Abstract
OBJECTIVESThe objective of this study was to evaluate the prevalence of Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran and to investigate related risk factors.METHODSThis cross-sectional study was conducted among 494 patients receiving immunosuppressive drugs, including cancer patients undergoing chemotherapy (n=188) and those treated with prolonged corticosteroid administration (n=306). All fresh fecal samples were examined using the direct wet-mount, formalin ethyl acetate concentration, and agar plate culture techniques.RESULTSIn total, 16.8% of patients were positive for at least 1 intestinal parasite; the helminthic and protozoan infection rates were 5.1% and 12.3%, respectively. The infection rate was significantly higher in corticosteroid-treated individuals (19.6%) than cancer patients (12.2%) (p<0.05). The prevalence rate of S. stercoralis among patients receiving chemotherapy and those treated with corticosteroids were 4.3% and 5.2%, respectively. The prevalence rate of S. stercoralis infection was significantly higher in older patients (p<0.05).CONCLUSIONSStrongyloidiasis is one of the most common parasites among patients receiving immunosuppressive drugs in northern Iran. Early diagnosis and proper treatment of these patients are necessary to minimize the complications of severe strongyloidiasis.
Highlights
Intestinal parasitic infections (IPIs) are major causes of significant morbidity and mortality rates worldwide
Immunocompromised patients are at risk of serious and deadly infections with intestinal parasites in many countries, in tropical and subtropical developing countries
The prevalence rate of IPIs in cancer patients was 12.2%, which is higher than that previously reported for central Iran (6.7%) [17] and northwest Iran (10%) [18], yet significantly lower than that reported for Tehran, Iran (25.9%) [19], Yemen (63.1%) [20], southern Brazil (61.6%) [21], and Egypt (85.5%) among cancer therapy recipients with concurrent diarrhea [22]
Summary
Intestinal parasitic infections (IPIs) are major causes of significant morbidity and mortality rates worldwide. The number of people with immune deficiencies continues to increase yearly due to the spread of human immunodeficiency virus (HIV) and the prescriptions of immunosuppressive medications such as corticosteroids and chemotherapy drugs for autoimmune diseases [2]. Strongyloides stercoralis is a soil-transmitted helminth estimated to infect about 370 million people worldwide, especially in tropical and subtropical countries [3] It is transmitted through the penetration of infective larvae into human skin when in contact with soil. Rapidly diagnosing chronic infections, updating epidemiological information, and screening people at risk are helpful measures to reduce the mortality and morbidity rate of strongyloidiasis [6,9]
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