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The Global Prevalence of Strongyloides stercoralis Infection
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Clinical Features Associated with Strongyloidiasis in Migrants and the Potential Impact of Immunosuppression: A Case Control Study

CAP Casanova, Consorci d’Atenció Primaria en Salut Barcelona Esquerra, 08036 Barcelona, Spain
Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
Tropical Medicine Unit, Hospital de Poniente, El Ejido, 04700 Almería, Spain
Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain
Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL; University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Infectious Diseases Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain
Department of Microbiology, Hospital Sant Pau, 08001 Barcelona, Spain
Department of Infectious Diseases, Hospital Clinic, 08036 Barcelona, Spain
Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain
Department of Microbiology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain
Tropical Medicine Unit Vall d’Hebron-Drassanes, PROSICS Barcelona, 08035 Barcelona, Spain
Internal Medicine Department, Hospital Universitario General de Catalunya, 08915 Barcelona, Spain
Centro de Investigação em Saúde de Manhiça, 1929 Maputo, Mozambique
Division of Infectious Diseases, Department of Medicine-Solna, Karolinska Institutet, 17177 Solna, Sweden
Author to whom correspondence should be addressed.
STRONG-SEMTSI working group: Maria Teresa Cabezas Fernández (El Ejido, 04700 Almería, Spain), José Vázquez Villegas (El Ejido, 04700 Almería, Spain), Gracia Cruz (El Ejido, 04700 Almería, Spain), Philip Wikman (03550 Alicante, Spain), Guillermo Girones (08036 Barcelona, Spain), Jose Maria Saugar (28220 Majadahonda, Madrid, Spain)., Esperanza Rodríguez (28220 Majadahonda, Madrid, Spain), Maria Eugenia Valls (08036 Barcelona, Spain), Carme Subirá (08036 Barcelona, Spain). Membership of the STRONG-SEMTSI working group is provided in the Acknowledgements.
Pathogens 2020, 9(6), 507;
Received: 8 May 2020 / Revised: 16 June 2020 / Accepted: 17 June 2020 / Published: 23 June 2020
(This article belongs to the Special Issue Prevalence of Strongyloidiasis and Schistosomiasis)
Strongyloides stercoralis is a widely distributed nematode more frequent in tropical areas and particularly severe in immunosuppressed patients. The aim of this study was to determine factors associated with strongyloidiasis in migrants living in a non-endemic area and to assess the response to treatment and follow-up in those diagnosed with the infection. We performed a multicenter case-control study with 158 cases and 294 controls matched 1:2 by a department service. Participants were recruited simultaneously at six hospitals or clinics in Spain. A paired-match analysis was then performed looking for associations and odds ratios in sociodemographic characteristics, pathological background, clinical presentation and analytical details. Cases outcomes after a six-month follow-up visit were also registered and their particularities described. Most cases and controls came from Latin America (63%–47%) or sub-Saharan Africa (26%–35%). The number of years residing in Spain (9.9 vs. 9.8, p = 0.9) and immunosuppression status (30% vs. 36.3%, p = 0.2) were also similar in both groups. Clinical symptoms such as diffuse abdominal pain (21% vs. 13%, p = 0.02), and epigastralgia (29% vs. 18%, p < 0.001); along with a higher eosinophil count (483 vs. 224 cells/mL in cases and controls, p < 0.001) and the mean total Immunoglobulin E (IgE) (354 U/L vs. 157.9 U/L; p < 0.001) were associated with having strongyloidiasis. Finally, 98.2% percent of the cases were treated with ivermectin in different schedules, and 94.5% met the cure criteria at least six months after their first consultation. Abdominal pain, epigastralgia, eosinophilia, increased levels of IgE and Latin American origin remain the main features associated with S. stercoralis infection, although this association is less evident in immunosuppressed patients. The appropriate follow-up time to evaluate treatment response based on serology titers should be extended beyond 6 months if the cure criteria are not achieved. View Full-Text
Keywords: Strongyloides stercoralis; migration; risk factors; case-control; immunosuppression Strongyloides stercoralis; migration; risk factors; case-control; immunosuppression
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Martinez-Pérez, A.; Soriano-Pérez, M.J.; Salvador, F.; Gomez-Junyent, J.; Villar-Garcia, J.; Santin, M.; Muñoz, C.; González-Cordón, A.; Salas-Coronas, J.; Sulleiro, E.; Somoza, D.; Treviño, B.; Pecorelli, R.; Llaberia-Marcual, J.; Lozano-Serrano, A.B.; Quinto, L.; Muñoz, J.; Requena-Méndez, A.; STRONG-SEMTSI working group. Clinical Features Associated with Strongyloidiasis in Migrants and the Potential Impact of Immunosuppression: A Case Control Study. Pathogens 2020, 9, 507.

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