Prevalence and risk factors of Strongyloides stercoralis in Takeo Province, Cambodia

Khieu, Virak; Schär, Fabian; Marti, Hanspeter; Bless, Philipp Justus; Char, Meng Chuor; Muth, Sinuon; Odermatt, Peter

doi:10.1186/1756-3305-7-221

Cited by 58 publications

(75 citation statements)

References 30 publications

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“…In the present study, the observed prevalence of S. stercoralis was significantly higher in males than in females, which is in accordance with the previous study carried out among indigenous people in Peninsular Malaysia [4] as well as in other countries, including Cambodia [9,10], Thailand [7,8], China [11], and Taiwan [26]. This is most likely due to agricultural practices in the surveyed communities.…”

supporting

confidence: 92%

“…Moreover, most of the previous studies were carried out mainly among rural communities in Peninsular Malaysia with prevalence rate ranging from 1.2% to 1.7% [4–6]. As for Thailand in particular, the epidemiology of S. stercoralis has been studied in some detail with prevalence ranging between 2.3% and 28.9% [7,8] and other countries, including Cambodia (10.3–21%) [9,10], China (11.7%) [11], and Japan (5–10%) [12]. …”

mentioning

confidence: 99%

“…The clinical features, including gastrointestinal and cutaneous symptoms are frequently associated with strongyloidiasis with more than a half of strongyloidiasis cases are asymptomatic [1,2,9,13]. Moreover, the clinical manifestations between strongyloidiasis and other infectious diseases particularly nematodes are not well described [13].…”

mentioning

confidence: 99%

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Epidemiological Characteristics of Strongyloidiasis in Inhabitants of Indigenous Communities in Borneo Island, Malaysia

et al. 2016

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Epidemiological study on strongyloidiasis in humans is currently lacking in Malaysia. Thus, a cross-sectional study was carried out to determine the prevalence of Strongyloides stercoralis infection among the inhabitants of longhouse indigenous communities in Sarawak. A single stool and blood sample were collected from each participant and subjected to microscopy, serological and molecular techniques. Five species of intestinal parasites were identified by stool microscopy. None of the stool samples were positive for S. stercoralis. However, 11% of 236 serum samples were seropositive for strongyloidiasis. Further confirmation using molecular technique on stool samples of the seropositive individuals successfully amplified 5 samples, suggesting current active infections. The prevalence was significantly higher in adult males and tended to increase with age. S. stercoralis should no longer be neglected in any intestinal parasitic survey. Combination of more than 1 diagnostic technique is necessary to increase the likelihood of estimating the ‘true’ prevalence of S. stercoralis.

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confidence: 92%

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confidence: 99%

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Epidemiological Characteristics of Strongyloidiasis in Inhabitants of Indigenous Communities in Borneo Island, Malaysia

et al. 2016

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“…stercoralis infections and sanitation has rarely been studied so far. Varying results were obtained mostly from cross-sectional studies, which either found no association or a decreased risk associated with defecation in or access to improved latrines [22, 34–36]. In our study, we found a strong impact of sanitation coverage in combination with treatment which explained the differences in infection rates at follow-up across villages.…”

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confidence: 38%

Ivermectin Treatment and Sanitation Effectively Reduce Strongyloides stercoralis Infection Risk in Rural Communities in Cambodia

et al. 2016

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BackgroundStrongyloides stercoralis is the only soil-transmitted helminth with the ability to replicate within its host, leading to long-lasting and potentially fatal infections. It is ubiquitous and its worldwide prevalence has recently been estimated to be at least half that of hookworm. Information on the epidemiology of S. stercoralis remains scarce and modalities for its large-scale control are yet to be determined.Methodology/Principal FindingsA community-based two-year cohort study was conducted among the general population in a rural province in North Cambodia. At each survey, participants infected with S. stercoralis were treated with a single oral dose of ivermectin (200μg/kg BW). Diagnosis was performed using a combination of the Baermann method and Koga agar plate culture on two stool samples. The cohort included participants from eight villages who were either positive or negative for S. stercoralis at baseline. Mixed logistic regression models were employed to assess risk factors for S. stercoralis infection at baseline and re-infection at follow-up. A total of 3,096 participants were examined at baseline, revealing a S. stercoralis prevalence of 33.1%. Of these participants, 1,269 were followed-up over two years. Re-infection and infection rates among positive and negative participants at baseline were 14.4% and 9.6% at the first and 11.0% and 11.5% at the second follow-up, respectively. At follow-up, all age groups were at similar risk of acquiring an infection, while infection risk significantly decreased with increasing village sanitation coverage.Conclusions/SignificanceChemotherapy-based control of S. stercoralis is feasible and highly beneficial, particularly in combination with improved sanitation. The impact of community-based ivermectin treatment on S. stercoralis was high, with over 85% of villagers remaining negative one year after treatment. The integration of S. stercoralis into existing STH control programs should be considered without further delay.

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“…Yet, the prevalence we observed is also substantially higher than that of other studies using the similar diagnostic approaches. Two recent studies in Kandal and Takeo provinces in Cambodia reported that about a quarter (24.4%) of schoolchildren and 21.0% of the general population were infected, respectively [16], [35]; while Steinmann et al, and Knopp et al found a prevalence rate of 11.7% in a village in Yunnan, China and of 10.8% among schoolchildren in Zanzibar, respectively [39], [40]. Hence, other factors such socioeconomic and sanitary conditions are likely to contribute to the differences observed.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence and Spatial Distribution of Strongyloides stercoralis in Rural Cambodia

et al. 2014

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BackgroundThe threadworm, Strongyloides stercoralis, endemic in tropical and temperate climates, is a neglected tropical disease. Its diagnosis requires specific methods, and accurate information on its geographic distribution and global burden are lacking. We predicted prevalence, using Bayesian geostatistical modeling, and determined risk factors in northern Cambodia.MethodsFrom February to June 2010, we performed a cross-sectional study among 2,396 participants from 60 villages in Preah Vihear Province, northern Cambodia. Two stool specimens per participant were examined using Koga agar plate culture and the Baermann method for detecting S. stercoralis infection. Environmental data was linked to parasitological and questionnaire data by location. Bayesian mixed logistic models were used to explore the spatial correlation of S. stercoralis infection risk. Bayesian Kriging was employed to predict risk at non-surveyed locations.Principal FindingsOf the 2,396 participants, 44.7% were infected with S. stercoralis. Of 1,071 strongyloidiasis cases, 339 (31.6%) were among schoolchildren and 425 (39.7%) were found in individuals under 16 years. The incidence of S. stercoralis infection statistically increased with age. Infection among male participants was significantly higher than among females (OR: 1.7; 95% CI: 1.4–2.0; P<0.001). Participants who defecated in latrines were infected significantly less than those who did not (OR: 0.6; 95% CI: 0.4–0.8; P = 0.001). Strongyloidiasis cases would be reduced by 39% if all participants defecated in latrines. Incidence of S. stercoralis infections did not show a strong tendency toward spatial clustering in this province. The risk of infection significantly decreased with increasing rainfall and soil organic carbon content, and increased in areas with rice fields.Conclusions/SignificancePrevalence of S. stercoralis in rural Cambodia is very high and school-aged children and adults over 45 years were the most at risk for infection. Lack of access to adequate treatment for chronic uncomplicated strongyloidiasis is an urgent issue in Cambodia. We would expect to see similar prevalence rates elsewhere in Southeast Asia and other tropical resource poor countries.

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Prevalence and risk factors of Strongyloides stercoralis in Takeo Province, Cambodia

Cited by 58 publications

References 30 publications

Epidemiological Characteristics of Strongyloidiasis in Inhabitants of Indigenous Communities in Borneo Island, Malaysia

Epidemiological Characteristics of Strongyloidiasis in Inhabitants of Indigenous Communities in Borneo Island, Malaysia

Ivermectin Treatment and Sanitation Effectively Reduce Strongyloides stercoralis Infection Risk in Rural Communities in Cambodia

High Prevalence and Spatial Distribution of Strongyloides stercoralis in Rural Cambodia

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