Is <i>Strongyloides</i> seropositivity associated with diabetes mellitus? A retrospective case-control study in an East London NHS Trust

McGuire, Emma; Welch, Catherine; Melzer, Mark

doi:10.1093/trstmh/try132

Cited by 20 publications

(22 citation statements)

References 36 publications

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“…Direct comparison showed that infection with trematode flukes [Schistosoma spp. (45,(51)(52)(53) and O. viverrini (46)] had a greater effect on all measures compared to infection with intestinal nematode parasites [S. stercoralis (49,50) and soil transmitted helminths (26)].…”

Section: Discussionmentioning

confidence: 99%

“…Pooled data from the three studies that compared the prevalence of T2D in infected vs. non-infected populations (49,52,53) demonstrated no difference in the prevalence of T2D (Figure 5A, OR 1.03, 95% CI 0.34, 3.09; I 2 = 96%). However, sub-group analysis demonstrated that the prevalence of T2D was 46% lower among those infected with Schistosoma spp.…”

Section: Prevalence Of Type 2 Diabetes In Infected and Non-infected Populationsmentioning

confidence: 97%

“…Of the fourteen studies assessed, nine reported that infection with a parasitic worm had protective effects on diabetes-related parameters (26,(44)(45)(46)(47)(50)(51)(52)(53), however three studies (48,49,55) reported a positive association between specific infections and T2D diagnosis, and two studies (54,56) reported no association. Individual glucose homeostasis related outcomes are summarized in Supplementary Table 4.…”

Section: Study Findingsmentioning

confidence: 98%

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The Impact of Helminth Infection on the Incidence of Metabolic Syndrome: A Systematic Review and Meta-Analysis

et al. 2021

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BackgroundThere are a growing number of publications that report an absence of inflammatory based disease among populations that are endemic to parasitic worms (helminths) demonstrating the ability of these parasites to potentially regulate human immune responses. The aim of this systematic review and meta-analysis was to determine the impact of helminth infection on metabolic outcomes in human populations.MethodsUsing PRISMA guidelines, six databases were searched for studies published up to August 2020. Random effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals using the Review Manager Software version 5.4.1.ResultsFourteen studies were included in the review. Fasting blood glucose was significantly lower in persons with infection (MD -0.22, 95% CI -0.40- -0.04, P=0.02), HbA1c levels were lower, although not significantly, and prevalence of the metabolic syndrome (P=0.001) and type 2 diabetes was lower (OR 1.03, 95% CI 0.34-3.09, P<0.0001). Infection was negatively associated with type 2 diabetes when comparing person with diabetes to the group without diabetes (OR 0.44, 95% CI 0.29-0.67, P=0.0001).ConclusionsWhile infection with helminths was generally associated with improved metabolic function, there were notable differences in efficacy between parasite species. Based on the data assessed, live infection with S. mansoni resulted in the most significant positive changes to metabolic outcomes.Systematic Review RegistrationWebsite: PROSPERO Identified: CRD42021227619.

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Section: Discussionmentioning

confidence: 99%

Section: Prevalence Of Type 2 Diabetes In Infected and Non-infected Populationsmentioning

confidence: 97%

Section: Study Findingsmentioning

confidence: 98%

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The Impact of Helminth Infection on the Incidence of Metabolic Syndrome: A Systematic Review and Meta-Analysis

et al. 2021

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“…We would be in favour of developing treatment algorithms for use in primary care which focus on patients who have travelled to Strongyloides-endemic regions [21] and present with an unexplained eosinophilia. In a case series with a similar underlying population from South Asia, presence of diabetes was associated with strongyloidiasis in multivariate analyses and this might form the basis of targeted screening strategies [22]. Further work should clarify the cost-effectiveness of screening strategies based on full blood count or serology for Strongyloides infection specific to UK migrant populations, as such analyses have been based on data conducted elsewhere and may not apply [8].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Several immunosuppression-related risk factors for Strongyloides hyperinfection have been described including the use of corticosteroids and other immunosuppressants, HTLV-1 infection, organ transplantation, and hematologic malignancies 1 , 7 . Other predisposing factors are malnutrition, alcoholism, and diabetes mellitus 1 , 8 , 9 . These three conditions were present in the patient whose case we report.…”

Section: Discussionmentioning

confidence: 99%

Fatal Strongyloides stercoralis hyperinfection syndrome in an alcoholic diabetic patient from México

et al. 2020

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Strongyloides stercoralis hyperinfection syndrome is a medical emergency that requires a high level of suspicion. Immunocompromised patients are at high risk of hyperinfection syndrome; however, malnutrition, alcoholism, and diabetes mellitus also need to be considered as predisposing factors. The diagnosis and treatment of Strongyloides hyperinfection are challenging and patients often have severe complications. Consequently, mortality is overwhelmingly high, with proportions above 60%.Herein, we report a case of Strongyloides hyperinfection in a 40-year-old alcoholic diabetic patient living in México. Unfortunately, the late diagnosis resulted in his death despite the treatment and supportive measures. Increased awareness is needed to prevent the dire consequences of strongyloidiasis.

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Is Strongyloides seropositivity associated with diabetes mellitus? A retrospective case-control study in an East London NHS Trust

Cited by 20 publications

References 36 publications

The Impact of Helminth Infection on the Incidence of Metabolic Syndrome: A Systematic Review and Meta-Analysis

The Impact of Helminth Infection on the Incidence of Metabolic Syndrome: A Systematic Review and Meta-Analysis

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

Fatal Strongyloides stercoralis hyperinfection syndrome in an alcoholic diabetic patient from México

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