Strongyloidiasis in Children Outside the Tropics: Do We Need to Increase Awareness?

Abstract

Strongyloidiasis belongs to the group of neglected tropical diseases, due to diagnostic difficulties and the lack of systematic screening. Studies on strongyloidiasis prevalence are often heterogenous and mainly performed in adults in endemic countries. We retrospectively enrolled 2633 children referred to a tertiary care hospital in Italy between 2009 and 2020 and tested for S. stercoralis infection. Sixty-one (2.3%) had a positive serology and for 55 of them, clinical and epidemiological information were available. Thirteen cases (24%) were diagnosed in Italian children without history residency or travel to foreign countries, while the remaining were internationally adopted or migrant children. Seropositive patients were mostly asymptomatic, and often eosinophilia was the only sign of strongyloidiasis. Sero-reactivity to Toxocara canis was found in 1/3 of patients. Ivermectin was used in 37 (75.5%) treated patients. A significant reduction of eosinophil levels and IgG titer was seen after treatment. Our study confirms that strongyloidiasis is usually asymptomatic in children. However, due to the ability of the parasite to cause a life-long infection together with the risk of a severe form in case of immunosuppression, it is important to identify and treat infected children. Special consideration should be reserved to high-risk groups, such as immigrants and international adoptees, where screening for S. stercoralis is indicated. However, the study highlights that sporadic cases of autochthonous strongyloidiasis in Italy may occur. Therefore, pediatricians should be aware of this condition, which is often under-recognized.

From evidence to practice: A systematic review‐based diagnostic algorithm for paediatric eosinophilia across socioeconomic context

“…Most of the individuals affected by parasitosis live in tropical regions. However, many pathogens, such as Echinococcus granulosus , Strongyloides stercoralis , and Toxocara canis , are spread worldwide 30–32 . These data were in line with our findings, showing that Toxocara spp.…”

“…However, many pathogens, such as Echinococcus granulosus, Strongyloides stercoralis, and Toxocara canis, are spread worldwide. [30][31][32] These data were in line with our findings, showing that Toxocara spp. and Strongyloides spp.…”

“…and Strongyloides spp. were the most reported parasites regardless of children's provenience 30–32 . Local European cases of schistosomiasis and strongyloidiasis have been documented recently, suggesting an epidemiological change 30,34 .…”

“…were the most reported parasites regardless of children's provenience 30–32 . Local European cases of schistosomiasis and strongyloidiasis have been documented recently, suggesting an epidemiological change 30,34 . Consequently, it is necessary to maintain a high suspicion of parasitic diseases in children living in high‐resource settings, regardless of their tropical travel history.…”

Fatal Case of Autochthonous Strongyloides stercoralis Hyperinfection in an Immunosuppressed Calabrian Patient

“…In non-endemic areas, strongyloidiasis is still a diagnostic challenge, mainly due to the variety of its clinical manifestations, which results in an underestimation of the disease prevalence [17,18]. Even in Italy, the phenomenon is underestimated, although cases of strongyloidiasis have been repeatedly reported in this country [19][20][21][22][23][24][25]. Herein, we describe for the first time a fatal case of autochthonous S. stercoralis HS in an immunocompromised patient from the Calabria region of Southern Italy.…”