Background: Strongyloidiasis, one of the neglected tropical diseases (NTDs), can be fatal in immunocompromised patients. Available data on Strongyloides stercoralis infection in high-risk patients in Iran; however, is limited. The aim of the present study was to determine the prevalence of S. stercoralis infection and associated risk factors among high-risk patients, as well as to evaluate the accuracy of the diagnostic tests used in the diagnose of S. stercoralis infection. Methods: This cross-sectional study was performed during 2019 to 2020 among 300 high-risk patients in Khuzestan Province, southwestern Iran. Patients with autoimmune diseases, uncontrolled diabetes, HIV/AIDS, cancer, organ transplant, hematologic malignancy, asthma and chronic obstructive pulmonary disease (COPD) were examined using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test. Culture-positive samples were confirmed by PCR amplification and sequencing of the nuclear 18S rDNA (SSU) hypervariable region (HVRIV) of the parasite.Results: The prevalence of S. stercoralis infection was 1%, 1.3%, 2%, 2.7%, and 8.7% using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test, respectively. All culture-positive samples were confirmed by SSU-PCR. According to the results, the most sensitive test was ELISA, with 100% sensitivity, followed by Baermann funnel technique with sensitivity of 75%. Direct smear examination, formalin-ether concentration technique, and Baermann funnel technique had the highest PPV (100%), while ELISA test had the highest NPV (100%). Eosinophilia significantly was observed in patients whose culture test were positive (7/8; p= 0.001). Of these, 5 patients had a history of asthma and COPD. In the present study, the majority of the positive cases by the agar plate culture had a history of prolonged exposure to soil, history of asthma and COPD, and were over the ages of 60. In two cases, S. stercoralis larva was observed 6 months and 8 months after treatment with albendazole.Conclusions: Given that the ELISA test had the highest NPV, screening of all high-risk patients for S. stercoralis infection in endemic areas is recommended prior to starting corticosteroid therapy with ELISA test. Ivermectin should be available to the strongyloidiasis patients in the endemic areas.

Background Fatal forms of strongyloidiasis, hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), are caused by exaggerated autoinfection of the intestinal nematode, Strongyloides stercoralis (S. stercoralis). Corticosteroids, frequently administered to patients with severe COVID-19, can transform chronic asymptomatic strongyloidiasis into the above-mentioned fatal diseases. This study aimed to investigate the prevalence of strongyloidiasis in COVID-19 patients receiving corticosteroids in a hypoendemic region. Methods The present cross-sectional study enrolled 308 COVID-19 patients admitted to two hospitals in Ahvaz and Abadan in the southwest of Iran between 2020 and 2022. A real-time reverse transcription polymerase chain reaction (RT-PCR) test and chest computed tomography (CT) scan were employed to detect and monitor the disease’s severity in the patients, respectively. All patients were evaluated for IgG/IgM against S. stercoralis using Enzyme-linked immunosorbent assay (ELISA) test. Subsequently, individuals with a positive ELISA test were confirmed using parasitological methods, including direct smear and agar plate culture (APC). Results The patients were between 15 and 94 years old, with a mean age of 57.99 ± 17.4 years. Of the 308 patients, 12 (3.9%) had a positive ELISA test, while 296 (96.1%) had negative results. Three of the 12 patients with a positive ELISA result died, and three failed to provide a stool sample. To this end, only six cases were examined parasitologically, in which S. stercoralis larvae were observed in five patients. Significant differences were found between S. stercoralis infection with sex (p = 0.037) and age (p = 0.027). Binary regression analysis revealed that strongyloidiasis was positively associated with sex (odds ratio [OR]: 5.137; 95% confidence interval [CI]: 1.107–23.847), age (OR: 5.647; 95% CI 1.216–26.218), and location (OR: 3.254; 95% CI: 0.864–12.257). Conclusions Our findings suggest that screening for latent strongyloidiasis in COVID-19 patients in endemic areas using high-sensitivity diagnostic methods, particularly ELISA, before receiving suppressive drugs should be given more consideration.

Background: Cystic echinococcosis (CE) is a zoonotic disease caused by the Echinococcus granulosus senso lato (E. granulosus s.l.) larval stages. Parasite-derived products have been shown to regulate host matrix metalloproteinases (MMPs), contributing to CE pathogenesis and progressive liver fibrosis in intermediate hosts. The current study aimed to investigate the potential role of MMP1, 7, 8, and 13 in E. granulosus s.l-¬induced liver fibrosis. Methods: Thirty CE patients with active, transitional, or inactive hydatid cysts were enrolled in this study using qRT-PCR to determine the inductive effects of E. granulosus on the expression of MMP-1, MMP-7, MMP-8, and MMP-13 in healthy liver tissue and fibrotic liver tissue. Results: According to the WHO-IWGE classification, patients with functional cysts (CE1 and CE2) had the highest percentage (46.6%). MMP-1, MMP-7, MMP-8, and MMP-13 expression levels were significantly higher in fibrotic liver than in normal liver tissue. MMP-13 and MMP-1 had the highest and lowest expression levels among MMPs. Compared to the normal group, the fold change for MMP-13 in the fibrotic group was greater than 12 and had the highest AUC value (AUC= 0.8283). Conclusions: Our findings suggest that E. granulosus-derived products might be involved in regulating host MMPs. Thus, MMPs may be considered potential biomarkers for predicting CE prognosis. Because of the non-normal distribution of our patients’ CE types, further research, particularly on circulation MMPs, is needed to confirm the potential role of MMPs in CE pathogenesis and to follow up on CE patients.

Background: Blastocystis hominis is an enteric protozoan in humans and animals. This survey aimed to assess the knowledge and practice of physicians about B. hominis. Methods: This study was performed on physicians working in Ahvaz County, using a convenience sampling method from January to June 2020. Data were collected through face-to-face interviews and an electronic questionnaire. Descriptive statistics, including frequencies and percentages, were calculated for all variables. P-values < 0.05 were considered significant. Results: Our results showed that of the 352 physicians, 64.2% and 58.0% knew that B. hominis might cause abdominal pain and diarrhea, respectively, but their knowledge was poor about the possibility of extraintestinal clinical symptoms such as urticaria. Regarding the transmission route, 91.8% agreed that the fecal-oral route is the main mode of B. hominis transmission, but only 17.9% were aware of the role of host animals in its transmission. Furthermore, the physicians had poor knowledge of the need to treat symptomatic patients and resistance to metronidazole in some cases. More than two-thirds of the physicians (68%) had good practice treating infected immunocompromised patients but had poor practice treating symptomatic patients. Conclusions: This study emphasizes improving physicians’ knowledge of pathogenicity, clinical symptoms, and treating B. hominis. Since B. hominis is a common protozoan with pathogenic potential, we recommend training sessions for physicians to inform them of new findings about B. hominis.

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