Strongyloides stercoralis: systematic review of barriers to controlling strongyloidiasis for Australian indigenous communities.

Adrian Miller,Jenni A Judd,Rick Speare,Michelle L Smith

doi:10.1371/journal.pntd.0003141

Abstract

Background Strongyloides stercoralis infects human hosts mainly through skin contact with contaminated soil. The result is strongyloidiasis, a parasitic disease, with a unique cycle of auto-infection causing a variety of symptoms and signs, with possible fatality from hyper-infection. Australian Indigenous community members, often living in rural and remote settings, are exposed to and infected with S. stercoralis. The aim of this review is to determine barriers to control of strongyloidiasis. The purpose is to contribute to the development of initiatives for prevention, early detection and effective treatment of strongyloidiasis.Methodology/Principle FindingsSystematic search reviewing research published 2012 and earlier was conducted. Research articles discussing aspects of strongyloidiasis, context of infection and overall health in Indigenous Australians were reviewed. Based on the PRISMA statement, the systematic search of health databases, Academic Search Premier, Informit, Medline, PubMed, AMED, CINAHL, Health Source Nursing and Academic was conducted. Key search terms included strongyloidiasis, Indigenous, Australia, health, and community. 340 articles were retrieved with 16 original research articles published between 1969 and 2006 meeting criteria. Review found barriers to control defined across three key themes, (1) health status, (2) socioeconomic status, and (3) health care literacy and procedures.Conclusions/SignificanceThis study identifies five points of intervention: (1) develop reporting protocols between health care system and communities; (2) test all Indigenous Australian patients, immunocompromised patients and those exposed to areas with S. stercoralis; (3) health professionals require detailed information on strongyloidiasis and potential for exposure to Indigenous Australian people; (4) to establish testing and treatment initiatives within communities; and (5) to measure and report prevalence rates specific to communities and to act with initiatives based on these results. By defining barriers to control of strongyloidiasis in Australian Indigenous people, improved outcomes of prevention, treatment of strongyloidiasis and increased health overall are attainable.

Highlights

Strongyloidies stercoralis, a nematode parasite, is well documented as a potentially fatal soil transmitted helminth, described as a unique and complex human parasite in Speare [1]
Conclusions/Significance: This study identifies five points of intervention: (1) develop reporting protocols between health care system and communities; (2) test all Indigenous Australian patients, immunocompromised patients and those exposed to areas with S. stercoralis; (3) health professionals require detailed information on strongyloidiasis and potential for exposure to Indigenous Australian people; (4) to establish testing and treatment initiatives within communities; and (5) to measure and report prevalence rates specific to communities and to act with initiatives based on these results
Australia’s Indigenous communities have high prevalence of strongyloidiasis as do immigrants from other endemic countries, travellers to these countries and military personnel who have spent time in endemic regions [6,7]

Summary

Introduction

Strongyloidies stercoralis, a nematode parasite, is well documented as a potentially fatal soil transmitted helminth, described as a unique and complex human parasite in Speare [1]. Australia’s Indigenous communities have high prevalence of strongyloidiasis (disease resulting from S. stercoralis) as do immigrants from other endemic countries, travellers to these countries and military personnel who have spent time in endemic regions [6,7]. Hewagama and Brady [8] report four cases of strongyloidiasis in non-Indigenous people resulting from workrelated exposure presenting at Alice Springs Hospital and by implication acquired indirectly from Indigenous populations. Those infected included a teacher at an Indigenous school, a child care worker, an ex-nurse and a paediatrician. The purpose is to contribute to the development of initiatives for prevention, early detection and effective treatment of strongyloidiasis

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Discussion

Conclusion