Endemic strongyloidiasis on the Spanish Mediterranean coast

Abstract

Diagnosis and treatment of Strongyloides stercoralis infection can be difficult, and a high degree of clinical suspicion in patients who have visited an endemic area is required. We describe the epidemiology and clinical features of 152 prospectively identified cases of strongyloidiasis in an European region, and identify risk factors for the development of severe forms of the disease. This was a prospective study of all patients admitted to a single institution over an 8-year period. Patients (n=152) were mainly elderly male farmers (79%) who had acquired the disease by working barefoot in contact with soil and ingesting non-drinking water. Eosinophilia was a sensitive marker for the infection (82%). Twenty patients (13%) developed severe forms of the illness and six patients (4%) died. A significant association was found between severe forms of strongyloidiasis and steroid usage (OR 9.0, 95%CI 2.1-37.6), immunodebilitating illness (OR 10.1, 95%CI 3.2-32.3) and other immunosuppressive therapy (OR 13.7, 95%CI 2.9-58.7), but by logistic regression analysis, only immunodebilitating disease was as a risk factor (OR 2.1, 95%CI 1.78-2.43). S. stercolaris infection is endemic in the Spanish Mediterranean coast. The frequent development of severe forms of the disease, with a high mortality, makes early recognition and treatment essential.

Severe strongyloidiasis in corticosteroid-treated patients: Case series and literature review

“…It is possible that hyperinfective strongyloidiasis be preponderant among males because males are widely infected by the nematode. Indeed, in a second study, Sanchez et al 138 described the epidemiology and clinical features of 152 prospectively identified cases of strongyloidiasis (patients receiving or not corticosteroids) and found a male/female ratio of 3/1. A third study 139 reviewing 3271 stool examinations (52 patients infected with Ss), this ratio was 2/1.…”

Strongyloides stercoralisin the Immunocompromised Population

“…Clusters of cases in institutionalized individuals with mental retardation (8,93) suggest that nosocomial transmission can occur. Occupations that increase contact with soil contaminated with human waste, which may include farming (69,98) and coal mining (127, 128) depending on local practices, increase the risk of infection. Swimming in or drinking contaminated water has not been proven to be a significant source of transmission, perhaps because larvae do not thrive when immersed in water (88).…”

Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and initial management

“…Distribution: Widely distributed throughout the tropics, small foci in temperate regions. 62,63 Mode of transmission: Larvae penetrate the skin of humans walking barefoot on affected soil or sand.…”