Abstract
BackgroundStrongyloides stercoralis is a neglected soil-transmitted helminth that occurs worldwide, though it is particularly endemic in tropical and subtropical areas. It can cause long-lasting and potentially fatal infections due to its ability to replicate within its host. S. stercoralis causes gastrointestinal and dermatological morbidity. The objective of this study was to assess the S. stercoralis infection risk and, using geostatistical models, to predict its geographical distribution in Cambodia.Methodology / Principal findingsA nation-wide, community-based parasitological survey was conducted among the Cambodian population, aged 6 years and older. S. stercoralis was diagnosed using a serological diagnostic test that detects IgG antibodies in urine. Data on demography, hygiene and knowledge about helminth infection were collected. S. stercoralis prevalence among 7,246 participants with a complete data record was 30.5%, ranging from 10.9% to 48.2% across provinces. The parasite was ubiquitous in Cambodia; only five south-eastern provinces had prevalence rates below 20%. Infection risk increased with age for both men and women, although girls under the age of 13 and women aged 50 years and over had lower odds of infection than their male counterparts. Open defecation was associated with higher odds of infection, while having some knowledge of the health problems caused by worms was a protective factor. Infection risk was positively associated with nighttime maximum temperature, minimum rainfall, and distance to water; it was negatively associated with land occupied by rice fields.Conclusions / SignificanceS. stercoralis infection is rampant in Cambodia. Control programs delivering ivermectin are needed to manage the parasite. However, the high cost of this drug in Cambodia currently precludes the implementation of control initiatives. Donations, subsidies or affordable generics are needed so that S. stercoralis, which infects almost a third of the Cambodian population, can be addressed through an adequate control program.
Highlights
Strongyloides stercoralis is a highly neglected intestinal nematode, for which larvae living in soil polluted with feces infect humans transcutaneously, like hookworms
The purpose of this study was to predict the risk of S. stercoralis infection in unsurveyed locations, assess risk factors for infection, and map its geographical distribution in Cambodia
Prevalence rates below 20% were found in just five south-eastern provinces
Summary
Strongyloides stercoralis is a highly neglected intestinal nematode, for which larvae living in soil polluted with feces infect humans transcutaneously, like hookworms. Chronic infection with S. stercoralis may cause abdominal pain, nausea, vomiting, and diarrhea, as well as urticaria and larva currens [15,16,17] The latter is a serpiginous intermittent moving eruption due to parasite migration under the skin. Its location on the buttocks, thighs, and trunk, together with the high speed of migration (i.e. 5 to 10 centimeters an hour), makes it a symptom highly specific to strongyloidiasis [11, 13]. This aspect of infection needs to be confirmed, S. stercoralis infection might be associated with growth retardation in children [17]. The national prevalence and the location of high-risk zones are unknown
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