Abstract
Background: Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. Methods: Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. Results: We included 36 patients (21 men) with a mean age of 60.8 years ±17.6; 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs. 53.3 years; p = 0.002), male sex (odds ratio (OR) 5.33; 95% confidence interval (CI) 1.15–24.68; p = 0.041), and agricultural activity (OR 13.5; 95% CI 2.4–73.7; p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs. 75%; p = 0.207), treatment received, or clinical response (85.7% vs. 88.9% cured; p = 1). Conclusion: In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed.
Highlights
Strongyloides stercoralis is an intestinal helminth acquired by humans when larvae penetrate intact skin following contact with infected soil [1]
In Spain, autochthonous cases of strongyloidiasis are concentrated in the Mediterranean basin, namely in the autonomous regions of Valencia and Murcia, where autochthonous cases coexist with imported strongyloidiasis
A recent systematic review of autochthonous cases [21] of strongyloidiasis in Spain reports a high percentage of men (82.9%), agricultural occupations, and a mean age of
Summary
Strongyloides stercoralis is an intestinal helminth acquired by humans when larvae penetrate intact skin following contact with infected soil [1] It has a peculiar autoinfection life cycle that may lead to lifelong chronic infection if left untreated. Its clinical spectrum can range from cutaneous (pruritus, larva currens, urticaria), digestive (diarrhea, abdominal pain), or respiratory (chronic cough, dyspnea) symptoms to asymptomatic eosinophilia or even silent infections, which constitute the vast majority of infections in endemic areas [2,3]. On occasion, it manifests as a life-threatening complication with the development of hyperinfection syndrome. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology
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