Strongyloidiasis: A review of the evidence for Australian practitioners

Johnston, Fay H.; Morris, Peter S.; Speare, Rick; McCarthy, James S.; Currie, Bart J.; Ewald, Dan; Page, Wendy; Dempsey, Karen

doi:10.1111/j.1440-1584.2005.00710.x

Cited by 67 publications

(78 citation statements)

References 44 publications

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“…Hyperinfection by Strongyloides stercoralis is mainly seen amongst immunocompromised individuals with a high case fatality rate of around 60%. (19)(20)(21) The mortality rate of the patients having hyperinfection of the present study was 33.3%. This is characterized by an acceleration of the normal life cycle of Strongyloides stercoralis that increases its burden either in the skin or lungs or gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 79%

Strongyloides Stercoralis and Its Risk Factors: An Experience at a Tertiary Care Hospital

Kuyare¹,

Koticha²,

Mehta³

2016

jemds

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Strongyloides stercoralis is one of the most neglected tropical parasitic infestations. The present study was carried out considering the paucity of data available from Indian context regarding the prevalence and risk factors associated with Strongyloides stercoralis infestation. METHODSThe present study was an observational, retrospective audit/analysis where the hospital records of stool specimens received in Parasitology division for detection of intestinal parasites over a period of three years (January 2011 to December 2013) were analysed. The clinical features and laboratory data of patients infected with larvae of Strongyloides stercoralis were recorded. Descriptive statistics was applied to represent the categories of risk factors in percentages and chi-square test for its association with parasitic infection. RESULTSLarvae of Strongyloides stercoralis were detected in 0.4% (65/15530) stool specimens with a male preponderance. The most common presenting complaints by patients were attributed to diarrhoea 26/65 (40%) and 14/65 (21.5%) patients were asymptomatic. Peripheral eosinophilia was seen in 10.8% (7/65) patients; 52/65 (80%) of patients were identified to have one or more of the known risk factors for Strongyloidiasis of which nearly half gave history of alcoholism (29/52,55.8%); 3/65 (4.6%) patients had hyperinfection of which one died. All three patients had two risk factors (alcoholism and steroids). Oral albendazole was used to treat the parasitic infestation in 31 (48.4%), whereas 34 (51.6%) received oral ivermectin. CONCLUSIONThe study findings of prevalence, clinical features and associated risk factors for Strongyloidiasis can be considered as preliminary report from Western Indian population. The presence of two risk factors in all cases of hyperinfection calls for further studies.

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Section: Discussionmentioning

confidence: 79%

Strongyloides Stercoralis and Its Risk Factors: An Experience at a Tertiary Care Hospital

Kuyare¹,

Koticha²,

Mehta³

2016

jemds

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“…Most (28,32,37,38,43,46) reported a decline in antibody titer within 6 to 12 months. However, results are heterogeneous and difficult to compare due to variable and nonstandardized laboratory techniques and follow-up timings (26).…”

Section: Discussionmentioning

confidence: 99%

“…Most studies have evaluated the accuracy of ELISA, with reported sensitivities ranging from 80% to 97% and specificities ranging from 29% to 99% (9,13,17,26,33,36,55,58), while little data are available on the IFAT (22,33). The IFAT is technically more complex than ELISA and requires skillful personnel both for antigen preparation and for reading.…”

Section: Discussionmentioning

confidence: 99%

“…Current estimates indicate that it affects 30 to 100 million people, but accurate prevalence data are lacking. Although strongyloidiasis is endemic in many tropical and subtropical countries (sub-Saharan Africa, Latin America, Southeast Asia, and Northern Australia), foci of low endemicity are also reported in temperate climates, such as the Mediterranean coast, Eastern Europe, and the southeastern United States (1,3,8,18,20,23,26,38,39,42,47,48,50,52,53). Due to its unique autoinfective cycle, Strongyloides stercoralis may persist in the host for indefinite periods (21).…”

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confidence: 99%

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Evaluation of an Indirect Immunofluorescence Assay for Strongyloidiasis as a Tool for Diagnosis and Follow-Up

Boscolo

Gobbo

Mantovani

et al. 2007

Clin Vaccine Immunol

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The diagnostic accuracy of an indirect immunofluorescence antibody test (IFAT) for Strongyloides stercoralis at different serum antibody titers was evaluated. To assess diagnostic sensitivity, sera from 156 patients with known strongyloidiasis were collected. Negative control sera were obtained from a composite group of 427 subjects (blood donors and hospitalized patients). With an area under the receiver-operating characteristic plot of 0.98, the IFAT showed a high level of diagnostic accuracy for strongyloidiasis. An antibody titer of >1:20, with 97% sensitivity and 98% specificity, was identified as the diagnostic threshold with the best overall performance. Cross-reactions were evaluated with 41 additional samples from patients with other known helminth infections, and the IFAT detected low-titer positivity in only one subject with filariasis. A positive IFAT result at an antibody dilution of >1:80 was virtually 100% specific, with 71% sensitivity. To test the usefulness of the IFAT as a monitoring tool, the changes in specific-antibody titers after treatment in a group of 155 patients were evaluated. Seroreversion or a decrease in antibody titer of twofold or more was observed in 60% of the patients. Response to treatment was directly correlated to the initial antibody titer, and a baseline titer of >1:80 was identified as the best predictor of response. In conclusion, a positive IFAT result at an antibody dilution of >1:20 is the optimal cutoff for screening. A titer of >1:80, with virtually no false-positive result, is a reliable cutoff for a serological assessment of treatment efficacy and for inclusion in clinical trials.

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“…Extension into temperate regions has also been reported, including pockets of endemicity in the southeastern United States (2,3). Given its wide geographical distribution, S. stercoralis has been estimated to infect as many as 100 million people worldwide and is therefore an important infection to consider in patients who either reside in or have traveled to regions that are endemic for strongyloidiasis (4,5).…”

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confidence: 99%

Comparison of Three Immunoassays for Detection of Antibodies to Strongyloides stercoralis

Anderson¹,

Klein²,

Dornink³

et al. 2014

Clin. Vaccine Immunol.

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Due to the limited sensitivities of stool-based microscopy and/or culture techniques for Strongyloides stercoralis, the detection of antibodies to this intestinal nematode is relied upon as a surrogate for determining exposure status or making a diagnosis of S. stercoralis infection. Here, we evaluated three immunoassays, including the recently released InBios Strongy Detect IgG enzyme-linked immunosorbent assay (ELISA) (InBios International, Inc., Seattle, WA), the SciMedx Strongyloides serology microwell ELISA (SciMedx Corporation, Denville, NJ), and the luciferase immunoprecipitation system (LIPS) assay performed at the National Institutes of Health (NIH), for their detection of IgG antibodies to S. stercoralis. A total of 101 retrospective serum samples, previously submitted for routine S. stercoralis antibody detection using the SciMedx assay, were also evaluated by the InBios and LIPS assays. The qualitative results from each assay were compared using a Venn diagram analysis, to the consensus result among the three assays, and each ELISA was also evaluated using the LIPS assay as the reference standard. By Venn diagram analysis, 65% (66/101) of the samples demonstrated perfect agreement by all three assays. Also, the numbers of samples considered positive or negative by a single method were similar. Compared to the consensus result, the overall percent agreement of the InBios, SciMedx, and LIPS assays were comparable at 87.1%, 84.2%, and 89.1%, respectively. Finally, the two ELISAs performed analogously but demonstrated only moderate agreement (kappa coefficient for the two assays, 0.53) with the LIPS assay. Collectively, while the two commercially available ELISAs perform equivalently, neither should be used independently of clinical evaluation to diagnose strongyloidiasis.

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Strongyloidiasis: A review of the evidence for Australian practitioners

Cited by 67 publications

References 44 publications

Strongyloides Stercoralis and Its Risk Factors: An Experience at a Tertiary Care Hospital

Strongyloides Stercoralis and Its Risk Factors: An Experience at a Tertiary Care Hospital

Evaluation of an Indirect Immunofluorescence Assay for Strongyloidiasis as a Tool for Diagnosis and Follow-Up

Comparison of Three Immunoassays for Detection of Antibodies to Strongyloides stercoralis

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