Strongyloidiasis screening in migrants living in Spain: systematic review and meta-analysis.

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.

OBJECTIFS: Fournir des informations sur la prévalence de la strongyloïdose parmi les migrants résidant en Espagne et provenant de zones endémiques pour Strongyloides stercoralis. MÉTHODES: Revue systématique de la littérature et méta-analyse des études montrant la prévalence de l'infection à S. stercoralis parmi les migrants d'Amérique latine, d'Afrique, d'Europe de l'Est, d'Asie et d'Océanie qui résident en Espagne. Nous avons inclus des articles publiés jusqu'au 30 avril e 2019 sans restriction de langue. Les mots clés utilisés pour la recherche comprenaient "Strongyloides stercoralis", "strongyloïdose", "Espagne", "dépistage" et "migrants". RÉSULTATS: Vingt-quatre études ont été incluses dans la revue et la méta-analyse, comprenant 12.386 personnes dépistées. Onze études (7.020 patients) ont évalué la présence d'une infection à S. stercoralis uniquement en examinant les larves dans les selles, montrant une prévalence globale de 1% (IC95%: 1-1%). Treize études (5.366 patients) ont utilisé un test sérologique, montrant une prévalence globale de 14% (IC95%: 11-17%). La séroprévalence de la strongyloïdose était de 20% (IC95%: 15-24%) chez les migrants d'Afrique subsaharienne, 14% (IC95%: 10-18%) chez ceux d'Amérique latine et 8% (IC95%: 5-11%) chez ceux d'Afrique du Nord. CONCLUSIONS: Les migrants en provenance de zones d'endémie pour la strongyloïdose vivant en Espagne avaient une prévalence élevée d'infection à S. stercoralis, en particulier ceux d'Afrique subsaharienne et d'Amérique latine. Cette population devrait être dépistée en utilisant la sérologie comme le test le plus sensible pour l' infection à S. stercoralis. Cela pourrait être facilement mis en œuvre au niveau des soins primaires.

Strongyloidiasis in Latin American immigrants: a pilot study.

The United States of America (USA) has the largest international population of any nation in the world. Immigrants from Latin American countries, where intestinal parasites are endemic, comprise more than half of this population. This study aims to determine the prevalence of strongyloidiasis, a potentially deadly parasitic infection, in foreign-born individuals. We conducted a cross-sectional study in Washington, DC, to determine the seroprevalence of Strongyloides stercoralis infection using an NIE-ELISA IgG antibody assay. Multi-parallel quantitative real-time polymerase chain reaction (qPCR) was performed in stool samples of NIE-ELISA-positive patients to investigate possible polyparasitism. The NIE-ELISA assay detected an S. stercoralis prevalence of 4.2% in a group of 119 volunteers. Combining NIE-ELISA and qPCR detected a parasite prevalence of 5.0%. Our results underscore the relevance of systematic testing for gastrointestinal parasites in individuals from endemic regions. It also makes a case for a survey in the USA to identify immigrants' risk for strongyloidiasis and other gastrointestinal parasitic infections.

Should we look for Strongyloides stercoralis in foreign-born HIV-infected persons?

The objective was to evaluate the implementation of a systematic Strongyloides stercoralis screening programme in HIV infected immigrants attending an HIV Unit in Spain. An enzyme-linked immunosorbent assay (ELISA) was performed to assess the presence of Strongyloides IgG. Patients with a positive serology were treated with ivermectin; serologic follow-up testing was performed. 237 patients were screened (65.4 % men). Origin: 64.1 % came from Latin America, 16.5 % from Sub-Saharan Africa, 9.7 % from the Caribbean, 9.7 % from other areas. Strongyloides stercolaris IgG was positive in 13 cases (5.5 %). In the multivariate analysis, factors associated with a positive Strongyloides serology were illiteracy (OR: 23.31; p = 0.009) and eosinophilia (OR: 15.44; p < 0.0001). Nine of the 13 patients positive for S. stercoralis IgG and treated with ivermectin had a follow up serologic test: 77.8 % achieved a serologic response (55.5 % seroreversion). Screening of HIV-positive immigrants may be desirable, at least in those with higher risk of hyperinfection syndrome. Serologic testing seems a useful tool in both diagnosis and follow-up of these patients.

Strongyloides stercoralis: a cause of morbidity and mortality for indigenous people in Central Australia.

BACKGROUND: Strongyloides stercoralis may cause a complicated infection in immunocompromised patients, which has a high case fatality rate. Death generally results from sepsis with enteric pathogens. Globally, infection with the human T-cell lymphotropic virus type 1 (HTLV-1) is a major risk factor for this syndrome. Both S. stercoralis and HTLV-1 are endemic to Central Australia. AIMS: The aim of the study was to determine whether complicated strongyloidiasis occurs in association with HTLV-1 infection in Central Australia. METHODS: A retrospective audit of all cases of complicated strongyloidiasis presenting to Alice Springs Hospital between January 2000 and December 2006 was carried out. Diagnosis was defined as definite or probable according to whether diagnosis was made by faecal studies or serology respectively. The medical records, investigations and outcomes of patients who met predetermined criteria for a diagnosis of complicated strongyloidiasis were reviewed. RESULTS: Eighteen indigenous patients met the criteria for complicated strongyloidiasis (definite 9, probable 9). Seven of 11 patients tested were HTLV-1 seropositive. At diagnosis, no treatment was documented for nine patients (definite 4, probable 5), three received a single dose of ivermectin and one a single dose of albendazole. Fifteen patients (83%) died because of sepsis (definite 7, probable 8). Pathogens isolated and their foci of infection included Klebsiella pneumoniae pneumonia (4), bloodstream infection with Enterococcus spp. (2), K. pneumoniae peritonitis (1) and streptococcal meningitis (1). CONCLUSION: Complicated strongyloidiasis occurs in association with HTLV-1 infection in central Australia. This finding has significant implications for the management of S. stercoralis in the region.

Frequent HTLV-1 infection in the offspring of Peruvian women with HTLV-1-associated myelopathy/tropical spastic paraparesis or strongyloidiasis / Infección frecuente por HTLV-1 en los hijos de mujeres peruanas con mielopatía/paraparesia espástica tropical asociada con el HTLV-1 o con estrongiloidiasis

OBJECTIVES: To describe the frequency of HTLV-1 infection among offspring of mothers who had presented with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), strongyloidiasis, or asymptomatic HTLV-1 infection, and to identify factors associated with HTLV-1 infection. METHODS: In a descriptive study, records were reviewed of HTLV-1-positive women and their offspring who had been tested for HTLV infection at a public hospital in Lima, Peru, from 1989 to 2003. Sons and daughters of women who had presented with strongyloidiasis, HAM/TSP, or asymptomatic infection were eligible for this study. RESULTS: Three hundred seventy subjects were included: 279 were the offspring of 104 mothers presenting with HAM/TSP, 58 were the offspring of 22 mothers with strongyloidiasis, and 33 were the offspring of 26 asymptomatic mothers. Mean age of the offspring at the time of testing was 26 years (standard deviation 12). Nineteen percent of the offspring tested positive for HTLV-1: 6 percent (2/33) of those with asymptomatic mothers, 19 percent (52/279) among the offspring of mothers with HAM/TSP, and 31 percent (18/58) among the offspring of mothers presenting with strongyloidiasis On multiple logistic regression analysis, three factors were significantly associated with HTLV-1: (a) duration of breast-feeding (odds ratio [OR] = 15.1; [4.2-54.1] for 12 to 24 months versus less than 6 months breast-feeding); (b) clinical condition of the mother (OR = 8.3 [1.0-65.3] for HAM/TSP and OR = 11.5 [1.4-98.4] for strongyloidiasis in comparison with offspring of asymptomatic mothers); and (c) transfusion history (OR = 5.5 [2.0-15.2]). CONCLUSIONS: In addition to known risk factors for HTLV-1 transmission (duration of breast-feeding and history of blood transfusion), maternal HAM/TSP and strongyloidiasis were associated with seropositivity among offspring of HTLV-1-infected mothers.

OBJETIVOS: Describir la frecuencia de la infección por HTLV-1 en los hijos e hijas de madres diagnosticadas con mielopatía/paraparesia espástica tropical asociada con el HTLV-1 (M/PET-HTLV-1), estrongiloidiasis o infección asintomática por HTLV-1, e identificar los factores asociados con la infección por HTLV-1. MÉTODOS: Para este estudio descriptivo se revisaron los registros de mujeres positivas a HTLV-1 y de sus hijos evaluados con pruebas para la infección por HTLV en un hospital público de Lima, Perú, entre 1989 y 2003. Eran elegibles para este estudio los hijos y las hijas de las mujeres que se presentaron con estrongiloidiasis, M/PET-HTLV-1 o infección asintomática. RESULTADOS: En el estudio participaron 370 personas: 279 hijos de 104 madres con M/PET-HTLV-1, 58 hijos de 22 madres con estrongiloidiasis y 33 hijos de 26 madres asintomáticas. La edad promedio de los participantes en el momento de su prueba para HTLV era de 26 años (desviación estándar: 12 años). De las personas estudiadas, 19 por ciento resultaron positivas a la infección por HTLV-1: 6 por ciento (2/33) de los hijos de madres asintomáticas, 19 por ciento (52/279) de los hijos de madres con M/PET-HTLV-1 y 31 por ciento (18/58) de los hijos de madres con estrongiloidiasis. Según el análisis de regresión logística múltiple, tres factores se asociaron significativamente con la infección por HTLV-1: a) duración de la lactancia materna por 12_24 meses (razón de posibilidades [odds ratio, OR] = 15,1; intervalo de confianza de 95 por ciento [IC95 por ciento]: 4,2 a 54,1, frente a la lactancia materna por menos de 6 meses); b) que la madre presentara M/PET-HTLV-1 o estrongiloidiasis (OR = 8,3; IC95 por ciento: 1,0 a 65,3 y OR = 11,5; IC95 por ciento: 1,4 a 98,4, respectivamente, en comparación con los hijos de madres asintomáticas); y c) los antecedentes de haber recibido una transfusión sanguínea (OR = 5,5; IC95 por ciento: 2,0 a 15,2). CONCLUSIONES: Además de los factores de riesgo de la transmisión de la infección por HTLV-1 conocidos (duración de la lactancia materna y antecedentes de transfusión sanguínea), el diagnóstico materno de M/PET-HTLV-1 y el de estrongiloidiasis se asociaron significativamente con la infección por HTLV-1 en los hijos de madres seropositivas

Undiagnosed and potentially lethal parasite infections among immigrants and refugees in Australia.

Intestinal parasite infections are a major cause of ill health in many resource-poor countries. This study compares the types and rates of these infections and their risk factors in recently arrived and long-term immigrants in Australia. Cross-sectional surveys of 127 East African and 234 Cambodian immigrants and refugees were undertaken in 2000 and 2002, respectively, to assess the burden of intestinal parasites and collect demographic information. Serum samples were assessed for eosinophilia and Strongyloides stercoralis and Schistosoma antibodies, and feces examined for ova, cysts, and parasites. Intestinal parasites were identified in 77/117 fecal samples from East African and in 25/204 samples collected from Cambodian participants. Eleven percent (14/124) of East Africans and 42% (97/230) of Cambodians had positive or equivocal serology for S stercoralis. Schistosoma serology was positive or equivocal in 15% (19/124) of East African participants. Potentially serious intestinal parasite infections are common among recent and longer term immigrants despite multiple visits to health care providers. Immigrants and refugees from high-risk countries would benefit from comprehensive health checks soon after resettlement.

Pseudoparasitic pneumonia after bone marrow transplantation.

We present a female patient from Somalia with an acute lymphoblastic leukemia, who received an allogeneic bone marrow transplantation (BMT) and developed several periods of moderate to severe pulmonary symptoms that were accompanied by pulmonary infiltrates and peripheral blood eosinophilia. After several recurrences an open lung biopsy was performed, which initially gave rise to the diagnosis parasitic infection. Later on this diagnosis was questioned and it was suggested that the structures were artifacts that might have been aspirated. Nevertheless, after the immediately given antihelminthic treatment no peripheral blood eosinophilia occurred anymore, but at that point of time pulmonary function was already severely hampered and eventually led to a lethal complication. With the worldwide increasing migration from Third World countries with a high prevalence of parasitic infections, more patients will receive immunosuppressive therapies in countries less familiar with parasites. This may complicate diagnostic procedures, prevent early recognition and delay adequate treatment. Specific screening for opportunistic parasitic infections of the population at risk before BMT and a great awareness for these infections is strongly recommended.

[Strongyloides stercoralis infection in a patient with AIDS and non-Hodgkin lymphoma]. / Strongyloides-stercoralis-Infektion bei einem Patienten mit AIDS und Non-Hodgkin-Lymphom.

HISTORY AND CLINICAL FINDINGS: The patient, now 50 years old, an immigrant miner from the former Yugoslavia who was known to have AIDS, was in 1992 found to have non-Hodgkin lymphoma of the oesophagus and given five cycles of multiple chemotherapy (CHOP) with complete remission. Subsequently he complained of retrosternal pain, dysphagia, dry cough and upper abdominal discomfort. On admission he had slight fever of 39.1 degrees C, but physical examination was unremarkable. LABORATORY TESTS: Blood count revealed an eosinophilia of 41%. IgE concentration was raised to 432IU/ml. The CD4+ T-cell count was reduced to 10/microliter, that of CD8+ to 89/microliter. ADDITIONAL TESTS: Blood culture, fecal and sputum samples and bronchoalveolar lavage demonstrated Mycobacterium avium intracellulare. TREATMENT AND COURSE: Treatment of the disseminated atypical mycobacterial infection was started with clarithromycin, rifabutin, ciprofloxacin and ethambutol. There was no improvement of the upper abdominal discomfort, but the fever subsided. Oesophagogastroscopy excluded recurrence of the lymphoma. Biopsy and examination of the duodenal juice revealed worms and larvae of Strongyloides stercoralis. Stool samples contained no mycobacteria, but strongyloides larvae were demonstrated. Albendazole was given (2 x 400 mg daily for 6 days, followed by a maintenance dose of 1 x 400 mg daily). Repeat endoscopy and stool sample after a month no longer showed any parasites. CONCLUSION: Even in Western Europe, persons coming from endemic areas who, as this patient, have various risk factors that may facilitate the occurrence of strongyloidiasis. With early diagnosis and treatment albendazole is an efficacious drug.

[Chronic recurrent subileus due to Strongyloides stercoralis infection under immunosuppressive therapy]. / Chronisch-rezidivierender Subileus durch Strongyloides-stercoralis-Infektion unter immunsuppressiver Therapie.

HISTORY AND CLINICAL FINDINGS: A 33-year-old woman from Laos was admitted due to recurrent vomiting and weight loss. Since one year, she was receiving immunosuppressive therapy (azathioprine 50 mg/d and methylprednisolone 18 mg/d) for a mixed connective tissue disease. Because of a drug induced Stevens-Johnson-Syndrome one month earlier high doses of methylprednisolone (100 mg/d intravenously) had been administered. The patient's general condition was reduced. Examination elicited a mild pain in the middle abdomen on palpation but no resistance or tumour. The differential diagnosis included obstructive and (or) inflammatory disease of the gastrointestinal tract. INVESTIGATIONS: Elevated IgE-levels (1111 IU/ml; normal up to 100 IU/ml) and eosinophilia (8%) lead to the suspicion of a helminthiasis. Oesophagogastroduodenoscopy showed a significant duodenal stenosis. Duodenal biopsy revealed a severe infestation with Strongyloides stercoralis. Stool examinations were negative though. TREATMENT AND COURSE: With administration of thiabendazole (2 g/d) a rapid recovery was noted. A second oesophagogastroduodenoscopy one week after the onset of therapy revealed no further stenosis. Since there was no activity of the mixed connective tissue disease the methylprednisolone dosage was reduced and the administration of azathioprine was ceased. 3 weeks after beginning of treatment the patient was discharged in improved condition. CONCLUSION: In immunocompromised patients suffering from gastrointestinal complaints who have been in endemic areas an infection with Strongyloides stercoralis should be excluded. Without treatment, this helminthiasis may be fatal.