those countries in which strongyloidiasis prevalence is highest and where mass drug administration (MDA) should be deployed for its prevention and control. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
Strongyloides stercoralis in Alcoholic Patients: Implications of Alcohol Intake in the Frequency of Infection and Parasite Load
Pathogens 2020, 9(6), 422; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9060422 - 28 May 2020
Cited by 3 | Viewed by 958
Abstract
Strongyloides stercoralis infection in immunocompromised subjects, including chronic alcoholics, can lead to a severe disease. Moreover, its prevalence in alcoholic patients seems to be higher than that in the general population. The aims of this study were to evaluate the frequency of S. [...] Read more.
Strongyloides stercoralis infection in immunocompromised subjects, including chronic alcoholics, can lead to a severe disease. Moreover, its prevalence in alcoholic patients seems to be higher than that in the general population. The aims of this study were to evaluate the frequency of S. stercoralis infection in alcoholic patients and to investigate the influence of alcohol intake on the parasite load, as well as to evaluate the sensitivity of three different parasitological methods according to the larval output. Fecal samples of 1290 chronic alcoholic patients were examined by spontaneous sedimentation, Baermann–Moraes, and agar plate culture (APC) methods. S. stercoralis was the most frequent parasite found (14.5%; n = 187). Alcoholic individuals infected with Strongyloides stercoralis had a higher daily consumption of alcohol than those who were not infected, 528.6 and 403.0 g/day, respectively (p < 0.05). In addition, individuals with higher alcohol intake presented an increase in parasite load. The S. stercoralis diagnostic method with the highest sensitivity was APC, 97.9% (183/187). In conclusion, S. stercoralis seems to be the most frequent parasite found in alcoholic individuals from endemic areas and alcohol intake is positively associated with S. stercoralis larvae output. In addition, this study confirms that APC is the most sensitive parasitological method used for Strongyloides diagnosis. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
Article
Seroprevalence of the Strongyloides stercoralis Infection in Humans from Yungas Rainforest and Gran Chaco Region from Argentina and Bolivia
Pathogens 2020, 9(5), 394; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9050394 - 20 May 2020
Cited by 1 | Viewed by 1477
Abstract
The threadworm, Strongyloides stercoralis, is endemic in tropical and subtropical areas. Data on the prevalence and distribution of infection with this parasite species is scarce in many critical regions. We conducted a seroprevalence study of S. stercoralis infection in 13 locations in [...] Read more.
The threadworm, Strongyloides stercoralis, is endemic in tropical and subtropical areas. Data on the prevalence and distribution of infection with this parasite species is scarce in many critical regions. We conducted a seroprevalence study of S. stercoralis infection in 13 locations in the Gran Chaco and Yungas regions of Argentina and Bolivia during the period 2010–2016. A total of 2803 human serum samples were analyzed by ELISA-NIE which has a sensitivity of 75% and specificity of 95%. Results showed that 551 (19.6%) of those samples were positive. The adjusted prevalence was 20.9%, (95% confidence interval (CI) 19.4–22.4%). The distribution of cases was similar between females and males with an increase of prevalence with age. The prevalence in the different locations ranged from 7.75% in Pampa del Indio to 44.55% in Santa Victoria Este in the triple border between Argentina, Bolivia, and Paraguay in the Chaco region. Our results show that S. stercoralis is highly prevalent in the Chaco and Yungas regions, which should prompt prospective surveys to confirm our findings and the design and deployment of control measures. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
Should We Screen HIV-Positive Migrants for Strongyloidiasis?
Pathogens 2020, 9(5), 388; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9050388 - 18 May 2020
Cited by 1 | Viewed by 1115
Abstract
Background: Strongyloides stercoralis, a nematode endemic in all (sub)tropical regions, can cause life-threatening disease, especially in immunosuppressed patients. Many countries with high HIV-prevalence rates are also highly S. stercoralis endemic, and co-infection may occur. Methods: Retrospective study based on serological testing for S. [...] Read more.
Background: Strongyloides stercoralis, a nematode endemic in all (sub)tropical regions, can cause life-threatening disease, especially in immunosuppressed patients. Many countries with high HIV-prevalence rates are also highly S. stercoralis endemic, and co-infection may occur. Methods: Retrospective study based on serological testing for S. stercoralis in all HIV-infected migrants followed at the Institute of Tropical Medicine, Antwerp, Belgium. If untested, serologic testing was performed on stored samples, dating from the first HIV viral load determination. The epidemiological, clinical and laboratory features of patients with and without strongyloidiasis were retrieved from the electronic medical files. Results: Of the 2846 HIV patients in active follow-up, 723 (25.4%) had a migration background. Thirty-six patients (5.1%) were diagnosed with Strongyloides co-infection, including 29 during their medical evaluation and seven retrospectively. Patients had a median age of 35.3 years (IQR 30.3–44.4), 28 patients (78%) originated from Sub-Saharan Africa and median time in Belgium was 3.5 years (IQR 0.8–5.7). Symptoms compatible with strongyloidiasis were present in 17 (47%) patients, of whom two were diagnosed retrospectively. Eosinophilia (eosinophil cell count > 450/µL) was observed in 19 (53%) participants. Median CD4 level was 386 /µL (IQR 299–518) at diagnosis of co-infection. Of note, 8 (22%) patients with strongyloidiasis had no reported symptoms nor eosinophilia. None of the patients developed hyperinfection syndrome. There were no differences in age, gender, geographic origin, clinical presentation, CD4 level or viral load between patients with and without strongyloidiasis. Only eosinophilia was strongly correlated with the presence of Strongyloides in multivariate analysis (OR 10.74 (95% CI 5.19–22.25), p < 0.001); the positive likelihood ratio (LR+) of eosinophilia for strongyloidiasis was 5.38 (95% CI 3.66–7.91). Conclusion: Strongyloidiasis was diagnosed in 5.1% of HIV-infected migrants. Eosinophilia had good confirming power for the presence of the disease. However, a sizeable proportion (22%) of co-infected individuals were asymptomatic and had normal eosinophil count, supporting universal screening of all HIV-positive patients native to tropical countries. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
A Cross-Sectional Study of Seroprevalence of Strongyloidiasis in Pregnant Women (Peruvian Amazon Basin)
Pathogens 2020, 9(5), 348; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9050348 - 04 May 2020
Cited by 4 | Viewed by 1166
Abstract
Strongyloidiasis is a soil-transmitted helminthiasis with a high global prevalence. Objectives: We aimed to evaluate the prevalence of Strongyloides stercoralis infection and assess strongyloidiasis serology as a screening technique in the Peruvian Amazon. Material and Methods: We performed a cross-sectional study of strongyloidiasis [...] Read more.
Strongyloidiasis is a soil-transmitted helminthiasis with a high global prevalence. Objectives: We aimed to evaluate the prevalence of Strongyloides stercoralis infection and assess strongyloidiasis serology as a screening technique in the Peruvian Amazon. Material and Methods: We performed a cross-sectional study of strongyloidiasis in 300 pregnant women in Iquitos (Peru) from 1 May 2019 to 15 June 2019. Women were tested using serology (Strongyloides IgG IVD-ELISA kit) as an index test and the modified Baermann technique and/or charcoal fecal culture as the parasitological reference standard. Results: The reference tests showed S. stercoralis in the stool of 30 women (prevalence: 10%; 95% confidence interval [CI] 7.1% to 13.9%), while 101 women tested positive on the blood test (prevalence: 33.7%; 95% CI 28.6% to 39.4%). Fourteen of the 15 women (93.3%) with positive results according to the modified Baermann technique, and 14 of the 23 women (56.5%) with positive charcoal cultures also had positive serological results. Serology showed a sensitivity of 63.3% and a negative predictive value of 94.4%. Conclusion: In Iquitos, pregnant women have a high prevalence of S stercoralis. S. stercoralis ELISA could be an excellent tool for population-based screening, as it has a high negative predictive value that can help to rule out the presence of active infection. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
Will Nigerians Win the War Against Urinary Schistosomiasis? Prevalence, Intensity, Risk Factors and Knowledge Assessment among Some Rural Communities in Southwestern Nigeria
Pathogens 2020, 9(2), 128; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9020128 - 17 Feb 2020
Cited by 3 | Viewed by 1005
Abstract
Urinary schistosomiasis is a devastating parasitic disease in Nigeria. This study was carried out to investigate the current prevalence, intensity, risk factors and knowledge assessment among some rural communities in southwestern Nigeria. A cross-sectional study was carried out in which a standard urine [...] Read more.
Urinary schistosomiasis is a devastating parasitic disease in Nigeria. This study was carried out to investigate the current prevalence, intensity, risk factors and knowledge assessment among some rural communities in southwestern Nigeria. A cross-sectional study was carried out in which a standard urine filtrations technique was used to determine the prevalence and intensity of infection. A well-designed questionnaire was used to collect subject’s data on demographic and socioeconomic characteristics. Of the total 620 urine samples examined, overall 346 (55.81%) were positive with a mean egg intensity (S.D) of 65.60 (59.33) egg/10 mL of urine. Significant differences occurred in the analysis. Males had the highest prevalence and intensity of 224 (61.9%) and 69.20 egg/10 mL of urine, respectively. The 10–14 years age group had the highest prevalence of 65.9% while mean intensity of infection among the age group decreases with increasing age, with the highest mean intensity of infection (80.14 egg/10 mL) recorded among the age group ≤ 4 years. Bivariate logistic regression analysis showed that being age group 10–14 (COR 0.27, 95% CI: 0.09–0.79) and dependent on river (COR 0.67, 95% CI: 0.33–1.33) increased the odd of contracting an infection. Similarly, the knowledge of respondents on urinary schistosomiasis was low. Conclusively, urinary schistosomiasis is still persistent at a very high rate in the study area and appropriate control measure should be deployed. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
High Prevalence of Strongyloidiasis in Spain: A Hospital-Based Study
Pathogens 2020, 9(2), 107; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9020107 - 11 Feb 2020
Cited by 2 | Viewed by 1575
Abstract
Introduction: Strongyloidiasis is a prevailing helminth infection ubiquitous in tropical and subtropical areas, however, seroprevalence data are scarce in migrant populations, particularly for those coming for Asia. Methods: This study aims at evaluating the prevalence of S. stercoralis at the hospital [...] Read more.
Introduction: Strongyloidiasis is a prevailing helminth infection ubiquitous in tropical and subtropical areas, however, seroprevalence data are scarce in migrant populations, particularly for those coming for Asia. Methods: This study aims at evaluating the prevalence of S. stercoralis at the hospital level in migrant populations or long term travellers being attended in out-patient and in-patient units as part of a systematic screening implemented in six Spanish hospitals. A cross-sectional study was conducted and systematic screening for S. stercoralis infection using serological tests was offered to all eligible participants. Results: The overall seroprevalence of S. stercoralis was 9.04% (95%CI 7.76–10.31). The seroprevalence of people with a risk of infection acquired in Africa and Latin America was 9.35% (95%CI 7.01–11.69), 9.22% (7.5–10.93), respectively. The number of individuals coming from Asian countries was significantly smaller and the overall prevalence in these countries was 2.9% (95%CI −0.3–6.2). The seroprevalence in units attending potentially immunosuppressed patients was significantly lower (5.64%) compared with other units of the hospital (10.20%) or Tropical diseases units (13.33%) (p < 0.001). Conclusions: We report a hospital-based strongyloidiasis seroprevalence of almost 10% in a mobile population coming from endemic areas suggesting the need of implementing strongyloidiasis screening in hospitalized patients coming from endemic areas, particularly if they are at risk of immunosuppression. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Article
High Prevalence of Strongyloides among South Asian Migrants in Primary Care―Associations with Eosinophilia and Gastrointestinal Symptoms
Pathogens 2020, 9(2), 103; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9020103 - 06 Feb 2020
Cited by 1 | Viewed by 1507
Abstract
Gastrointestinal (GI) symptoms are a frequent reason for primary care consultation, and common amongst patients with strongyloidiasis. We conducted a prospective cohort and nested case control study in East London to examine the predictive value of a raised eosinophil count or of GI [...] Read more.
Gastrointestinal (GI) symptoms are a frequent reason for primary care consultation, and common amongst patients with strongyloidiasis. We conducted a prospective cohort and nested case control study in East London to examine the predictive value of a raised eosinophil count or of GI symptoms, for Strongyloides infection in South Asian migrants. We included 503 patients in the final analyses and all underwent a standardised GI symptom questionnaire, eosinophil count and Strongyloides serology testing. Positive Strongyloides serology was found in 33.6% in the eosinophilia cohort against 12.5% in the phlebotomy controls, with adjusted odds ratio of 3.54 (95% CI 1.88–6.67). In the GI symptoms cohort, 16.4% were seropositive but this was not significantly different compared with controls, nor were there associations between particular symptoms and Strongyloidiasis. Almost a third (35/115) of patients with a positive Strongyloides serology did not have eosinophilia at time of testing. Median eosinophil count declined post-treatment from 0.5 cells × 109/L (IQR 0.3–0.7) to 0.3 (0.1–0.5), p < 0.001. We conclude Strongyloides infection is common in this setting, and the true symptom burden remains unclear. Availability of ivermectin in primary care would improve access to treatment. Further work should clarify cost-effectiveness of screening strategies for Strongyloides infection in UK migrant populations. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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Review

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Review
Autochthonous Human and Canine Strongyloides stercoralis Infection in Europe: Report of a Human Case in An Italian Teen and Systematic Review of the Literature
Pathogens 2020, 9(6), 439; https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens9060439 - 03 Jun 2020
Cited by 3 | Viewed by 2783
Abstract
Autochthonous human and canine strongyloidiasis is reported in Europe but is unclear whether the transmission of infection still occurs. We report a previously unpublished human case in an Italian teen and perform a systematic review of literature on autochthonous human and canine strongyloidiasis [...] Read more.
Autochthonous human and canine strongyloidiasis is reported in Europe but is unclear whether the transmission of infection still occurs. We report a previously unpublished human case in an Italian teen and perform a systematic review of literature on autochthonous human and canine strongyloidiasis in Europe to investigate the current dynamic of transmission. Overall, 109 papers published after 1987 were included and one previously unpublished Italian case was added. Eighty case reports were retrieved and 42 of them (52.5%) had severe strongyloidiasis. Most cases were diagnosed in Spain, Italy and France. The median age was 58, the most represented age group was 61–70 years, 11 patients were under 30, and 7 of them were diagnosed after 2000. Epidemiological studies on human strongyloidiasis showed prevalence ranging from 0.56% to 28%. Overall, agriculture work, mine work and walking barefoot were the most commonly reported risk factors for infection. Canine strongyloidiasis was reported mainly in Italy (68 cases), but a few cases occurred also in Iceland, Finland, England, Germany, France, Switzerland, Russia, Slovakia, Romania and Greece. Autochthonous strongyloidiasis is still reported in Europe and sporadic transmission still occurs. Health care professionals should be aware of this issue to identify infected subjects and avoid adverse outcomes, especially in immunosuppressed patients. Further investigations are needed to clarify the zoonotic transmission of this nematode. Full article
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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