Stercoralis Infection Research Articles

Strongyloidiasis in Children Outside the Tropics: Do We Need to Increase Awareness?

Strongyloidiasis belongs to the group of neglected tropical diseases, due to diagnostic difficulties and the lack of systematic screening. Studies on strongyloidiasis prevalence are often heterogenous and mainly performed in adults in endemic countries. We retrospectively enrolled 2633 children referred to a tertiary care hospital in Italy between 2009 and 2020 and tested for S. stercoralis infection. Sixty-one (2.3%) had a positive serology and for 55 of them, clinical and epidemiological information were available. Thirteen cases (24%) were diagnosed in Italian children without history residency or travel to foreign countries, while the remaining were internationally adopted or migrant children. Seropositive patients were mostly asymptomatic, and often eosinophilia was the only sign of strongyloidiasis. Sero-reactivity to Toxocara canis was found in 1/3 of patients. Ivermectin was used in 37 (75.5%) treated patients. A significant reduction of eosinophil levels and IgG titer was seen after treatment. Our study confirms that strongyloidiasis is usually asymptomatic in children. However, due to the ability of the parasite to cause a life-long infection together with the risk of a severe form in case of immunosuppression, it is important to identify and treat infected children. Special consideration should be reserved to high-risk groups, such as immigrants and international adoptees, where screening for S. stercoralis is indicated. However, the study highlights that sporadic cases of autochthonous strongyloidiasis in Italy may occur. Therefore, pediatricians should be aware of this condition, which is often under-recognized.

Strongyloides stercoralis seropositivity is not associated with increased symptoms in a remote Aboriginal community.

Strongyloides stercoralis is a soil-transmitted helminth, endemic in remote Aboriginal and Torres Strait Islander communities in northern Australia with estimates of prevalences up to 60%. Hyperinfection in the setting of immunosuppression is a rare, but well recognised cause of significant morbidity and mortality. However, the morbidity associated with chronic uncomplicated infection is less well characterised. To measure the prevalence of symptoms potentially attributable to S. stercoralis infection and their association with seropositivity. This retrospective matched case-control study reviewed records of primary healthcare presentations for symptoms in the 12 months before and after an ivermectin mass drug administration (MDA) in a remote Aboriginal community. One hundred and seventy-five S. stercoralis seropositive cases were matched with 175 seronegative controls. The most frequently reported symptom overall in the 12 months prior to the MDA was cough followed by abdominal pain, weight loss/malnutrition, diarrhoea and pruritis. Seropositive cases were not more likely than matched controls to have symptoms typically attributed to strongyloidiasis. In the seropositive cohort, we found no difference in symptoms in the 12 months before and after an ivermectin MDA despite a reduction in seroprevalence. We found no evidence to suggest that S. stercoralis seropositivity was associated with increased symptoms when compared to matched seronegative controls. Treatment with ivermectin did not reduce symptoms in seropositive cases. Without evidence to support that population-based screening or treatment programmes reduce symptoms, the emphasis must remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life-threatening hyperinfection.

Parasitic Disease Surveillance, Mississippi, USA.

Surveillance for soil-transmitted helminths, strongyloidiasis, cryptosporidiosis, and giardiasis was conducted in Mississippi, USA. PCR performed on 224 fecal samples for all soil-transmitted helminths and on 370 samples for only Necator americanus and Strongyloides stercoralis identified 1 S. stercoralis infection. Seroprevalences were 8.8% for Toxocara, 27.4% for Cryptosporidium, 5.7% for Giardia, and 0.2% for Strongyloides parasites.

Strongyloides stercoralis, a neglected parasite in north of Iran with remarkable exposure

Background and objectiveStrongyloides stercoralis (S. stercoralis) is a nematode that causes the fatal infection in immune-compromised patients. This infection is highly prevalent in tropical and subtropical regions. This study aimed to study the seroepidemiology of S. stercoralis infection in the population of Qaemshahr city in the North of Iran, where no seroepidemiology study was conducted before. Materials and methodsSampling in this cross-sectional study was performed on the patients referred to Rural Health Centers in Qaemshahr. At the same time, the demographic information of each person were recorded in a questionnaire 615 participants were assessed for the existence of Anti- S. stercoralis antibodies using ELISA diagnostic kit (Novalisa, NovaTec, Germany). ResultsThe study population consisted of 615 individuals (150 males and 465 females). The mean (SD) age of all patients was 46.21 (17.41) years. The percentage of positive cases in women and men was 51.7 and 48.3, respectively. The majority of positive cases were in rural centers of Qarakheil (44.8%). In addition, out of 87 of the positive cases, about 93.1% consumed vegetables, 13.8% cases had abdominal pain, and 72.4% were in touch with soil. None of the cases had GI problems and diarrhea. Age, sex, and rural health center were the variables affecting S. stercoralis infection (p < 0.05). ConclusionThis study can conclude that the nematode of S. stercoralis in Qaemshahr, Mazandaran, has an approximately high prevalence. It seems that the ELISA can be used as a diagnosis method which is an efficient screening method to detect S. stercoralis in suspected patients.

Prevalence of Stronglyoides Stercoralis and Elevated Immunoglobulin E in Patients with Eosinophilia in a New York City Physician's Practice

Background The most common etiology of eosinophilia (EOA) in the United States is allergic disease. Steroid therapy may be advised. Strongyloides stercoralis (Ss) infection is also associated with EOA. Steroids can precipitate Ss hyperinfection syndrome with multi-organ failure. Therefore, Ss should be identified and treated in EOA prior to initiating steroids. Ss is common in the tropics and in the subtropics. While the prevalence of Ss in the U.S. is low (0-6.1%), it is higher in immigrant populations (0-46.1%) (CDC 2014).AIM To determine the prevalence of Ss and elevated immunoglobulin E (IgE) in patients with EOA in a New York City physician's practice with a large Dominican Republic constituent.Methods The ICD10 code D72.1 was used to identify patients with EOA (absolute eosinophil count > 500/uL) seen in the physician's practice between 10/01/15 (inception of ICD10) and 06/30/17. Chart review indicated that the majority of patients had been screened for Ss antibody, fecal ova and parasites (O&P), and elevated IgE (> 114 kU/L).Results Twenty-nine patients had EOA. Thirteen (46%) of 28 patients tested had Ss antibody, 4 (22%) of 18 patients tested had O&P (Blastocystis hominis [Bh]), and 18 (72%) of 25 patients tested had elevated IgE. Ten patients had both Ss antibody and elevated IgE. Ten patients with Ss antibody also had O&P testing, which did not detect Ss. Twelve patients with Ss received ivermectin (1 declined) and all 4 patients with Bh received metronidazole. AEC normalized following treatment in all 9 Ss patients (3 were lost to follow-up) and in all 4 Bh patients restudied.Discussion The high prevalence of elevated IgE in this cohort is consistent with allergic disease being a common etiology of EOA. The high prevalence of Ss in this cohort underscores the importance of testing for Ss in EOA, particularly in immigrant populations. During acute Ss infections, stool larval output is large and O&P yield is high. During chronic Ss infections, immune response and EOA decrease larval production, which diminishes O&P yield; Ss serology should be performed. Diagnosis and treatment of Ss in EOA is essential to avoid clinical deterioration, particularly in patients who may receive steroids. DisclosuresNo relevant conflicts of interest to declare.

Occult strongyloides stercoralis infection masquerading as a drug reaction with eosinophilic pneumonia

Background: Pseudomelanosis or melanosis duodeni is seen in association with drugs, microorganisms or occasional bleeding, usually from peptic ulceration. We present a case of Strongyloides stercoralis presenting as pseudomelanosis duodeni during anemia workup after patient’s initial presentation as eosinophilic pneumonia. Case presentation: The patient is a 77 year-old female with a history of diastolic congestive heart failure, chronic kidney disease, diabetes mellitus, and hypertension who presented for evaluation of black stool. Two months earlier, in her prior admission for acute eosinophilic pneumonitis, the patient’s hematocrit was 26%. In her current admission with heme-positive dark stool on exam, the hematocrit dropped to 19%. The patient underwent esophagogastroduodenoscopy to identify the source of bleeding. The upper endoscopy revealed three non-bleeding ulcers in the gastric antrum and discoloration of the duodenal bulb and second portion of the duodenum. By histology, the duodenal biopsies showed areas of hemosiderin-laden macrophages in the lamina propria, focal helminth eggs and larvae in the crypt lumen with sizes ranging from 35-65 microns x ~20 microns. Polymerase chain reaction of the paraffin embedded tissue with 28S primer set detected Strongyloides stercoralis DNA, confirming the histologic findings. Given the confirmation of Strongyloides stercoralis, the patient’s initial presentation of eosinophilic pneumonia (Loeffler syndrome) may be a result of the parasitic infection or the successful response to steroid treatment for acute eosinophilic pneumonia caused Strongyloidiasis hyperinfection. The patient’s symptoms were improved with Ivermectin and hematocrit level increased to 28%. Conclusions: This case highlights the importance in recognition of helminth infection in the evaluation of eosinophilic pneumonia and pseudomelanosis duodeni. Keywords: Pseudomelanosis duodeni; Strongyloides stercoralis; Eosinophilic pneumonia; polymerase chain reaction.

Control programs for strongyloidiasis in areas of high endemicity: an economic analysis of different approaches

BackgroundImplementation of control programmes for Strongyloides stercoralis infection is among the targets of the World Health Organization Roadmap to 2030. Aim of this work was to evaluate the possible impact in terms of economic resources and health status of two different strategies of preventive chemotherapy (PC) compared to the current situation (strategy A, no PC): administration of ivermectin to school-age children (SAC) and adults (strategy B) versus ivermectin to SAC only (strategy C).MethodsThe study was conducted at the IRCCS Sacro Cuore Don Calabria hospital, Negrar di Valpolicella, Verona, Italy, at the University of Florence, Italy, and at the WHO, Geneva, Switzerland, from May 2020 to April 2021. Data for the model were extracted from literature. A mathematical model was developed in Microsoft Excel to assess the impact of strategies B and C in a standard population of 1 million subjects living in a strongyloidiasis endemic area. In a case base scenario, 15% prevalence of strongyloidiasis was considered; the 3 strategies were then evaluated at different thresholds of prevalence, ranging from 5 to 20%. The results were reported as number of infected subjects, deaths, costs, and Incremental-Effectiveness Ratio (ICER). A 1-year and a 10-year horizons were considered.ResultsIn the case base scenario, cases of infections would reduce dramatically in the first year of implementation of PC with both strategy B and C: from 172 500 cases to 77 040 following strategy B and 146 700 following strategy C. The additional cost per recovered person was United States Dollar (USD) 2.83 and USD 1.13 in strategy B and C, respectively, compared to no treatment in the first year. For both strategies, there was a downtrend in costs per recovered person with increasing prevalence. The number of adverted deaths was larger for strategy B than C, but cost to advert one death was lower for strategy C than B.ConclusionsThis analysis permits to estimate the impact of two PC strategies for the control of strongyloidiasis in terms of costs and adverted infections/deaths. This could represent a basis on which each endemic country can evaluate which strategy can be implemented, based on available funds and national health priorities.

Occurrence of Strongyloides stercoralis in rural areas adjacent to Dhaka city

The present study was designed to investigate Strongyloides stercoralis infection in rural communities of Savar and Gazipur. A total of 160 stool samples were collected from the inhabitants of the study areas during December 2016 to November 2017. The samples were processed by direct smear, formol-ether concentration technique and Harada-Mori culture. The overall prevalence of S. stercoralis was 10.63%; 11% in Savar and 10% in Gazipur. The elderly people were more prone to S. stercoralis infection. No respondent belonging to age group of 11-20 years was found positive for infection. Poor educational status, inferior financial condition and inadequate hygiene practice were found as potential risk factors (P&lt;0.05). Noticeable prevalence was observed among the respondents living in mud floored house (13.46%), irregular nail clippers (22.73%), bare footers (14.89%) and laborers (27.27%) in Savar. Prevalence was high among the respondents deprived of institutional education (17.86%) in Gazipur.&#x0D; Bangladesh J. Zool. 48(2): 313-320, 2020

Efficacy and safety of ascending doses of moxidectin against Strongyloides stercoralis infections in adults: a randomised, parallel-group, single-blinded, placebo-controlled, dose-ranging, phase 2a trial

Strongyloidiasis represents a major public health issue, particularly in resource-limited countries. Preliminary studies suggest that moxidectin might serve as an alternative to the only available treatment option, ivermectin. We aimed to evaluate the efficacy and safety of ascending doses of moxidectin in Strongyloides stercoralis-infected patients. We did a randomised, parallel-group, single-blinded, placebo-controlled, dose-ranging, phase 2a trial in four villages in northern Laos. Eligible adults (aged 18-65 years) with S stercoralis infection intensities of at least 0·4 larvae per g of stool in at least two stool samples were randomly assigned (1:1:1:1:1:1:1) by use of computerised, stratified, block randomisation into seven treatment groups: 2 mg of moxidectin, 4 mg of moxidectin, 6 mg of moxidectin, 8 mg of moxidectin, 10 mg of moxidectin, 12 mg of moxidectin, or placebo. Participants and primary outcome assessors were masked to treatment allocation, but study site investigators were not. Participants received a single oral dose of their allocated dose of moxidectin in 2 mg tablets, or four placebo tablets. Three stool samples were collected at baseline and two stool samples were collected 28 days after treatment from each participant. A Baermann assay was used to quantify S stercoralis infection and Kato-Katz thick smears were used to qualitatively identify coinfections with additional helminths species. The primary endpoint was cure rate against S stercoralis and was analysed in an available case analysis set, defined as all randomly assigned participants with primary endpoint data. Predicted cure rates and associated CIs were estimated with hyperbolic Emax models. Safety was evaluated in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT04056325, and is complete. Between Nov 27, 2019, and March 15, 2020, 785 adults were screened for trial eligibility. Of these, 223 participants were randomly assigned to treatment groups and 209 completed the study and were analysed for the primary outcome. 2 mg of moxidectin had a predicted cure rate of 75% (95% CI 59-87; 22 [73%] of 30 cured) against S stercoralis compared with a predicted cure rate of 14% (5-31; four [14%] of 29 cured) for placebo. With escalating doses, the probability of cure increased from 83% (95% CI 76-88; 26 [90%] of 29 cured) at 4 mg to 86% (79-90; 27 [84%] of 32 cured) at 6 mg, and to 87% (80-92; 24 [83%] of 29 cured) at 8 mg, levelling off at 88% (80-93; 29 [97%] of 30 cured) at 10 mg and 88% (80-93; 26 [87%] of 30 cured) at 12 mg. Moxidectin was well tolerated across all treatment groups, with no serious adverse events being recorded and all reported symptoms being classified as mild. 4-12 mg of moxidectin showed promising tolerability and efficacy profiles in the treatment of S stercoralis infections in adults. Because 8 mg of moxidectin is used for the treatment of onchocerciasis and has been evaluated for other helminth infections, we recommend this dose for phase 2b and phase 3 trials of strongyloidiasis therapy. Fondazione Adiuvare.

Moxidectin: an ally to ivermectin for treating Strongyloides stercoralis?

Strongyloides stercoralis infection has long been neglected by the scientific community, despite the threat it poses to the individual and collective health. 1 Krolewiecki AJ Lammie P Jacobson J et al. A public health response against Strongyloides stercoralis: time to look at soil-transmitted helminthiasis in full. PLoS Negl Trop Dis. 2013; 7e2165 Crossref PubMed Scopus (97) Google Scholar In 2020, WHO included this infection in its public health targets for 2030, 2 Montresor A Mupfasoni D Mikhailov A et al. The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030. PLoS Negl Trop Dis. 2020; 14e0008505 Crossref PubMed Scopus (27) Google Scholar pointing out that control measures for strongyloidiasis are of paramount importance in endemic countries. This target might necessitate the massive use of ivermectin, the only drug, effective in a single dose, that can contribute to decisively decreasing the prevalence of this deadly parasite. 3 Henriquez-Camacho C Gotuzzo E Echevarria J et al. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016; 2016CD007745 Google Scholar Efficacy and safety of ascending doses of moxidectin against Strongyloides stercoralis infections in adults: a randomised, parallel-group, single-blinded, placebo-controlled, dose-ranging, phase 2a trial4–12 mg of moxidectin showed promising tolerability and efficacy profiles in the treatment of S stercoralis infections in adults. Because 8 mg of moxidectin is used for the treatment of onchocerciasis and has been evaluated for other helminth infections, we recommend this dose for phase 2b and phase 3 trials of strongyloidiasis therapy. Full-Text PDF

Seropositivity and geographical distribution of Strongyloides stercoralis in Australia: A study of pathology laboratory data from 2012-2016.

BackgroundThere are no national prevalence studies of Strongyloides stercoralis infection in Australia, although it is known to be endemic in northern Australia and is reported in high risk groups such as immigrants and returned travellers. We aimed to determine the seropositivity (number positive per 100,000 of population and percent positive of those tested) and geographical distribution of S. stercoralis by using data from pathology laboratories.MethodologyWe contacted all seven Australian laboratories that undertake Strongyloides serological (ELISA antibody) testing to request de-identified data from 2012–2016 inclusive. Six responded. One provided positive data only. The number of people positive, number negative and number tested per 100,000 of population (Australian Bureau of Statistics data) were calculated including for each state/territory, each Australian Bureau of Statistics Statistical Area Level 3 (region), and each suburb/town/community/locality. The data was summarized and expressed as maps of Australia and Greater Capital Cities.Principal findingsWe obtained data for 81,777 people who underwent serological testing for Strongyloides infection, 631 of whom were from a laboratory that provided positive data only. Overall, 32 (95% CI: 31, 33) people per 100,000 of population were seropositive, ranging between 23/100,000 (95% CI: 19, 29) (Tasmania) and 489/100,000 population (95%CI: 462, 517) (Northern Territory). Positive cases were detected across all states and territories, with the highest (260-996/100,000 and 17–40% of those tested) in regions across northern Australia, north-east New South Wales and north-west South Australia. Some regions in Greater Capital Cities also had a high seropositivity (112-188/100,000 and 17–20% of those tested). Relatively more males than females tested positive. Relatively more adults than children tested positive. Children were under-represented in the data.Conclusions/SignificanceThe study confirms that substantial numbers of S. stercoralis infections occur in Australia and provides data to inform public health planning.

Prevalence of Strongyloidiasis in a Cohort of Migrants in Italy and Accuracy of a Novel ELISA Assay for S. stercoralis Infection, a Cross-Sectional Study.

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.

Environmental Risk Factors of Hookworm and Strongyloides stercoralis infections among school children in rural areas Kutai Kertanegara Regency, Indonesia.

Background: Hookworm and S. stercoralis are still challenge in public health problem especially in developing countries where have environmental risk factors that are potential for transmitting of hookworm and S. stercoralis in Kutai Kertanegara Regency, East Kalimantan Province, Indonesia have high-risk factors of the prevalence of hookworm and S. stercoralis especially environmental risk factors. Methods: In this study was showed the infection rates, correlation analysis between risk factors, and prevalence of hookworm and S. stercoralis were used statistical analysis. A cross-sectional study was performed among 107 schoolchildren participants from rural schoolchildren of Kutai Kertanegara Regency, Indonesia. This study used two diagnostic methods: Kato Katz and Koga agar plate culture/KAP culture for diagnosing hookworm and Strongyloides infections. Pearson chi-square analysis was used to the study correlation between environmental risk factors with hookworm and S stercoralis infections. Results: Hookworm, and S stercoralis were found in this study; 37 (31.8) and 11 (10.3%) respectively. hookworm infection has been correlated significantly with school location (OR: 1.78 (95%CI: 0.87-3.71, p-value=0.006). While S. stercoralis infection has correlated significantly such as school location (OR: 1.28 (95%CI: 0.73-2.23, (p=0.027), Environmental risk others have not significantly correlated with hookworm infection among school children. While S stercoralis infection has correlated with environmental risk factors such as the texture of soil (OR: 5.50 (95%CI: 0.84-36.01, p-value: 0.010), wet soil surrounding houses (OR: 5.50 (0.84-36.02, p-value: 0.010). School location in surrounding rice field (OR: 5.50 (95%CI: 0.84-36.02, p-value: 0.012). Elevation in hill area (OR: 5.50 (95%CI: 0.84-36.02, p-value: 0.010). Conclusions: This study has explained the determinant of environmental risk factors and the prevalence of hookworm infection and S. stercoralis in schoolchildren. The risk factors should be used for preventing program of reduced prevalence of hookworm and S stercoralis infections in schoolcrildren, especially in rural areas.

Screening of Strongyloides stercoralis infection in high-risk patients in Khuzestan Province, Southwestern Iran

BackgroundStrongyloidiasis, one of the neglected tropical diseases (NTDs), can be fatal in immunocompromised patients. Available data on Strongyloides stercoralis infection in high-risk patients in Iran are limited. The aim of the present study was to determine the prevalence of S. stercoralis infection and associated risk factors among high-risk patients as well as to evaluate the sensitivity of the diagnostic tests used in the diagnose of S. stercoralis infection.MethodsThis cross-sectional study was performed from 2019 to 2020 among 300 high-risk patients in Khuzestan Province, southwestern Iran. Patients with autoimmune diseases, uncontrolled diabetes, HIV/AIDS, cancer, organ transplant, hematological malignancy, asthma and chronic obstructive pulmonary disease (COPD) were examined using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test. Since agar plate culture was considered the reference diagnostic test, culture-positive samples were confirmed by PCR amplification and the sequencing of the nuclear 18S rDNA (SSU) hypervariable region (HVRIV) of the parasite.ResultsThe prevalence of S. stercoralis infection was 1%, 1.3%, 2%, 2.7%, and 8.7% using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test, respectively. All culture-positive samples were confirmed by SSU-PCR. According to the results, the most sensitive test was ELISA, with 100% sensitivity, followed by the Baermann funnel technique with the sensitivity of 75%. Direct smear examination, formalin-ether concentration technique, and Baermann funnel technique had the highest PPV (100%) while the ELISA test had the highest NPV (100%). Significant eosinophilia was observed in the patients whose culture test was positive (7/8; P < 0.05). In the present study, the majority of the positive cases by the agar plate culture had a history of prolonged exposure to soil and of asthma and COPD and were > 60 years old.ConclusionsGiven that the ELISA test had the highest NPV, the screening of all high-risk patients for S. stercoralis infection in endemic areas is recommended prior to starting corticosteroid therapy with the ELISA test. The results indicate the importance of paying attention to patients with unknown eosinophilia in endemic areas. Ivermectin should be available to strongyloidiasis patients in the endemic areas.

Strongyloidiasis in a Puppy in Northeastern Brazil

Background: Strongyloides stercoralis is a nematode that causes intestinal infection in vertebrate hosts, especially in humans and dogs. The species S. stercoralis is responsible for chronic and asymptomatic infections in adult dogs or serious infections in puppies and immunosuppressed animals. In Brazil, natural infection in dogs was demonstrated by coproparasitological and serological methods, however, there are no reports that address the clinicopathological characteristics of the infection in the canine species. Thus, this paper aims to describe the epidemiological, clinical and pathological aspects of S. stercoralis infection in a puppy in Northeastern Brazil.Case: A puppy female Chihuahua was referred to the Animal Pathology Laboratory of the Veterinary Hospital of the Federal University of Campina Grande for necropsy with a historic of severe respiratory symptoms and gastrointestinal changes that included sanguineous diarrhea and vomiting that evolved to death in 5 days. Grossly, there was a moderate amount of slightly reddish fluid in the thoracic cavity. The lungs remained expanded with a smooth, shiny, and diffusely reddish pleural surface interspersed with multifocal and blackened coalescent areas. Upon cutting, a moderate amount of slightly yellow foamy liquid flowed from the airways and trachea. In the duodenum, the mucosa was diffusely reddened. Histologically, there were multifocal to coalescent areas of moderate interalveolar accumulation of fibrin, edema and hemorrhage in the lung surrounded by an inflammatory infiltrate composed of foamy macrophages associated with numerous parasitic structures in longitudinal and transverse sections in the alveolar lumen and pleural surface. In the duodenum, we observed flattening with diffuse and moderate fusion of the villi and multifocal areas of mucosal erosion. The crypts were moderately dilated, covered by attenuated epithelium, with numerous longitudinal and transversal sections of adult nematode parasites, larvae and eggs associated with inflammatory lymphplasmocytic infiltrate in the lamina propria. The morphological characteristics were compatible with the nematode S. stercoralis.Discussion: The diagnosis of strongyloidiasis was performed by means of microscopic lesions associated with parasitic structures morphologically compatible with the nematode S. stercoralis. This species is responsible for parasitism especially in humans, dogs, and cats. Parasites are the only ones that have a life cycle that involve free living form and parasitic. In this case, it was not possible to determine the primary portal of entry for the infection, but most infections commonly occur through the penetration of the larvae into the skin or mucous membranes, where they migrate via the haematogenous to the lung, then they are swallowed up to the intestine. Occasionally, there is autoinfection by larvae that enter the intestinal mucosa or perianal region and the contamination of neonates and puppies through the ingestion of milk. The clinical signs evidenced in this case, revealed the committed respiratory and gastrointestinal, possibly may be related to the migration of the larvae in the lungs and the destruction of the intestinal epithelium caused by the high number of parasites, respectively. It is concluded that strongyloidiasis is an uncommon infectious disease in puppies in Brazil, capable of causing severe respiratory and gastrointestinal changes that result in the death of animals with a high parasitic load and should be included in the differential diagnosis of diseases that affect the respiratory system and gastrointestinal tract of dogs.Keywords: dog disease, parasitic infection, nematode, Strongyloides stercoralis.

Agar Plate Culture: An Alternative Sensitive Routine Laboratory Detection Method for Strongyloides stercoralis and Hookworm Parasites.

Background:Human infection with Strongyloides stercoralis and hookworm parasites is usually under reported due to less sensitive diagnostic methods. Agar plate culture (APC) is the most sensitive technique for parasites having larval stage. However, using APC in routine diagnosis is uncommon. This study aimed to determine the detection rate and sensitivity of APC in comparison with formal ether concentration technique (FECT) and spontaneous tube sedimentation techniques (STSTs) for S. stercoralis and hookworm larvae.Methods:Stool samples collected from 844 schoolchildren in Amhara Regional State, northwestern Ethiopia in 2019, transported to nearby health institutions and processed by APC, FECT and STSTs. The prevalence of S. stercoralis and hookworm was computed by descriptive statistics and Chi-square. The diagnostic agreement among the three techniques was evaluated using Kappa value.Results:The overall prevalence of S. stercoralis and hookworm infections by combining the three methods was 13.2% (111/844) and 33.8% (277/844), respectively. Using APC alone, the prevalence of S. stercoralis and hookworm were found to be 10.9% (92/844) and 24.5% (207/844), respectively. Agar plate culture was 5.4 and 2.7 times respectively more sensitive than FECT and STST, with slight and fair agreement in the detection of S. stercoralis. Hookworm diagnostic agreement was moderate between APC and FECT, and APC and STST. The Kappa value between STST and FECT diagnostic methods was substantial.Conclusion:APC has a better detection rate of S stercoralis and hookworm larvae. Therefore, APC can be used as an alternative routine diagnostic method to S. stercoralis and hookworm co-endemic countries.

Intestinal parasitic infections and risk factors among Myanmar migrant workers in northeast Thailand

Objective: To determine the prevalence and associated factors of intestinal parasitic infections in migrant workers in Nakhon Ratchasima Province, Northeast Thailand. Methods: A cross-sectional study was conducted from August 2017 to July 2018 in 600 Myanmar migrant workers. Questionnaires were employed for collecting the demographic data of participants. Stool samples were collected and examined using the formalin-ether concentration technique. Risk factors for intestinal parasitic infections were determined using multiple logistic regressions analyses. Results: The overall infection rate of intestinal parasitic infections was 27.67% (166/600). Among the intestinal helminthes observed, hookworm was most abundant (8.67%) followed by Trichuris trichiura (8.50%), Opisthorchis viverrini(4.17%), Ascaris lumbricoides(1.50%), Strogyloides stercoralis(1.17%) and Hymenolepis nana(0.5%). Meanwhile, Entamoeba coli was the most prevalent intestinal protozoa (4.33%, 26/600) followed by Endolimax nana (1.33%), Entamoeba histolytica complex (1.17%), Blastocystis sp. (1.0%) and Giardia duodenalis (0.17%). The study found significant associations between gender and Strogyloides stercoralis infection (ORadj=5.61, 95% CI=1.18–26.70, P=0.03), workers aged 30 years old were likely to have a lower risk of the T. trichiura infection (ORadj=0.45, 95% CI= 0.23–0.89). Moreover, the history of consuming raw or undercooked cyprinoid fish was a risk factor of Opisthorchis viverrini infection (ORadj=2.82, 95% CI=1.22–6.49, P=0.015). Conclusions: There remains a high prevalence of intestinal parasitic infections among Myanmar migrant workers in the study area and therefore health screenings for all migrant workers in Thailand are required.

Prevalence, risk factors and health consequences of soil-transmitted helminth infection on the Bijagos Islands, Guinea Bissau: A community-wide cross-sectional study.

Soil-transmitted helminths (STH) are endemic and widespread across Sub-Saharan Africa. A community wide soil-transmitted helminth (STH) prevalence survey was performed on the island of Bubaque in Guinea-Bissau using both Kato-katz microscopy and qPCR methodology. Predictors of infection and morbidity indicators were identified using multivariable logistic regression, and diagnostic methods were compared using k statistics. Among 396 participants, prevalence of STH by microscopy was 23.2%, hookworm was the only species identified by this method and the mean infection intensity was 312 eggs per gram. qPCR analysis revealed an overall prevalence of any STH infection of 47.3%, with the majority A. duodenale (32.3%), followed by N. americanus (15.01%) and S. stercoralis (13.2%). A. lumbricoides, and T. trichiura infections were negligible, with a prevalence of 0.25% each. Agreement between diagnostic tests was k = 0.22, interpreted as fair agreement, and infection intensity measured by both methods was only minimally correlated (Rs = -0.03). STH infection overall was more common in females and adults aged 31–40. STH infection was associated with open defaecation, low socio-economic status and further distance to a water-source. The prevalence of anaemia (defined as a binary outcome by the WHO standards for age and sex) was 69.1%, and 44.2% of children were malnourished according to WHO child growth standards. Hookworm infection intensity by faecal egg count showed no statistically significant association with age (Rs 0.06) but S. Stercoralis infection intensity by qPCR cycle threshold was higher in pre-school aged children (Rs = 0.30, p-value 0.03) There was no statistically significant association between STH infection and anaemia (OR 1.0 p = 0.8), stunting (OR 1.9, p-value 0.5) and wasting (OR 2.0, p-value 0.2) in children. This study reveals a persistent reservoir of STH infection across the community, with high rates of anaemia and malnutrition, despite high-coverage of mebendazole mass-drug administration in pre-school children. This reflects the need for a new strategy to soil-transmitted helminth control, to reduce infections and ultimately eliminate transmission.

Correlation of Nutritional Status with Hookworm and Strongyloides stercoralis Infection in Children Under Five Years in Kokar Public Health Center, Alor Regency, East Nusa Tenggara

Malnutrition can reduce immune response particularly in cytokine (IL-4, IL-5, IL-10) production and immune effector (eosinophil, IgE, and mast cell), thus increasing the probability of intestinal nematode infection. Through this study, intestinal nematode infections occurred among children under five years, at different nutrition status, in Kokar Public Health center, Alor Regency, East Nusa Tenggara was captured. Hookworm and Strongyloides stercoralis were studied as both of them have devastating impacts compare to other helminthes compare to other helminths. This study is a cross- sectional study with a quote sampling technique. As many as 238 children, aged 12-59 months living in Kokar’s Public Health Center area, Alor regency were recruited in this study i.e. 7.7% severely underweight, 19.2% underweight, 70.5% normal and 2.6% overweight. Data were collected in August - October 2016. Hookworm and S. stercoralis infection were determined from collected fecal samples of all subjects using either Baermann test, Koga Agar Plate (KAP), or Harada- Mori culture method. The prevalence of hookworm and S. stercoralis infection was 8.82%, and 0,42%. Correlation between nutritional status and hookworm infection were analyzed by Mann-Whitney test with p value = 0.54 (p &gt; 0.05). Prevalence of hookworm and S. stercoralis among children under five years in Kokar were 8.82% and 0.42%. There was no significant correlation between nutritional status with hookworm infection prevalence.

Hotspots and correlates of soil-transmitted helminth infections in a Venezuelan rural community: Which are the “wormy” houses?

ObjectivesTo determine spatial clustering and risk factors for occurrence and intensity of infection for soil-transmitted helminthiasis (STH), namely Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis and hookworms in a Venezuelan rural community. MethodsMIF-fixed faecal samples were individually collected for STH testing. The Getis–Ord statistic was used to determine significant STH clustering within 25/50/100 m radiuses around houses. Individual- and house-level factors associated with STH occurrence and intensity of infection were determined using generalized estimating equations. ResultsSignificant clusters of “wormy” houses for one or multiple parasites were found at distances of 25–50 m around 13 houses. Risk factors differed between occurrence and intensity of infection. Overcrowding in the house increased occurrence of S. stercoralis, T. trichiura and hookworm infections, while poor housing conditions increased A. lumbricoides infection risk. Overcrowding, poor faecal disposal system, economic dependency and lack of basic services differentially influenced the STHs. The “wormy” houses were mainly those built with waste materials, under economic dependency and lacking indoor water supply. ConclusionsSTH distribution in a community is clustered, with significant hotspots of STH occurrence and intensity of infection and different associated risk factors. Targeting the “wormy” houses is expected to affect STH morbidity more efficiently.