Abstract
Strongyloides stercoralis infection is a life-threatening neglected tropical disease. Diagnostic issues have caused an underestimation of its global burden. The choice of appropriate diagnostic tests for the screening of populations at risk of the infection, such as migrants from endemic countries, is of paramount importance. From November 2017 to July 2018, all migrants presenting to the National Institute for Health Migration and Poverty (INMP) in Rome, Italy were offered screening tests for S. stercoralis infection. The study objective was to estimate the prevalence of strongyloidiasis in the study population and the accuracy of a novel ELISA assay. The following tests were carried out at the IRCCS Sacro Cuore Don Calabria hospital in Negrar, Verona: stool microscopy, real-time PCR for S. stercoralis, in-house immunofluorescence test (IFAT), a commercial ELISA assay (Bordier ELISA), and a novel ELISA assay (Euroimmun ELISA). A latent class analysis (LCA) model set up with test results, clinical variables, and eosinophilia indicated a prevalence around 7.5%, in line with previous findings. The sensitivity and the specificity of Euroimmun ELISA were 90.6% (95% CI 80.5–100) and 87.7% (95CI 84.5–91.0); these results indicate that the novel ELISA assay would be suitable for screening of migrants from endemic countries.
Highlights
Strongyloides stercoralis infection is a neglected tropical disease (NTD) affecting an estimated 640 million people worldwide [1]
Campaigns for promotion of the screening activities were conducted in order to disseminate information about selected NTDs and about the free access to a dedicated Institute for Health Migration and Poverty (INMP) outpatient clinic
Other samples were sent to the DITM, where the following tests were carried out: microscopy examination of faeces concentrated by Ritchie’s modified method, a commercial ELISA for S. stercoralis, an in-house immunofluorescence test (IFAT), a novel ELISA kit, and real-time Polymerase chain reaction (PCR) for S
Summary
Strongyloides stercoralis infection is a neglected tropical disease (NTD) affecting an estimated 640 million people worldwide [1]. The infection is transmitted through direct penetration of the skin by infective (filariform) larvae free-living in soil contaminated by human faeces. The larvae moult while migrating in the human body, and the adult female worm settles in the intestine, where it produces eggs. Some of them moult into the filariform stage before leaving the body and can re-infect the host through rectal mucosa or perianal skin. This auto-infective cycle leads to a chronic infection, which can perpetuate through the years even in absence of re-exposure to an external infective source [2].
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