1
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Alam AM, Ozdemir C, Reza N. Strongyloides stercoralis infection in the UK: A systematic review and meta-analysis of published cases. Clin Med (Lond) 2024; 24:100227. [PMID: 39009349 PMCID: PMC11342261 DOI: 10.1016/j.clinme.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/10/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024]
Abstract
Strongyloidiasis is a helminth infection where symptoms vary, and asymptomatic presentation is common. Chronic strongyloidiasis can cause a high mortality 'hyper-infection' in immunocompromised states. Understanding at risk populations and symptomology can guide screening and early treatment to reduce hyper-infection risk. A systematic review of studies describing patients in the UK with strongyloidiasis pooled a total of 1,308 patients. Weighted pooled prevalence (WPP) of asymptomatic cases was 27.7% (95% CI 17.1-39.5%, I2 = 92%, p < 0.01). At-risk populations included migrants, returning travellers and armed forces personnel. The most common symptoms reported were abdominal pain (WPP 32.1% (95% CI 20.5-44.8%), I2 = 93%, p < 0.01), rashes (WPP 38.4% (95% CI 13.1-67.7%), I2 = 99%, p < 0.01) and diarrhoea (WPP 12.6% (95% CI 6.7-19.9%), I2=70%, p = 0.03). Symptomatology varied with cohort characteristics. Although asymptomatic presentation is common, patients may present with abdominal pain, diarrhoea or rashes. A low threshold for screening symptomatic individuals in at-risk groups is required.
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Affiliation(s)
- Ali M Alam
- Newham Hospital, Barts Health NHS Trust, London, UK
| | - Cansu Ozdemir
- GKT School of Medical Education, King's College London, London, UK
| | - Nada Reza
- Antimicrobial Pharmacodynamics and Therapeutics Group, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, 6 West Derby Street, University of Liverpool, Liverpool L7 8TX, UK.
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2
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Molaei S, Asfaram S, Mashhadi Z, Mohammadi-Ghalehbin B, Iranpour S. Insights into parasites and COVID-19 co-infections in Iran: a systematic review. Trans R Soc Trop Med Hyg 2024; 118:350-358. [PMID: 38288655 DOI: 10.1093/trstmh/trae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 11/28/2023] [Accepted: 01/23/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND It is well-documented that using immunosuppressive drugs such as corticosteroids or cytokine blockers in treating coronavirus disease 2019 (COVID-19) increases the risk of co-infections. Here we systematically summarized the cases of COVID-19-associated parasitic infections (CAPIs) in Iran. METHODS From 19 February 2020 to 10 May 2023, all studies on Iranian patients suffering from CAPIs were collected from several databases using a systematic search strategy. RESULTS Of 540 records, 11 studies remained for data extraction. In this research, most of the studies were related to Lophomonas and Toxoplasma. Of 411 cases of CAPIs, toxoplasmosis (385 [93.7%]) had the highest rate of infection among Iranian patients, followed by blastocystosis (15 [3.6%]), fascioliasis (4 [0.97%]), leishmaniasis (3 [0.7%]), lophomoniasis (3 [0.7%]) and strongyloidiasis (1 [0.2%]). In general, Blastocystis enhanced diarrhoea in patients with COVID-19. Lophomonas, Toxoplasma and Strongyloides increased the severity of COVID-19, but Fasciola decreased its intensity. Patients with a history of cutaneous leishmaniasis showed mild symptoms of COVID-19. Also, patients with a prior history of hydatid cysts were not affected by COVID-19. CONCLUSIONS Due to the similar symptoms of some parasitic diseases and COVID-19 and immunosuppressive treatment regimens in these patients that may cause the reactivation or recurrence of parasitic infections, early diagnosis and treatment are required.
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Affiliation(s)
- Soheila Molaei
- Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil 56189-53141, Iran
| | - Shabnam Asfaram
- Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil 56189-53141, Iran
| | - Zahra Mashhadi
- School of Medicine, Ardabil University of Medical Sciences, Ardabil 56189-53141, Iran
| | - Behnam Mohammadi-Ghalehbin
- Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil 56189-53141, Iran
- Department of Microbiology and Immunology, School of Medicine, Ardabil University of Medical Sciences, Ardabil 56189-53141, Iran
| | - Sohrab Iranpour
- Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil 56189-53141, Iran
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil 56189-53141, Iran
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3
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Le B, Clarke NE, Legrand N, Nery SV. Effectiveness of ivermectin mass drug administration in the control of soil-transmitted helminth infections in endemic populations: a systematic review and meta-analysis. Infect Dis Poverty 2024; 13:16. [PMID: 38369483 PMCID: PMC10874526 DOI: 10.1186/s40249-024-01185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Current soil-transmitted helminth (STH) control guidelines endorse the use of albendazole or mebendazole for school-based targeted preventive chemotherapy (PC), yet their reduced efficacy against Strongyloides stercoralis and Trichuris trichiura presents significant limitations. Emerging evidence indicates that community-wide PC [or mass drug administration (MDA)] using ivermectin, commonly used in other neglected tropical disease (NTD) control programs, may play an important role in controlling these parasites. We conducted a systematic review and meta-analysis to evaluate the effectiveness of ivermectin PC in reducing STH prevalence in endemic populations. METHODS We searched Pubmed, EMBASE, and Web of Science on February 14, 2023, for studies that investigated the effectiveness of ivermectin PC, either alone or in combination with other anthelmintic drugs, on STH infections, and provided a measure of STH prevalence before and after PC. We calculated pooled prevalence reductions for each STH using random-effects meta-analyses. Our protocol is available on PROSPERO (registration number CRD42023401219). RESULTS A total of 21 were eligible for the systematic review, of which 15 were eligible for meta-analysis. All studies delivered ivermectin through MDA. The pooled prevalence reduction of S. stercoralis following MDA with ivermectin alone was 84.49% (95% CI 54.96-94.66) across five studies and 81.37% (95% CI 61.62-90.96) across seven studies with or without albendazole. The prevalence reduction of T. trichiura was 49.93% (95% CI 18.23-69.34) across five studies with ivermectin alone, and 89.40% (95% CI 73.66-95.73) across three studies with the addition of albendazole. There was high heterogeneity for all syntheses (I2 > 65%). CONCLUSIONS This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S. stercoralis and T. trichiura. Based on these findings, revising international STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination of STHs and other NTDs.
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Affiliation(s)
- Brandon Le
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Naomi E Clarke
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Nicolas Legrand
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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4
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Gordon CA, Utzinger J, Muhi S, Becker SL, Keiser J, Khieu V, Gray DJ. Strongyloidiasis. Nat Rev Dis Primers 2024; 10:6. [PMID: 38272922 DOI: 10.1038/s41572-023-00490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.
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Affiliation(s)
- Catherine A Gordon
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Department of Microbiology and Immunology, Parkville, Victoria, Australia
| | - Sören L Becker
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Darren J Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
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Bryant AS, Akimori D, Stoltzfus JDC, Hallem EA. A standard workflow for community-driven manual curation of Strongyloides genome annotations. Philos Trans R Soc Lond B Biol Sci 2024; 379:20220443. [PMID: 38008112 PMCID: PMC10676816 DOI: 10.1098/rstb.2022.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/18/2023] [Indexed: 11/28/2023] Open
Abstract
Advances in the functional genomics and bioinformatics toolkits for Strongyloides species have positioned these species as genetically tractable model systems for gastrointestinal parasitic nematodes. As community interest in mechanistic studies of Strongyloides species continues to grow, publicly accessible reference genomes and associated genome annotations are critical resources for researchers. Genome annotations for multiple Strongyloides species are broadly available via the WormBase and WormBase ParaSite online repositories. However, a recent phylogenetic analysis of the receptor-type guanylate cyclase (rGC) gene family in two Strongyloides species highlights the potential for errors in a large percentage of current Strongyloides gene models. Here, we present three examples of gene annotation updates within the Strongyloides rGC gene family; each example illustrates a type of error that may occur frequently within the annotation data for Strongyloides genomes. We also extend our analysis to 405 previously curated Strongyloides genes to confirm that gene model errors are found at high rates across gene families. Finally, we introduce a standard manual curation workflow for assessing gene annotation quality and generating corrections, and we discuss how it may be used to facilitate community-driven curation of parasitic nematode biodata. This article is part of the Theo Murphy meeting issue 'Strongyloides: omics to worm-free populations'.
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Affiliation(s)
- Astra S. Bryant
- Department of Physiology and Biophysics, University of Washington, Seattle, WA 98195, USA
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, CA 90095, USA
| | - Damia Akimori
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, CA 90095, USA
- Molecular Biology Interdepartmental PhD Program, University of California, Los Angeles, CA 90095, USA
| | | | - Elissa A. Hallem
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California, Los Angeles, CA 90095, USA
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Bradbury RS, Streit A. Is strongyloidiasis a zoonosis from dogs? Philos Trans R Soc Lond B Biol Sci 2024; 379:20220445. [PMID: 38008118 PMCID: PMC10676807 DOI: 10.1098/rstb.2022.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/29/2023] [Indexed: 11/28/2023] Open
Abstract
Strongyloides stercoralis infection remains a major veterinary and public health challenge globally. This chronic and potentially lifelong disease has fatal outcomes in immunosuppressed people and dogs. Currently, the role of dogs in the transmission cycle of human strongyloidiasis remains enigmatic. While zoonotic transmission to humans from companion animals has been proposed, this has not been confirmed. Modern molecular methods have allowed greater opportunity to explore the genotypes of S. stercoralis in dogs and humans. Work thus far has demonstrated that at least two distinct lineages exist, one apparently confined to canine hosts and one found in canine, feline, human and non-human primate hosts. Although genotyping of dog and human isolates from the same village has demonstrated identical genotypes in both species, coprophagia of human waste by dogs confounds interpretation. It remains unclear if dogs act as a zoonotic reservoir for human infection, or vice versa, or if this occurs only in some regions of the world and not in others. These questions must be answered before effective control strategies for strongyloidiasis can be instituted. This review explores the evidence for and against cross-species transmission of S. stercoralis between dogs and humans and summarizes future directions for research in this area. This article is part of the Theo Murphy meeting Issue 'Strongyloides: omics to worm-free populations'.
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Affiliation(s)
- Richard S. Bradbury
- School of Health and Life Sciences, Federation University, Melbourne, Victoria 3806, Australia
| | - Adrian Streit
- Department for Integrative Evolutionary Biology, Max Planck Institute for Biology Tübingen, Tübingen, 72076, Germany
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Buonfrate D, Bradbury RS, Watts MR, Bisoffi Z. Human strongyloidiasis: complexities and pathways forward. Clin Microbiol Rev 2023; 36:e0003323. [PMID: 37937980 PMCID: PMC10732074 DOI: 10.1128/cmr.00033-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/11/2023] [Indexed: 11/09/2023] Open
Abstract
Strongyloidiasis is a World Health Organization neglected tropical disease usually caused by Strongyloides stercoralis, a parasitic worm with a complex life cycle. Globally, 300-600 million people are infected through contact with fecally contaminated soil. An autoinfective component of the life cycle can lead to chronic infection that may be asymptomatic or cause long-term symptoms, including malnourishment in children. Low larval output can limit the sensitivity of detection in stool, with serology being effective but less sensitive in immunocompromise. Host immunosuppression can trigger catastrophic, fatal hyperinfection/dissemination, where large numbers of larvae pierce the bowel wall and disseminate throughout the organs. Stable disease is effectively treated by single-dose ivermectin, with disease in immunocompromised patients treated with multiple doses. Strategies for management include raising awareness, clarifying zoonotic potential, the development and use of effective diagnostic tests for epidemiological studies and individual diagnosis, and the implementation of treatment programs with research into therapeutic alternatives and medication safety.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Richard S. Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, Victoria, Australia
| | - Matthew R. Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research – New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
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Zulfiqar S, Gasser RB, Ghodsian S, Almukhtar M, Holland C, Rostami A. Strongyloides coinfection in COVID-19 patients treated with corticosteroids: A systematic review. Rev Med Virol 2023; 33:e2469. [PMID: 37353858 DOI: 10.1002/rmv.2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023]
Abstract
The COVID-19 pandemic linked to the virus SARS-CoV-2, which began in China, affected ∼765 million people as of 30 April 2023. The widespread use of corticosteroids for the symptomatic treatment of COVID-19 could lead to the reactivation of infections of opportunistic pathogens, including Strongyloides. We sought to determine the clinical symptoms and demographic characteristics of SARS-CoV-2-Strongyloides co-infection, particularly in patients with severe disease and being treated with immunosuppressive drugs. To do this, we undertook a systematic review of the literature, and searched public accessible scientific databases-the Web of Science, Scopus, PubMed/Medline and Embase -for eligible studies (1 December 2019 to 30 August 2022). The review protocol is registered in PROSPERO (CRD42022377062). Descriptive statistical analyses were used to present the clinical and laboratory parameters of the co-infection; for this, we calculated prevalence using the following formula: positive cases/total number of cases × 100. Of a total of 593 studies identified, 17 studies reporting 26 co-infected patients met the criteria for inclusion in this review. The median age of these patients was 55.14 years. Most of cases (53.8%) were treated with dexamethasone, followed by methylprednisolone (26.9%). Eighteen of 26 patients were immigrants living in European countries or the USA; most of these immigrants originated from Latin America (58%) and South-East Asia (11%). The commonest symptoms of co-infection were abdominal pain (50%), fever (46.1%), dyspnoea (30.7%) and cough (30.7%), and frequently reported laboratory findings were high absolute eosinophil count (38.4%), high white blood cell count (30.7%), high C-reactive protein (23.0%) and high neutrophil count (19.2%). Two of the 26 patients (7.7%) had fatal outcomes. Most of the SARS-CoV-2-Strongyloides coinfected cases were immigrants living in developed countries, emphasising the need for clinicians in these countries to be aware of clinical and laboratory parameters associated with such co-infections, as well as the key importance of rapid and accurate diagnostic tests for timely and effective diagnosis and patient management.
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Affiliation(s)
- Sana Zulfiqar
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Robin B Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - Sahar Ghodsian
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mustafa Almukhtar
- Takhar Family Medicine and Urgent Care, Sacramento, California, United States
| | - Celia Holland
- Department of Zoology, School of Natural Sciences, Trinity College Dublin, the University of Dublin, College Green Dublin, Ireland
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Magnaval JF, Fillaux J, Fabre R, Cassaing S, Valentin A, Iriart X, Berry A. Epidemiological, Clinical and Laboratory Features of Strongyloidiasis in 69 Attendees at a French Outpatient Clinic. Pathogens 2023; 12:983. [PMID: 37623943 PMCID: PMC10459160 DOI: 10.3390/pathogens12080983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
The present retrospective study analyzed the characteristics of strongyloidiasis in patients who were diagnosed at the Outpatient Clinic of the Department of Parasitology-Mycology, Toulouse, France. Sixty-nine file records were included in the study on the basis of a positive stool examination that used Baermann's method. The prominent epidemiological findings were the presence of former immigrants from Italy or Portugal, veterans from the 1st Indochina war, and autochthonous cases. Almost 1/4 of the patients were asymptomatic. Manifestations of skin allergy were the main clinical feature. Blood eosinophilia was present in 76.8% of the patients, and serum total IgE was ≥150 kIU/L in 79.7%. Immunodiagnosis was achieved from 1990 to 2001 by indirect immunofluorescence (IFAT) that was then replaced with ELISA, both methods using Strongyloides ratti filariform larvae. ELISA was found to be similar to IFAT in terms of specificity but exhibited a greater sensitivity. Patients were primarily treated with albendazole or ivermectin beginning in 1993. Forty-eight patients attended the follow-up consultation. Kinetics of the clinical picture and blood eosinophilia were found to be the most convenient parameters to assess the efficacy of anthelmintic therapy. In conclusion, strongyloidiasis remains a neglected disease in Southwestern France. The resolution of clinical features along with the kinetics of eosinophilia appeared to be the most appropriate parameters to check during the posttreatment follow-up.
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Affiliation(s)
- Jean-François Magnaval
- Service de Parasitologie Médicale, Faculté de Médecine, Université de Toulouse, 31000 Toulouse, France
| | - Judith Fillaux
- Service de Parasitologie-Mycologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, TSA 4003, 31059 Toulouse, France
| | - Richard Fabre
- DENDRIS, 335 Rue du Chêne Vert, 31670 Labège, France
| | - Sophie Cassaing
- Service de Parasitologie-Mycologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, TSA 4003, 31059 Toulouse, France
- FLAMES/RESTORE (Inserm UMR 1301/CNRS UMR 5070/EFS), Université de Toulouse, 31100 Toulouse, France
| | - Alexis Valentin
- Service de Parasitologie-Mycologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, TSA 4003, 31059 Toulouse, France
- PHARMA-DEV (UMR 152), Institut de Recherche Pour le Développement, Université de Toulouse, 31062 Toulouse, France
| | - Xavier Iriart
- Service de Parasitologie-Mycologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, TSA 4003, 31059 Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (UMR “Infinity”, Inserm/CNRS/Université de Toulouse III), 31024 Toulouse, France
| | - Antoine Berry
- Service de Parasitologie-Mycologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, TSA 4003, 31059 Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (UMR “Infinity”, Inserm/CNRS/Université de Toulouse III), 31024 Toulouse, France
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Akanksha K, Kumari A, Dutta O, Prasanth A, Deeba F, Salam N. Prevalence of soil-transmitted helminth infections in HIV patients: a systematic review and meta-analysis. Sci Rep 2023; 13:11055. [PMID: 37422549 PMCID: PMC10329649 DOI: 10.1038/s41598-023-38030-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/01/2023] [Indexed: 07/10/2023] Open
Abstract
Soil-transmitted Helminth (STH) infections have been found associated with people living with human immunodeficiency virus (HIV) but little is known about the overall burden of STH coinfection in HIV patients. We aimed to assess the burden of STH infections among HIV patients. Relevant databases were systematically searched for studies reporting the prevalence of soil-transmitted helminthic pathogens in HIV patients. Pooled estimates of each helminthic infection were calculated. The odds ratio was also determined as a measure of the association between STH infection and the HIV status of the patients. Sixty-one studies were finally included in the meta-analysis, consisting of 16,203 human subjects from all over the world. The prevalence of Ascaris lumbricoides infection in HIV patients was found to be 8% (95% CI 0.06, 0.09), the prevalence of Trichuris trichiura infection in HIV patients was found to be 5% (95% CI 0.04, 0.06), the prevalence of hookworm infection in HIV patients was found to be 5% (95% CI 0.04, 0.06), and prevalence of Strongyloides stercoralis infection in HIV patients was found to be 5% (95% CI 0.04, 0.05). Countries from Sub-Saharan Africa, Latin America & Caribbean and Asia were identified with the highest burden of STH-HIV coinfection. Our analysis indicated that people living with HIV have a higher chance of developing Strongyloides stercoralis infections and decreased odds of developing hookworm infections. Our findings suggest a moderate level of prevalence of STH infections among people living with HIV. The endemicity of STH infections and HIV status both are partially responsible for the burden of STH-HIV coinfections.
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Affiliation(s)
- Kumari Akanksha
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Ashu Kumari
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Omprokash Dutta
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Ajay Prasanth
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Farah Deeba
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Nasir Salam
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India.
- Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India.
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Caraballo L, Llinás-Caballero K. The Relationship of Parasite Allergens to Allergic Diseases. Curr Allergy Asthma Rep 2023; 23:363-373. [PMID: 37269427 PMCID: PMC10354133 DOI: 10.1007/s11882-023-01089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE OF REVIEW Helminth infections modify the natural history of allergic diseases, by either decreasing or increasing their symptoms. Several helminth components are involved in the increasing of the allergic response and symptoms, overcoming the concomitant immunosuppression of helminthiases. However, the role of individual IgE-binding molecules in this process remains to be defined. RECENT FINDINGS We updated the list of helminth allergens and IgE-binding molecules, their effects on asthma presentation, and their impact on allergy diagnosis. Data from genetic and epigenetic studies of ascariasis are analyzed. A new species-specific A. lumbricoides allergen has been discovered, with potential use in molecular diagnosis. Most helminth IgE-binding components are not officially classified as allergens in the WHO/IUIS database, although there is evidence of their influence increasing allergic manifestations. Further immunological characterization of these components is needed to better understand their mechanisms of action and evaluate the ways in which they can influence the diagnosis of allergy.
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Affiliation(s)
- Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia
| | - Kevin Llinás-Caballero
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia
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Stroffolini G, Tamarozzi F, Fittipaldo A, Mazzi C, Le B, Vaz Nery S, Buonfrate D. Impact of preventive chemotherapy on Strongyloides stercoralis: A systematic review and meta-analysis. PLoS Negl Trop Dis 2023; 17:e0011473. [PMID: 37428815 PMCID: PMC10358935 DOI: 10.1371/journal.pntd.0011473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/20/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Strongyloides stercoralis is a neglected soil-transmitted helminth (STH) that leads to significant morbidity in endemic populations. Infection with this helminth has recently been recognised by the World Health Organization (WHO) as a major global health problem to be addressed with ivermectin preventive chemotherapy, and therefore, there is now, the need to develop guidelines for strongyloidiasis control that can be implemented by endemic countries. This study aimed to evaluate the impact of ivermectin preventive chemotherapy (PC) on S. stercoralis prevalence in endemic areas to generate evidence that can inform global health policy. METHODOLOGY/PRINCIPAL FINDINGS This study was a systematic review and meta-analysis. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS for literature published between 1990 and 2022 and reporting prevalence of S. stercoralis before and after PC with ivermectin, administered either at school or at community level. The search strategy identified 933 records, eight of which were included in the meta-analysis. Data extraction and quality assessment were carried out by two authors. Meta-analysis of studies based on fecal testing demonstrated a significant reduction of S. stercoralis prevalence after PC: prevalence Risk Ratio (RR) 0.18 (95% CI 0.14-0.23), I2 = 0. A similar trend was observed in studies that used serology for diagnosis: RR 0.35 (95% CI 0.26-0.48), I2 = 4.25%. A sensitivity analysis was carried out for fecal tests where low quality studies were removed, confirming a post-intervention reduction in prevalence. The impact of PC could not be evaluated at different time points or comparing annual vs biannual administration due to insufficient data. CONCLUSIONS/SIGNIFICANCE Our findings demonstrate a significant decrease of S. stercoralis prevalence in areas where ivermectin PC has taken place, supporting the use of ivermectin PC in endemic areas.
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Affiliation(s)
- Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
| | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
| | - Andrea Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
| | - Cristina Mazzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
| | - Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
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13
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Seeger D, Cornejo Cisneros E, Lucar J, Denyer R. Strongyloides and COVID-19: Challenges and Opportunities for Future Research. Trop Med Infect Dis 2023; 8:127. [PMID: 36828543 PMCID: PMC9967524 DOI: 10.3390/tropicalmed8020127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.
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Affiliation(s)
- Daniel Seeger
- Infectious Diseases Section, DC Veterans Affairs Medical Center, Washington, DC 20422, USA
- Division of Infectious Diseases, School of Medicine and Health Sciences, George Washington University, Washington, DC 20052, USA
| | - Enrique Cornejo Cisneros
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
| | - Jose Lucar
- Division of Infectious Diseases, School of Medicine and Health Sciences, George Washington University, Washington, DC 20052, USA
| | - Rachel Denyer
- Infectious Diseases Section, DC Veterans Affairs Medical Center, Washington, DC 20422, USA
- Division of Infectious Diseases, School of Medicine and Health Sciences, George Washington University, Washington, DC 20052, USA
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14
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Scott J, Emeto TI, Melrose W, Warner J, Rush C. Seroepidemiology of Strongyloides spp. Infection in Balimo, Western Province, Papua New Guinea. Am J Trop Med Hyg 2023; 108:346-352. [PMID: 36572010 PMCID: PMC9896327 DOI: 10.4269/ajtmh.22-0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2022] Open
Abstract
Strongyloidiasis in Papua New Guinea (PNG) is poorly understood. There have been limited surveys describing the levels of endemicity in some regions of PNG, but in the Western Province, its occurrence and level of burden are unknown. This study aimed to determine the seroepidemiology of Strongyloides spp. seropositivity within a community located in the Balimo region of the Western Province. Plasma samples were collected from 120 adult participants and were subjected to anti-IgG Strongyloides spp. serological testing. Logistical regression analyses were performed to identify relationships between strongyloidiasis and attributes of sociodemography. In this cross-sectional cohort study, 22.5% (27/120; 95% CI: 15.9-30.8%) of participants were seropositive for strongyloidiasis. Participants with higher body mass indices were less likely to be seropositive for Strongyloides spp. infection (odds ratio [OR] = 0.85, P value = 0.008), and in the multivariable analysis, increasing units of age (adjusted OR [aOR] = 0.93, P value = 0.048) and participants ≤ 40 years old were associated with a decreased likelihood of Strongyloides spp. seropositivity (aOR = 0.07, P value = 0.034). The results from this study indicate that the occurrence of strongyloidiasis is high in the Western Province, PNG, and age is a determining factor of seroreactivity. This study provides evidence of endemic strongyloidiasis in this community and raises questions as to the impact of this neglected disease and other intestinal parasites on disease burden and comorbidities.
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Affiliation(s)
- Jessica Scott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Theophilus I. Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, Australia
| | - Wayne Melrose
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Jeffrey Warner
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Catherine Rush
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
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15
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Buonfrate D, Anselmi M, Prandi R, Marquez M, Mazzi C, Montresor A. Use of a "tablet pole" for the administration of ivermectin for strongyloidiasis in a field study in Ecuador. Infect Dis Poverty 2023; 12:3. [PMID: 36709311 PMCID: PMC9883947 DOI: 10.1186/s40249-023-01054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Establishment of efficient control programs for strongyloidiasis, the infection by Strongyloides stercoralis, is among the World Health Organization (WHO) targets for 2030. Ivermectin is a drug of choice for strongyloidiasis, but its weight-based administration can be unfeasible in remote areas. We evaluated a WHO tablet pole for administration of ivermectin in school-age children living in remote villages in Ecuador. METHODS Children were enrolled in 16 villages in Esmeraldas Province of Ecuador, between July 2021 and June 2022. The pole identified four height intervals corresponding to ivermectin doses going from one to four tablets. For each child, we calculated the dose (µg/kg) administered with both weight-based and pole-based administration. Results were classified as follows: optimal dose, acceptable, overdose, underdose. Agreement between the two methods for estimating the number of tablets was assessed with Cohen's kappa coefficient. Estimations were reported with 95% confidence intervals (CIs). RESULTS Total of 778 children (47.3% female) were enrolled, with median age of 9.59 years (interquartile range: 7.42‒11.22). Optimal dose was achieved for a higher proportion of children when assessed with weight (37.9%) than with pole (25.7%). Underdose and overdose were more frequent with the pole (8.3% and 19.2% children, respectively) than with the weight-based (3.7% and 6.0%, respectively) administration. Agreement between weight-based and pole-based administration was moderate: 0.56 (95% CI 0.51, 0.61). The two methods indicated the same number of tablets in 71.6% (95% CI 0.684, 0.748) cases. CONCLUSIONS In our setting, the tablet pole could be a valid alternative. The tool needs further evaluation in different populations.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | - Mariella Anselmi
- Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Rosanna Prandi
- Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Monica Marquez
- Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Cristina Mazzi
- grid.416422.70000 0004 1760 2489Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona Italy
| | - Antonio Montresor
- grid.3575.40000000121633745Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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16
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Gandasegui J, Onwuchekwa C, Krolewiecki AJ, Doyle SR, Pullan RL, Enbiale W, Kepha S, Hatherell HA, van Lieshout L, Cambra-Pellejà M, Escola V, Muñoz J. Ivermectin and albendazole coadministration: opportunities for strongyloidiasis control. THE LANCET. INFECTIOUS DISEASES 2022; 22:e341-e347. [PMID: 35850127 DOI: 10.1016/s1473-3099(22)00369-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
In 2020, WHO recognised the importance of strongyloidiasis alongside soil-transmitted helminths (STH) in their 2021-30 roadmap, which aspires to target Strongyloides stercoralis with preventive chemotherapy by use of ivermectin. Combination treatment with both albendazole, the primary drug used to treat STH, and ivermectin, would improve the efficiency of mass drug administration targeting both STH and S stercoralis. In this Personal View, we discuss the challenges and opportunities towards the development of an efficient control programme for strongyloidiasis, particularly if it is to run concurrently with STH control. We argue the need to define the prevalence threshold to implement preventive chemotherapy for S stercoralis, the target populations and optimal dosing schedules, and discuss the added benefits of a fixed-dose coformulation of ivermectin and albendazole. Implementation of an efficient control programme will require improvements to current diagnostics, and validation of new diagnostics, to target and monitor S stercoralis infections, and consideration of the challenges of multispecies diagnostics for S stercoralis and STH control. Finally, the evolution of ivermectin resistance represents a credible risk to control S stercoralis; we argue that genome-wide approaches, together with improved genome resources, are needed to characterise and prevent the emergence of resistance. Overcoming these challenges will help to reduce strongyloidiasis burden and enhance the feasibility of controlling it worldwide.
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Affiliation(s)
- Javier Gandasegui
- Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Chukwuemeka Onwuchekwa
- Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Alejandro J Krolewiecki
- Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina
| | | | - Rachel L Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Wendemagegn Enbiale
- Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia; Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity, Academic Medical Centre, Amsterdam, Netherlands
| | - Stella Kepha
- Eastern and Southern Africa Centre of International Parasite Control, Nairobi, Kenya; Medical Research Institute, Nairobi, Kenya
| | - Hollie Ann Hatherell
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, Netherlands
| | - María Cambra-Pellejà
- Instituto de Ganadería de Montaña, Consejo Superior de Investigaciones Científicas Universidad de León, Grulleros, Spain; Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | | | - José Muñoz
- Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona, Barcelona, Spain.
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17
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Luvira V, Siripoon T, Phiboonbanakit D, Somsri K, Watthanakulpanich D, Dekumyoy P. Strongyloides stercoralis: A Neglected but Fatal Parasite. Trop Med Infect Dis 2022; 7:310. [PMID: 36288051 PMCID: PMC9609954 DOI: 10.3390/tropicalmed7100310] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/01/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Strongyloidiasis is a disease caused by Strongyloides stercoralis and remains a neglected tropical infection despite significant public health concerns. Challenges in the management of strongyloidiasis arise from wide ranging clinical presentations, lack of practical high sensitivity diagnostic tests, and a fatal outcome in immunocompromised hosts. Migration, globalization, and increased administration of immunomodulators, particularly during the COVID-19 era, have amplified the global impact of strongyloidiasis. Here, we comprehensively review the diagnostic tests, clinical manifestations, and treatment of strongyloidiasis. The review additionally focuses on complicated strongyloidiasis in immunocompromised patients and critical screening strategies. Diagnosis of strongyloidiasis is challenging because of non-specific presentations and low parasite load. In contrast, treatment is simple: administration of single dosage ivermectin or moxidectin, a recent anthelmintic drug. Undiagnosed infections result in hyperinfection syndrome and disseminated disease when patients become immunocompromised. Thus, disease manifestation awareness among clinicians is crucial. Furthermore, active surveillance and advanced diagnostic tests are essential for fundamental management.
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Affiliation(s)
- Viravarn Luvira
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Tanaya Siripoon
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Danabhand Phiboonbanakit
- Division of Infectious Disease, Department of Medicine, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
- Vibhavadi Hospital, Bangkok 10900, Thailand
| | - Kollawat Somsri
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Dorn Watthanakulpanich
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Paron Dekumyoy
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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18
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Mahoney C, Brown CM, McIntyre B, Neal S. Disseminated strongyloidiasis after prolonged treatment with corticosteroids. BMJ Case Rep 2022; 15:e250559. [PMID: 35835488 PMCID: PMC9289025 DOI: 10.1136/bcr-2022-250559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/03/2022] Open
Abstract
Strongyloides stercoralis is a helminth found in the soil and transmitted to humans through larval penetration of the skin. It is endemic across most of the tropical regions of the world. Infection with S. stercoralis commonly causes minimal or mild symptoms. This case report describes an interesting final diagnosis for a woman presenting with persistent nausea, vomiting and epigastric pain. Her evaluation included imaging and oesophagogastroduodenoscopy with biopsy. Her biopsy results revealed oesophageal candidiasis and disseminated strongyloidiasis. Important historical clues in this case included previous prolonged treatment with steroids, recent diagnosis of gram-negative bacteraemia, prior residence in Rwanda, and unknown predeparture treatment for S. stercoralis She was ultimately treated with fluconazole and ivermectin with marked improvement in her symptoms.
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Affiliation(s)
- Caitlin Mahoney
- Family Medicine, Cone Health, Greensboro, North Carolina, USA
| | | | | | - Sara Neal
- Family Medicine, Cone Health, Greensboro, North Carolina, USA
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19
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Bryant AS, Ruiz F, Lee JH, Hallem EA. The neural basis of heat seeking in a human-infective parasitic worm. Curr Biol 2022; 32:2206-2221.e6. [PMID: 35483361 PMCID: PMC9158753 DOI: 10.1016/j.cub.2022.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023]
Abstract
Soil-transmitted parasitic nematodes infect over one billion people and cause devastating morbidity worldwide. Many of these parasites have infective larvae that locate hosts using thermal cues. Here, we identify the thermosensory neurons of the human threadworm Strongyloides stercoralis and show that they display unique functional adaptations that enable the precise encoding of temperatures up to human body temperature. We demonstrate that experience-dependent thermal plasticity regulates the dynamic range of these neurons while preserving their ability to encode host-relevant temperatures. We describe a novel behavior in which infective larvae spontaneously reverse attraction to heat sources at sub-body temperatures and show that this behavior is mediated by rapid adaptation of the thermosensory neurons. Finally, we identify thermoreceptors that confer parasite-specific sensitivity to body heat. Our results pinpoint the parasite-specific neural adaptations that enable parasitic nematodes to target humans and provide the foundation for drug development to prevent human infection.
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Affiliation(s)
- Astra S Bryant
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Felicitas Ruiz
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Joon Ha Lee
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Elissa A Hallem
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA; Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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20
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Caldrer S, Ursini T, Santucci B, Motta L, Angheben A. Soil-Transmitted Helminths and Anaemia: A Neglected Association Outside the Tropics. Microorganisms 2022; 10:microorganisms10051027. [PMID: 35630469 PMCID: PMC9143297 DOI: 10.3390/microorganisms10051027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Anaemia is an important cause of morbidity and mortality globally. Among infectious agents responsible for anaemia, helminthic infections are often neglected, particularly in non-endemic countries. However, they should not be neglected in this setting, as international travel and migration are on the rise. In this narrative review, we aimed to describe soil-transmitted helminths as a cause of or contributing factor to anaemia, focusing on hookworms (Necator americanus and Ancylostoma duodenale), the whipworm (Trichuris trichiura), the roundworm (Ascaris lumbricoides), and the threadworm (Strongyloides stercoralis). A general review on the epidemiology, lifecycle, and clinical spectrum of anaemia is proposed, with a special focus on helminthic infections’ association with anaemia as well as the diagnostic approach, which are both particularly important in non-endemic settings.
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21
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Tamarozzi F, Longoni SS, Mazzi C, Rizzi E, Noordin R, Buonfrate D. The accuracy of a recombinant antigen immunochromatographic test for the detection of Strongyloides stercoralis infection in migrants from sub-Saharan Africa. Parasit Vectors 2022; 15:142. [PMID: 35461265 PMCID: PMC9034504 DOI: 10.1186/s13071-022-05249-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Strongyloidiasis, a nematode infection which is mainly caused by Strongyloides stercoralis in humans, can lead to a fatal syndrome in immunocompromised individuals. Its diagnosis is challenging due to the absence of a diagnostic gold standard. The infection is highly prevalent in migrants from endemic countries in tropical and subtropical areas, and a rapid diagnostic test would be helpful for screening purposes. The aim of this study was to estimate the accuracy of a novel immunochromatographic test (ICT) for the diagnosis of S. stercoralis infection. Methods A single-centre diagnostic accuracy study was undertaken using well-characterized frozen sera available from the biobank of a referral hospital for parasitic diseases in Italy. The included sera were from migrants from sub-Saharan Africa, and matching results were available for agar plate culture and/or polymerase chain reaction for S. stercoralis; moreover, the results of both a commercial enzyme-linked immunosorbent assay test and an in-house immunofluorescence test for strongyloidiasis were made available. Laboratory staff who read the ICT results were blinded as regards the results of the other tests. Two readers independently read the ICT, and a third one was involved when results were discrepant. The accuracy of the ICT was assessed both against the results of the panel of faecal tests and by latent class analysis (LCA). Results Agreement between the readers was excellent [Cohen’s κ = 92.7%, 95% confidence interval (CI) 88.3–97.1%]. When assessed against the results of the faecal tests, the sensitivity and specificity of the ICT were 82.4% (95% CI 75.7–89.0%) and 73.8% (95% CI 66.8–80.9%), respectively. According to the LCA, the sensitivity and specificity were 86.3% (95% CI 80.1–92.5%) and 73.9% (95% CI 67.0–80.8%), respectively. Conclusions The results of the ICT demonstrated ease of interpretation. The accuracy proved good, though the sensitivity might be further improved for screening purposes. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05249-z.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024, Negrar, Verona, Italy
| | - Silvia Stefania Longoni
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024, Negrar, Verona, Italy
| | - Cristina Mazzi
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, 37024, Negrar, Verona, Italy
| | - Eleonora Rizzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024, Negrar, Verona, Italy
| | - Rahmah Noordin
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | - Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024, Negrar, Verona, Italy.
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22
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Inagaki K, Bradbury RS, Hobbs CV. Hospitalizations Associated with Strongyloidiasis in the United States, 2003-2018. Clin Infect Dis 2022; 75:1548-1555. [PMID: 35313336 DOI: 10.1093/cid/ciac220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis is considered to be historically endemic in Appalachia and the American South, but recent surveillance data, especially data evaluating strongyloidiasis associated with hospitalization, are lacking in most parts of the US. METHODS We performed a population-based retrospective analysis on strongyloidiasis using the National Inpatient Sample from 2003-2018. Geographic distribution of strongyloidiasis associated hospitalization was assessed. Logistic regression was used to identify risk factors associated with strongyloidiasis. RESULTS We identified 6931 hospitalizations associated with strongyloidiasis during the study period (11.8 per million hospitalizations). The rate of strongyloidiasis was highest in the US Northeast region including the Middle Atlantic division (47.1 cases per million population, adjusted odds ratio, aOR: 2.00 [95% confidence interval, CI: 1.58-2.53]), and the East South Central division (27.5 cases per million population, adjusted odds ratio, aOR: 2.77 [95% confidence interval, CI: 2.02-3.80]). Older age, male sex, non-white race/ethnicity particularly Hispanic and Asian, non-private insurance, and residence in neighborhoods with low median income were also associated with strongyloidiasis. Immunocompromising conditions, particularly human immunodeficiency virus infection, were present in 41.3% of hospitalizations with strongyloidiasis. In-hospital death was seen in 7.8% of cases with strongyloidiasis-associated hospitalization. CONCLUSIONS Strongyloidiasis-associated hospitalization is rare in the U.S. but can be associated with mortality. It occurs more frequently in poor and marginalized populations. Immunocompromised conditions were common among hospitalized patients with strongyloidiasis. Enhanced surveillance efforts are needed to inform health policies for improving the health of at-risk populations.
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Affiliation(s)
- Kengo Inagaki
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.,Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi.,Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University, Berwick, Victoria, Australia
| | - Charlotte V Hobbs
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
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23
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Niaki NZ, Désy D, Rashed S, Bougrine A. Strongyloides stercoralis infection causing reversible chronic urticaria with histologic findings of leukocytoclastic vasculitis. JAAD Case Rep 2022; 21:189-191. [PMID: 35252520 PMCID: PMC8888897 DOI: 10.1016/j.jdcr.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abdoli A, Falahi S, Kenarkoohi A. COVID-19-associated opportunistic infections: a snapshot on the current reports. Clin Exp Med 2022; 22:327-346. [PMID: 34424451 PMCID: PMC8381864 DOI: 10.1007/s10238-021-00751-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
Treatment of the novel Coronavirus Disease 2019 (COVID-19) remains a complicated challenge, especially among patients with severe disease. In recent studies, immunosuppressive therapy has shown promising results for control of the cytokine storm syndrome (CSS) in severe cases of COVID-19. However, it is well documented that immunosuppressive agents (e.g., corticosteroids and cytokine blockers) increase the risk of opportunistic infections. On the other hand, several opportunistic infections were reported in COVID-19 patients, including Aspergillus spp., Candida spp., Cryptococcus neoformans, Pneumocystis jiroveci (carinii), mucormycosis, Cytomegalovirus (CMV), Herpes simplex virus (HSV), Strongyloides stercoralis, Mycobacterium tuberculosis, and Toxoplasma gondii. This review is a snapshot about the main opportunistic infections that reported among COVID-19 patients. As such, we summarized information about the main immunosuppressive agents that were used in recent clinical trials for COVID-19 patients and the risk of opportunistic infections following these treatments. We also discussed about the main challenges regarding diagnosis and treatment of COVID-19-associated opportunistic infections (CAOIs).
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Affiliation(s)
- Amir Abdoli
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran ,Jahrom University of Medical Sciences, Ostad Motahari Ave, POBox 74148-46199, Jahrom, Iran
| | - Shahab Falahi
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Azra Kenarkoohi
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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25
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Hansen M, Currie BJ. Author reply. Intern Med J 2021; 51:2162. [PMID: 34939282 DOI: 10.1111/imj.15613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Martin Hansen
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Scope and limitations of a multiplex conventional PCR for the diagnosis of S. stercoralis and hookworms. Braz J Infect Dis 2021; 25:101649. [PMID: 34774469 PMCID: PMC9392200 DOI: 10.1016/j.bjid.2021.101649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Describe the diagnostic characteristics of a conventional multiplex PCR for the diagnosis of S. stercoralis, N. americanus and Ancylostomas spp. METHODS Fecal samples were collected from a cross-sectional study in Orán department, Salta province, Argentina. The stool samples were analyzed using concentration-sedimentation, Harada Mori, McMaster, and Baermann techniques. DNA was extracted from 50 mg fecal sample using the FastPrep® Spin Kit for Soil. Three pairs of primers were used for the amplification of three products of 101, 330, and 577 base pairs (bp) for S. stercoralis, N. americanus and Ancylostoma spp, respectively. The sensitivity and analytical specificity of multiplex PCR were evaluated, as well as the sensitivity and diagnostic specificity, using a composite standard and Bayesian approach. RESULTS AND CONCLUSIONS Multiplex PCR did not present cross-reaction with other intestinal parasites, and the detection limit for multiplex PCR was between 2 and 20 pg of genomic DNA. In addition it presented a diagnostic sensitivity of 97.4% for S. stercoralis and 90.3% for hookworms with a specificity of 100% and 87.6%, respectively. PCR identified a higher proportion (p <0.01) of coinfections (15.3%) than microscopic techniques (3.5%). Also, multiplex PCR showed that there was a positive association between S. stercoralis and hookworms (odds ratio = 2.12). However, this association was due to N. americanus (odds ratio= 3.22), since no association was observed between S. stercoralis and Ancylostoma spp. Neither was an association observed between the two species of hookworms.
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27
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Niederfahrenhorst A, Rothe C. [28/f-Migrant from Nigeria with eosinophilia, abdominal complaints and anemia : Preparation for the medical specialist examination: part 80]. Internist (Berl) 2021; 62:526-531. [PMID: 34448015 PMCID: PMC8390040 DOI: 10.1007/s00108-021-01114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
- A Niederfahrenhorst
- Abteilung für Infektions- und Tropenmedizin, Medizinische Klinik IV, Klinikum der Universität München, Leopoldstr. 5, 80802, München, Deutschland
| | - C Rothe
- Abteilung für Infektions- und Tropenmedizin, Medizinische Klinik IV, Klinikum der Universität München, Leopoldstr. 5, 80802, München, Deutschland.
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28
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Hansen M, Bowden E, Currie BJ, Ward L, Andrews RM, Dhurrkay RG, Gurruwiwi GG, Kearns T. Strongyloides stercoralis seropositivity is not associated with increased symptoms in a remote Aboriginal community. Intern Med J 2021; 51:1286-1291. [PMID: 32372503 DOI: 10.1111/imj.14884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Strongyloides stercoralis is a soil-transmitted helminth, endemic in remote Aboriginal and Torres Strait Islander communities in northern Australia with estimates of prevalences up to 60%. Hyperinfection in the setting of immunosuppression is a rare, but well recognised cause of significant morbidity and mortality. However, the morbidity associated with chronic uncomplicated infection is less well characterised. AIMS To measure the prevalence of symptoms potentially attributable to S. stercoralis infection and their association with seropositivity. METHODS This retrospective matched case-control study reviewed records of primary healthcare presentations for symptoms in the 12 months before and after an ivermectin mass drug administration (MDA) in a remote Aboriginal community. RESULTS One hundred and seventy-five S. stercoralis seropositive cases were matched with 175 seronegative controls. The most frequently reported symptom overall in the 12 months prior to the MDA was cough followed by abdominal pain, weight loss/malnutrition, diarrhoea and pruritis. Seropositive cases were not more likely than matched controls to have symptoms typically attributed to strongyloidiasis. In the seropositive cohort, we found no difference in symptoms in the 12 months before and after an ivermectin MDA despite a reduction in seroprevalence. CONCLUSION We found no evidence to suggest that S. stercoralis seropositivity was associated with increased symptoms when compared to matched seronegative controls. Treatment with ivermectin did not reduce symptoms in seropositive cases. Without evidence to support that population-based screening or treatment programmes reduce symptoms, the emphasis must remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life-threatening hyperinfection.
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Affiliation(s)
- Martin Hansen
- Infectious Diseases Department, Royal Darwin Hospital, Northern Territory, Australia
| | - Emily Bowden
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Infectious Diseases Department, Royal Darwin Hospital, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Linda Ward
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Buonfrate D, Fittipaldo A, Vlieghe E, Bottieau E. Clinical and laboratory features of Strongyloides stercoralis infection at diagnosis and after treatment: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:1621-1628. [PMID: 34325063 DOI: 10.1016/j.cmi.2021.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The clinical and laboratory characterization of Strongyloides stercoralis infection at diagnosis and after treatment is still poorly defined. OBJECTIVES The primary objective was to describe the pattern and frequency of clinical and laboratory characteristics associated with S. stercoralis infection. The secondary objectives were (a) comparison of characteristics reported in endemic versus non-endemic areas; and (b) the evaluation of the resolution of identified characteristics after treatment. METHODS We searched PubMed, EMBASE, LILACS and CENTRAL up to May 2021. Eligible studies were randomized controlled trials (RCTs) for the treatment of S. stercoralis infection and prospective observational studies reporting data on symptoms caused by strongyloidiasis in individuals diagnosed with a highly specific test. Quality assessment was performed to assess the risk of bias. Demographic and clinical data were summarized using descriptive statistics. Meta-analysis was done by pooling the proportion of participants with symptoms with random effects model. RESULTS Twenty studies were included: nine RCTs and 13 observational studies. Overall, symptoms were reported in 50.4% cases (95% CI 47.6-53.1), and were more often reported in non-endemic (58.6%, 95% CI 55.0-62.2) than in endemic (35.7%, 95% CI 31.4-39.9) areas. The removal of an article of lower quality did not impact on figures. Frequency of symptoms tended to reduce after treatment. Three studies reported the proportion of participants with eosinophilia before and after treatment: 76.9% of participants (95% CI 73.4-80.4) had eosinophilia at diagnosis, reducing to 27.4% (95% CI 24.0-30.7) after treatment. CONCLUSIONS About half of infected people complain at least of one symptom and almost 70% have eosinophilia. The frequency of symptoms and eosinophilia decreased after treatment, though the association with cure is not clearly defined. Providing relief from symptoms and eosinophilia is another reason, in addition to prevention of disseminated disease, for promoting screening and treatment of individuals with strongyloidiasis.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | - Andrea Fittipaldo
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Erika Vlieghe
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of General Internal Medicine Infectious Diseases and Tropical Medicine, University Hospital Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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30
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Wikman-Jorgensen PE, Llenas-Garcia J, Shedrawy J, Gascon J, Muñoz J, Bisoffi Z, Requena-Mendez A. Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union. BMJ Glob Health 2021; 5:bmjgh-2020-002321. [PMID: 32461226 PMCID: PMC7254101 DOI: 10.1136/bmjgh-2020-002321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions. METHODS We developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was €32 126.95/LYG. RESULTS The base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Δ1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Δ1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Δ1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Δ1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR -1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Δ1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters' ranges and iterations. CONCLUSION Presumptively treating all immunosuppressed migrants from areas with endemic Strongyloides would generate cost savings to the health system.
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Affiliation(s)
- Philip Erick Wikman-Jorgensen
- Medicina Interna, Hospital Universitari San Juan de Alicante, San Juan de Alicante, Alicante, Spain .,Foundation for the Promotion of the Research in Healthcare and Biomedicine, Valencia, Spain
| | - Jara Llenas-Garcia
- Medicina Interna/Enfermedades Infecciosas, Hospital Vega Baja-FISABIO, San Bartolome-Orihuela, Alicante, Spain.,Clinical Medicine, Universidad Miguel Hernandez de Elche Facultad de Medicina, Sant Joan D'Alacant, Spain
| | - Jad Shedrawy
- Public Health, Karolinska Institutet, Stockholm, Stockholm County, Sweden
| | | | | | - Zeno Bisoffi
- Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Veneto, Italy.,Diagnostics and Public Health, University of Verona, Verona, Veneto, Italy
| | - Ana Requena-Mendez
- Instituto de Salud Global Barcelona, Barcelona, Spain.,Division of Infectious Diseases, Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden
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Prevalence of Strongyloidiasis in a Cohort of Migrants in Italy and Accuracy of a Novel ELISA Assay for S. stercoralis Infection, a Cross-Sectional Study. Microorganisms 2021; 9:microorganisms9020401. [PMID: 33671980 PMCID: PMC7919371 DOI: 10.3390/microorganisms9020401] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 01/24/2023] Open
Abstract
Strongyloides stercoralis infection is a life-threatening neglected tropical disease. Diagnostic issues have caused an underestimation of its global burden. The choice of appropriate diagnostic tests for the screening of populations at risk of the infection, such as migrants from endemic countries, is of paramount importance. From November 2017 to July 2018, all migrants presenting to the National Institute for Health Migration and Poverty (INMP) in Rome, Italy were offered screening tests for S. stercoralis infection. The study objective was to estimate the prevalence of strongyloidiasis in the study population and the accuracy of a novel ELISA assay. The following tests were carried out at the IRCCS Sacro Cuore Don Calabria hospital in Negrar, Verona: stool microscopy, real-time PCR for S. stercoralis, in-house immunofluorescence test (IFAT), a commercial ELISA assay (Bordier ELISA), and a novel ELISA assay (Euroimmun ELISA). A latent class analysis (LCA) model set up with test results, clinical variables, and eosinophilia indicated a prevalence around 7.5%, in line with previous findings. The sensitivity and the specificity of Euroimmun ELISA were 90.6% (95% CI 80.5–100) and 87.7% (95CI 84.5–91.0); these results indicate that the novel ELISA assay would be suitable for screening of migrants from endemic countries.
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Human T-cell Leukemia Virus Type 1 and Strongyloides stercoralis: Partners in Pathogenesis. Pathogens 2020; 9:pathogens9110904. [PMID: 33137906 PMCID: PMC7692131 DOI: 10.3390/pathogens9110904] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
Infection with human T-cell leukemia/lymphoma virus type 1 (HTLV-1) has been associated with various clinical syndromes including co-infection with Strongyloides stercoralis, which is an intestinal parasitic nematode and the leading cause of strongyloidiasis in humans. Interestingly, HTLV-1 endemic areas coincide with regions citing high prevalence of S. stercoralis infection, making these communities optimal for elucidating the pathogenesis of co-infection and its clinical significance. HTLV-1 co-infection with S. stercoralis has been observed for decades in a number of published patient cases and case series; however, the implications of this co-infection remain elusive. Thus far, data suggest that S. stercoralis increases proviral load in patients co-infected with HTLV-1 compared to HTLV-1 infection alone. Furthermore, co-infection with HTLV-1 has been associated with shifting the immune response from Th2 to Th1, affecting the ability of the immune system to address the helminth infection. Thus, despite this well-known association, further research is required to fully elucidate the impact of each pathogen on disease manifestations in co-infected patients. This review provides an analytical view of studies that have evaluated the variation within HTLV-1 patients in susceptibility to S. stercoralis infection, as well as the effects of strongyloidiasis on HTLV-1 pathogenesis. Further, it provides a compilation of available clinical reports on the epidemiology and pathology of HTLV-1 with parasitic co-infection as well as data from mechanistic studies suggesting possible immunopathogenic mechanisms. Furthermore, specific areas of potential future research have been highlighted to facilitate advancing understanding of the complex interactions between these two pathogens.
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Colorectal Cancer Related to Chronic Strongyloides stercoralis Infection. Case Rep Gastrointest Med 2020; 2020:8886460. [PMID: 32963848 PMCID: PMC7492975 DOI: 10.1155/2020/8886460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022] Open
Abstract
The majority of individuals with Strongyloides stercoralis (S. stercoralis) colitis are clinically asymptomatic. Symptomatic individuals may complain of nonspecific gastrointestinal symptoms, such as abdominal pain, intermittent or persistent diarrhea, nausea, or loss of appetite. In addition, skin manifestations such as recurrent urticaria can occur. If infection is not diagnosed and left untreated, it can lead to chronic inflammation of the gastrointestinal tract. It is well documented that chronic colitis such as inflammatory bowel disease can predispose individuals to colorectal cancer. Additionally, there is evidence of chronic parasitic infections inducing the development of cancers in other organs within the gastrointestinal tract. In this case vignette, we describe a case of chronic Strongyloides stercoralis infection in a Peruvian woman presenting with colorectal cancer.
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Montresor A, Mupfasoni D, Mikhailov A, Mwinzi P, Lucianez A, Jamsheed M, Gasimov E, Warusavithana S, Yajima A, Bisoffi Z, Buonfrate D, Steinmann P, Utzinger J, Levecke B, Vlaminck J, Cools P, Vercruysse J, Cringoli G, Rinaldi L, Blouin B, Gyorkos TW. The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030. PLoS Negl Trop Dis 2020; 14:e0008505. [PMID: 32776942 PMCID: PMC7446869 DOI: 10.1371/journal.pntd.0008505] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/20/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022] Open
Abstract
Soil-transmitted helminth (STH) infections are the most widespread of the neglected tropical diseases, primarily affecting marginalized populations in low- and middle-income countries. More than one billion people are currently infected with STHs. For the control of these infections, the World Health Organization (WHO) recommends an integrated approach, which includes access to appropriate sanitation, hygiene education, and preventive chemotherapy (i.e., large-scale, periodic distribution of anthelmintic drugs). Since 2010, WHO has coordinated two large donations of benzimidazoles to endemic countries. Thus far, more than 3.3 billion benzimidazole tablets have been distributed in schools for the control of STH infections, resulting in an important reduction in STH-attributable morbidity in children, while additional tablets have been distributed for the control of lymphatic filariasis. This paper (i) summarizes the progress of global STH control between 2008 to 2018 (based on over 690 reports submitted by endemic countries to WHO); (ii) provides regional and country details on preventive chemotherapy coverage; and (iii) indicates the targets identified by WHO for the next decade and the tools that should be developed to attain these targets. The main message is that STH-attributable morbidity can be averted with evidence-informed program planning, implementation, and monitoring. Caution will still need to be exercised in stopping control programs to avoid any rebound of prevalence and loss of accrued morbidity gains. Over the next decade, with increased country leadership and multi-sector engagement, the goal of eliminating STH infections as a public health problem can be achieved.
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Affiliation(s)
- Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Denise Mupfasoni
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Alexei Mikhailov
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Pauline Mwinzi
- Expanded Special Programme for Elimination of Neglected Tropical Diseases, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ana Lucianez
- Neglected, Tropical and Vector Borne Diseases, World Health Organization Regional Office for the Americas, Washington, United States of America
| | - Mohamed Jamsheed
- Neglected Tropical Disease Control, World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Elkan Gasimov
- Malaria, NTDs and other Vector-Borne Diseases, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Supriya Warusavithana
- Control of Communicable Diseases, World Health Organization, Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Aya Yajima
- Malaria, other Vectorborne and Parasitic Diseases, World Health Organization, Regional Office for Western Pacific, Manila, The Philippines
| | - Zeno Bisoffi
- Department of Infectious–Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy (WHO Collaborating Centre ITA-102)
| | - Dora Buonfrate
- Department of Infectious–Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy (WHO Collaborating Centre ITA-102)
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland (WHO Collaborating Centre SWI-71)
- University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland (WHO Collaborating Centre SWI-71)
- University of Basel, Basel, Switzerland
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Merelbeke, Belgium (WHO Collaborating Centre BEL-42)
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Merelbeke, Belgium (WHO Collaborating Centre BEL-42)
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Merelbeke, Belgium (WHO Collaborating Centre BEL-42)
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Merelbeke, Belgium (WHO Collaborating Centre BEL-42)
| | - Giuseppe Cringoli
- Laboratory of Parasitology and Parasitic Diseases, Department of Veterinary Medicine and Animal Production. University of Naples, Naples, Italy (WHO Collaborating Centre ITA-116)
| | - Laura Rinaldi
- Laboratory of Parasitology and Parasitic Diseases, Department of Veterinary Medicine and Animal Production. University of Naples, Naples, Italy (WHO Collaborating Centre ITA-116)
| | - Brittany Blouin
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (WHO Collaborating Centre CAN-88)
| | - Theresa W. Gyorkos
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (WHO Collaborating Centre CAN-88)
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Zammarchi L, Tilli M, Botta A, Buonfrate D, Bartoloni A, Boccalini S. Strategies for management of strongyloidiasis in migrants from Sub-Saharan Africa recently arrived in Italy: A cost-effectiveness analysis. Travel Med Infect Dis 2020; 36:101561. [PMID: 31982632 DOI: 10.1016/j.tmaid.2020.101561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Italian and the European Centre for Disease Control and Prevention guidelines both recommend a systematic serological screening for strongyloidiasis in sub-Saharan migrants (SSA), however, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. METHODS A population of 100,000 migrants from SSA to Italy was considered and a Markov decision tree model was developed to assess the clinical and economic impact of two interventions for strongyloidiasis compared with the current practice (passive diagnosis of symptomatic cases): a) universal serological screening and treatment with ivermectin in case of positive test b) universal presumptive treatment with ivermectin. One and 10-year time horizon in the health-care perspective were considered. RESULTS In the one and 10-year time horizon respectively the costs for passive diagnosis was €1,164,169 and €9,735,908, those for screening option was € 2,856,011 and € 4,959,638 and those for presumptive treatment was €3,538,474 and € 4,883,272. Considering the cost per cured subject in the one-year time horizon, screening appears more favorable (€209.53), than the other two options (€232.55 per presumptive treatment and €10,197.29 per current strategy). Incremental cost-effectiveness ratio (ICERs) of screening strategy and presumptive treatment were respectively 265.27 and 333.19. The sensitivity analysis identified strongyloidiasis' prevalence as the main driver of ICER. CONCLUSIONS Compared to the current practice (passive diagnosis) both screening and presumptive treatment strategies are more favorable from a cost-effectiveness point of view, with a slight advantage of the screening strategy in a one-year time horizon.
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Affiliation(s)
- Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Italy
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Buonfrate D, Bisanzio D, Giorli G, Odermatt P, Fürst T, Greenaway C, French M, Reithinger R, Gobbi F, Montresor A, Bisoffi Z. The Global Prevalence of Strongyloides stercoralis Infection. Pathogens 2020; 9:pathogens9060468. [PMID: 32545787 PMCID: PMC7349647 DOI: 10.3390/pathogens9060468] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
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 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.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (F.G.); (Z.B.)
- Correspondence:
| | - Donal Bisanzio
- RTI International, Washington, DC 20005, USA; (D.B.); (M.F.); (R.R.)
- Epidemiology and Public Health Division, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Giovanni Giorli
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London E1 4NS, UK;
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, CH-4051 Basel, Switzerland; (P.O.); (T.F.)
- University of Basel, CH-4051 Basel, Switzerland
| | - Thomas Fürst
- Swiss Tropical and Public Health Institute, CH-4051 Basel, Switzerland; (P.O.); (T.F.)
- University of Basel, CH-4051 Basel, Switzerland
| | - Christina Greenaway
- Division of Infectious Diseases and Clinical Epidemiology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC H3A 2B2, Canada;
| | - Michael French
- RTI International, Washington, DC 20005, USA; (D.B.); (M.F.); (R.R.)
| | | | - Federico Gobbi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (F.G.); (Z.B.)
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, 1211 Geneva, Switzerland;
| | - Zeno Bisoffi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (F.G.); (Z.B.)
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy
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Ottino L, Buonfrate D, Paradies P, Bisoffi Z, Antonelli A, Rossolini GM, Gabrielli S, Bartoloni A, Zammarchi L. 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:E439. [PMID: 32503315 PMCID: PMC7350350 DOI: 10.3390/pathogens9060439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
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 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.
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Affiliation(s)
- Letizia Ottino
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
| | - Dora Buonfrate
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (D.B.); (Z.B.)
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, 70124 Bari, Italy;
| | - Zeno Bisoffi
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (D.B.); (Z.B.)
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Simona Gabrielli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, 50134 Florence, Italy
- Referral Center for Tropical Diseases of Tuscany, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, 50134 Florence, Italy
- Referral Center for Tropical Diseases of Tuscany, Careggi University Hospital, 50134 Florence, Italy
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Theunissen C, Bottieau E, Van Esbroeck M, Tsoumanis A, Florence E. Should We Screen HIV-Positive Migrants for Strongyloidiasis? Pathogens 2020; 9:pathogens9050388. [PMID: 32443596 PMCID: PMC7281463 DOI: 10.3390/pathogens9050388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/17/2022] Open
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. 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.
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Guevara AG, Anselmi M, Bisoffi Z, Prandi R, Márquez M, Silva R, Vicuña Y, Calvopiña M, Cevallos W, Pérez J, Baldeón L, Buonfrate D. Mapping the Prevalence of Strongyloides stercoralis Infection in Ecuador: A Serosurvey. Am J Trop Med Hyg 2020; 102:346-349. [PMID: 31833465 DOI: 10.4269/ajtmh.19-0565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Data on the prevalence of strongyloidiasis in Ecuador are patchy. The aim of this study was to document the presence of Strongyloides stercoralis infection in rural communities of different provinces of Ecuador. We tested 1,418 serum samples stored at the biobank of the Central University of Ecuador, Quito, with an ELISA test for Strongyloides. The samples had been collected in eight different provinces of Ecuador. Two hundred ninety-four samples (20.7%) were positive, and Jipijapa, Manabí Province, was the site with the largest proportion of positive samples (66.7%). Further surveys aimed at estimating the prevalence of the infection should be carried out in areas where the infection seems highly prevalent, and ad hoc control measures should be adopted.
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Affiliation(s)
- Angel Gustavo Guevara
- Instituto de Biomedicina, Carrera de Medicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Mariella Anselmi
- Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Zeno Bisoffi
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.,Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Rosanna Prandi
- Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Monica Márquez
- Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Ronaldo Silva
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Yosselin Vicuña
- Instituto de Biomedicina, Carrera de Medicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Manuel Calvopiña
- Escuela de Medicina, Universidad de las Américas (UDLA), Quito, Ecuador
| | - William Cevallos
- Instituto de Biomedicina, Carrera de Medicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Jorge Pérez
- Instituto de Biomedicina, Carrera de Medicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Lucy Baldeón
- Instituto de Biomedicina, Carrera de Medicina, Universidad Central del Ecuador, Quito, Ecuador
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Norman FF, Chamorro S, Comeche B, Pérez-Molina JA, López-Vélez R. Update on the major imported helminth infections in travelers and migrants. Future Microbiol 2020; 15:437-444. [PMID: 32250168 DOI: 10.2217/fmb-2019-0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Helminth infections cause considerable morbidity worldwide and may be frequently underdiagnosed especially in areas of lower endemicity. Patients may harbor latent infections that may become symptomatic years or decades after the initial exposure and timely diagnosis may be critical to prevent complications and improve outcomes. In this context, disease in special populations, such as immunosuppressed patients, may be of particular concern. Heightened awareness and recent diagnostic developments may contribute to the correct management of helminth infections in nonendemic regions. A review of the main helminth infections in travelers and migrants (strongyloidiasis, taeniasis-neurocysticercosis and schistosomiasis) is presented, focusing on epidemiology, developments in diagnosis, treatment and prevention.
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Affiliation(s)
- F F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - S Chamorro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - B Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - J A Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - R López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
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Strongyloides stercoralis infection in San Marino Republic: first epidemiological data from an observational study. Epidemiol Infect 2020; 147:e211. [PMID: 31364552 PMCID: PMC6624868 DOI: 10.1017/s0950268819000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Strongyloides stercoralis is a neglected parasite that can cause death in immunocompromised individuals. There were no data on the epidemiology of S. stercoralis infection in San Marino Republic until two patients (one of whom died) were diagnosed with severe strongyloidiasis (hyperinfection) between September 2016 and March 2017. A serology test for Strongyloides spp. was introduced in routine practice in the laboratory of the State Hospital to test patients considered to be at risk for strongyloidiasis. Between August 2017 and August 2018, of 42 patients tested with serology, two (4.8%) were positive. An additional case was found by gastric biopsy. Two of the positive cases were presumably autochthonous infections (elderly people with no significant travel history), while the other was a probable imported case (young man born in Nigeria and settled in Europe since 2003). Epidemiology of strongyloidiasis in San Marino might be similar to Northern Italy, where a relevant proportion of cases was diagnosed in immigrants (mainly from sub-Saharan Africa) and in elderly Italians with eosinophilia. Screening for strongyloidiasis might be worthwhile in inhabitants of San Marino in the same categories of individuals, particularly those at risk of immune suppression.
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Salvador F, Treviño B, Bosch-Nicolau P, Serre-Delcor N, Sánchez-Montalvá A, Oliveira I, Sulleiro E, Aznar ML, Pou D, Sao-Avilés A, Molina I. Strongyloidiasis screening in migrants living in Spain: systematic review and meta-analysis. Trop Med Int Health 2020; 25:281-290. [PMID: 31758828 DOI: 10.1111/tmi.13352] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To provide information regarding the prevalence of strongyloidiasis among migrants coming from Strongyloides stercoralis-endemic areas who reside in Spain. METHODS Systematic review of the literature and meta-analysis of studies showing prevalence of S. stercoralis infection among migrants from Latin America, Africa, Eastern Europe, Asia and Oceania who reside in Spain. We included articles published until 30 April 2019 without language restriction. The keywords used for the search included 'Strongyloides stercoralis', 'strongyloidiasis', 'Spain', 'screening' and 'migrants'. RESULTS Twenty-four studies were included in the review and meta-analysis, comprising 12 386 screened people. Eleven studies (7020 patients) evaluated the presence of S. stercoralis infection only through investigation of larvae in faeces, showing an overall prevalence of 1% (95%CI 1-1%). Thirteen studies (5366 patients) used a serological test, showing an overall prevalence of 14% (95%CI 11-17%). Strongyloidiasis seroprevalence was 20% (95%CI 15-24%) among migrants from sub-Saharan Africa, 14% (95%CI 10-18%) among those from Latin America and 8% (95%CI 5-11%) among migrants from North Africa. CONCLUSIONS Migrants coming from strongyloidiasis-endemic areas living in Spain had a high S. stercoralis infection prevalence, particularly those from sub-Saharan Africa and Latin America. This population should be screened using serology as the most sensitive test for S. stercoralis infection. This could be easily implemented at primary care level.
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Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Begoña Treviño
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Núria Serre-Delcor
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Inés Oliveira
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Mª Luisa Aznar
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Diana Pou
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Augusto Sao-Avilés
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
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Baker EC, Ming DK, Choudhury Y, Rahman S, Smith PJ, Muñoz J, Chiodini PL, Griffiths CJ, Whitty CJM, Brown M. High Prevalence of Strongyloides among South Asian Migrants in Primary Care-Associations with Eosinophilia and Gastrointestinal Symptoms. Pathogens 2020; 9:E103. [PMID: 32041352 PMCID: PMC7168230 DOI: 10.3390/pathogens9020103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
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 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.
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Affiliation(s)
| | - Damien K. Ming
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
| | - Yasmin Choudhury
- William Harvey Heart Centre, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK;
| | | | | | - Jose Muñoz
- Barcelona Centre for International Health Research, 08014 Barcelona, Spain;
| | - Peter L. Chiodini
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
| | - Chris J. Griffiths
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK;
| | - Christopher J. M. Whitty
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Michael Brown
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Abstract
Purpose of Review This paper constitutes an update of recent studies on the general biology, molecular genetics, and cellular biology of Strongyloides spp. and related parasitic nematodes. Recent Findings Increasingly, human strongyloidiasis is considered the most neglected of neglected tropical diseases. Despite this, the last 5 years has seen remarkable advances in the molecular biology of Strongyloides spp. Genome sequences for S. stercoralis, S. ratti, S. venezuelensis, S. papillosus, and the related parasite Parastrongyloides trichosuri were created, annotated, and analyzed. These genomic resources, along with a practical transgenesis platform for Strongyloides spp., aided a major achievement, the advent of targeted mutagenesis via CRISPR/Cas9 in S. stercoralis and S. ratti. The genome sequences have also enabled significant molecular epidemiologic and phylogenetic findings on human strongyloidiasis, including the first genetic evidence of zoonotic transmission of S. stercoralis between dogs and humans. Studies of molecular signaling pathways identified the nuclear receptor Ss-DAF-12 as one that can be manipulated in the parasite by exogenous application of its steroid ligands. The chemotherapeutic implications of this were unscored by a study in which a Ss-DAF-12 ligand suppressed autoinfection by S. stercoralis in a new murine model of human strongyloidiasis. Summary Seminal advances in genomics of Strongyloides spp. have transformed research into strongyloidiasis, facilitating fundamental phylogenetic and epidemiologic studies and aiding the deployment of CRISPR/Cas9 gene disruption and editing as functional genomic tools in Strongyloides spp. Studies of Ss-DAF-12 signaling in S. stercoralis demonstrated the potential of this pathway as a novel chemotherapeutic target in parasitic nematodes.
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Affiliation(s)
- Tegegn G. Jaleta
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James B. Lok
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
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