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

1
Whipps Cross University Hospital, London E11 1NR, UK
2
Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK
3
William Harvey Heart Centre, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
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Riverside Medical Centre, Hockley SS5 6JY, UK
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Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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Barcelona Centre for International Health Research, 08014 Barcelona, Spain
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Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
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Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
*
Author to whom correspondence should be addressed.
Pathogens 2020, 9(2), 103; https://doi.org/10.3390/pathogens9020103
Received: 29 November 2019 / Revised: 29 January 2020 / Accepted: 4 February 2020 / Published: 6 February 2020
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
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.
Keywords: Strongyloides; migrant health; primary care; gastrointestinal symptoms; eosinophilia; ivermectin Strongyloides; migrant health; primary care; gastrointestinal symptoms; eosinophilia; ivermectin
MDPI and ACS Style

Baker, E.C.; Ming, D.K.; Choudhury, Y.; Rahman, S.; Smith, P.J.; Muñoz, J.; Chiodini, P.L.; Griffiths, C.J.; Whitty, C.J.; Brown, M. High Prevalence of Strongyloides among South Asian Migrants in Primary Care―Associations with Eosinophilia and Gastrointestinal Symptoms. Pathogens 2020, 9, 103.

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