Human Strongyloidiasis in Hawaii: A Retrospective Review of Enzyme-Linked Immunosorbent Assay Serodiagnostic Testing

Abstract

Human strongyloidiasis is widely prevalent in tropical and subtropical regions worldwide but is not endemic in Hawaii. Subclinical, chronic infections may be lifelong; immunosuppressive therapy, particularly with glucocorticoids, may lead to serious or fatal disseminated disease, which is preventable. We performed a retrospective analysis of patients tested for immunoglobulin G antibody in an academic medical center in Honolulu, Hawaii, from 2005 to 2012. Of the 475 patients tested, 78 (16%) were seropositive. The largest proportion of seropositive cases was found among Micronesians (30%), Polynesians (26%), Filipinos (13%), and Southeast Asians (11%). Among the seropositive patients, the most likely reason for clinicians to order testing was blood eosinophilia. Stool parasite examination results were available for 58% of seropositive patients of which 11% were positive for larvae. Antihelminthic therapy, usually ivermectin, was ordered for 71% of patients. After treatment, blood eosinophilia and serology results were reassessed for 76% and 35% of patients, respectively; both tests tended to show improvement. Travelers and immigrants from-endemic areas, including Micronesia and Polynesia, should have serodiagnostic testing for latent strongyloidiasis, and if positive, treated empirically with ivermectin, particularly when corticosteroids or other immunosuppressive therapies are anticipated.

Improved diagnostic sensitivity of human strongyloidiasis using point-of-care mixed recombinant antigen-based immunochromatography

“…Due to the unique autoinfection cycle exhibited by Strongyloides, lifelong latent infection can occur. Given increased global mobility, the CDC recommends that all individuals who have ever resided in S. stercoralis-endemic areas should be screened for asymptomatic S. stercoralis infection prior to administration of steroids [8], immunosuppressive agents, or chemotherapy [1]. Also, the test has the potential for commercial translation, up-scaling and making an impact on disease control.…”

A Cross-Sectional Study of Seroprevalence of Strongyloidiasis in Pregnant Women (Peruvian Amazon Basin)

“…Outside Latin America, in Southeast Asia and the Pacific, Akiyama and Brown reported a seroprevalence of 16% in 475 residents of Hawaii; the largest proportion of seropositive cases was found in Micronesians (30%) [34]. In Vietnam, Diep et al [35] observed a sero-reactivity to S. stercoralis in 29.1% of adults (N = 1340) and 5.5% of children (N = 270); men were more frequently sero-reactive when living in rural central highlands.…”