Morbidity Associated with Chronic Strongyloides stercoralis Infection: A Systematic Review and Meta-Analysis

Tamarozzi, Francesca; Martello, Elisa; Giorli, Giovanni; Fittipaldo, Veronica Andrea; Staffolani, Silvia; Montresor, Antonio; Bisoffi, Zeno; Buonfrate, Dora

doi:10.4269/ajtmh.18-0895

Cited by 52 publications

(52 citation statements)

References 21 publications

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“…While eosinophilia, a readily accessible result from a standard full blood count, is clearly a predictor of infection, the similar prevalence among controls and GI patients, and the lack of association between GI symptoms and Strongyloides infection in the questionnaires, precludes substantial conclusions about the association between nonspecific GI symptoms and chronic Strongyloides infection. This finding accords with existing literature which has been inconsistent in demonstrating associations between GI symptoms and chronic Strongyloides infection, and where asymptomatic chronic infection is common [18].…”

Section: Discussionsupporting

confidence: 91%

High Prevalence of Strongyloides among South Asian Migrants in Primary Care―Associations with Eosinophilia and Gastrointestinal Symptoms

et al. 2020

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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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Section: Discussionsupporting

confidence: 91%

High Prevalence of Strongyloides among South Asian Migrants in Primary Care―Associations with Eosinophilia and Gastrointestinal Symptoms

et al. 2020

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“…S. stercoralis infection may cause dermatological and gastro-intestinal morbidity, chronic malnutrition in children, and even mortality in immunocompromised patients [31]. The drug of choice for treating this infection is ivermectin given as a single dose [32].…”

Section: Establish An Efficient Strongyloidiasis Control Program In Smentioning

confidence: 99%

The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030

et al. 2020

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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 PLOS NEGLECTED TROPICAL DISEASES

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“…The morbidity caused by S. stercoralis is not well defined compared to other STHs. A systematic review evaluated the clinical burden caused by strongyloidiasis and reported that urticaria (reported by 33% of infected individuals in the included studies), abdominal pain (62%), and diarrhea (50%) might be frequently affecting people with strongyloidiasis [ 6 ]. Although the results of the review were limited by the paucity of studies focusing on this topic, the clinical relevance of S. stercoralis infection cannot be disregarded, because in immunosuppressed individuals it can lead to a syndrome (hyperinfection/dissemination) that is invariably fatal if not promptly and properly cured and is often fatal despite treatment [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The Global Prevalence of Strongyloides stercoralis Infection

et al. 2020

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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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Morbidity Associated with Chronic Strongyloides stercoralis Infection: A Systematic Review and Meta-Analysis

Cited by 52 publications

References 21 publications

High Prevalence of Strongyloides among South Asian Migrants in Primary Care―Associations with Eosinophilia and Gastrointestinal Symptoms

High Prevalence of Strongyloides among South Asian Migrants in Primary Care―Associations with Eosinophilia and Gastrointestinal Symptoms

The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030

The Global Prevalence of Strongyloides stercoralis Infection

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