Prevalence and Associated Risk Factors of Strongyloides sp. Infection in Diabetic Patients in the Central Part of Mazandaran, Northern Iran

Abstract

Background: Strongyloides stercoralis, a soil transmitted helminth, is well known as a potentially fatal parasite in immunosuppressed patients. Objectives: The current study aimed to evaluate the prevalence of strongyloidiasis in diabetic patients, in the central parts of Mazandaran province, Iran, using coprological examination and enzyme-linked immunosorbent assay (ELISA). Methods: Fresh stool and serum samples were obtained from diabetic patients. The stool samples were examined using direct smear and formalin-ether concentration methods. The serum samples were tested for the existence of Strongyloides sp. antibodies using a commercial diagnostic kit (Strongyloides -ELISA). Results: The overall prevalence rates were 13.3% (4/30) and 25.6% (46/180) using parasitological and ELISA methods, respectively. The sensitivity and specificity of ELISA compared with stool examination were 100% and 84.6%, respectively. The seroprevalence rate of this infection was higher in females (27.3%) than males (19.5%), and among participants living in rural regions (31%) compared with urban areas (20%). The prevalence rate of Strongyloides sp. infection was higher in patients with diabetic foot (39.1%) compared with cases with non-diabetic foot (23.6%). It also was higher in insulin dependent patients (29.9%) compared with non-insulin dependent subjects (23%). However, these differences were not statistically significant which may have resulted from the small sample size. Conclusions: Our findings demonstrated a high seroprevalence of Strongyloides sp. infection in diabetic patients. Furthermore, this is the first seroprevalence study of strongyloidiasis in diabetic patients from Iran. It seems that the ELISA technique can be used for the diagnosis of individual cases and is a good screening assay to rule out strongyloidiasis in diabetic patients.

Seroprevalence of Strongyloides stercoralis among patients with leptospirosis in northern Iran: a descriptive cross-sectional study

“…This seroprevalence rate is slightly higher than previous studies in the north of Iran among the high-risk population. Previous studies reported the seroprevalence rates of strongyloidiasis as 25.6%, 27.9% and 30% in diabetic patients, suspected patients to infectious diseases and immunocompromised patients, respectively (Gorgani-Firouzjaee et al, 2018; Javanian et al, 2019;Kalantari et al, 2019). While the seroprevalence rate reported in our study is much higher than previous reports in Khuzestan Province, south-west of Iran, where the seroprevalence rates were 8.7% and 14.4% among high-risk patients (Rafiei et al, 2016;Ashiri et al, 2021).…”

Effects of helminths and anthelmintic treatment on cardiometabolic diseases and risk factors: A systematic review

“…In total, 29 studies compared baseline measures of diabetes or pancreatic inflammation in those with and without helminth infection. Seventeen studies (59%; 11 animal, 6 human) reported lower measures of diabetes or pancreatic inflammation [14,25,32,68,[72][73][74][75][76][77][78][79][80][81][82][83][84], 6 (21%; all human) demonstrated higher measures of these factors [6,[85][86][87][88][89], and 5 (17%; all human) showed no association with respect to helminth infections [53,58,59,71,90]. In the final study there was no difference in hemoglobin A1c or fasting glucose regardless of helminth infection or antiretroviral status among HIV-infected individuals, while among HIV-uninfected individuals, soil-transmitted helminth (STH) infection was inversely associated with hemoglobin A1c (5.2% vs. 5.5% in STH-uninfected controls) after adjustment for age and sex [69].…”

“…Of the 5 that reported on the effects of anthelmintic treatment, 3 (60%) showed that blood glucose increased after treatment of helminth infection. Among human studies that reported median age and sex distribution, 2 out of 5 [6,25,53,89,90] with median ages over 50 years observed a different cross-sectional trend and suggested that helminth infection may possibly increase diabetes risk in older women, although the sample size of studies is admittedly limited and women were over-represented in those 2 studies, which both focused on Strongyloides [89,90].…”