Strongyloidiasis is caused by Strongyloides stercoralis, an
intestinal nematode. It is usually acquired by walking barefoot
on infested soil, and is an endemic infection in the tropics and
subtropics. The worldwide prevalence is estimated at between 3
million and 100 million. Autochthonous cases have been reported
in Spain, mainly in the Mediterranean area, but data from cases
in immigrants and travelers are scarce. Other foci in Europe
have also been reported.
Strongyloidiasis is one of the most difficult parasitic diseases to
diagnose, because there is no gold standard for this purpose. It can be suspected in symptomatic patients with digestive, respiratory,
or cutaneous complaints; however asymptomatic eosinophilia and
even ‘silent’ infections have also been described. Traditional
diagnostic methods are based on the visualization of S. stercoralis in
stools and the demonstration of antibodies by serology, but the
sensitivity and specificity can vary in different groups of patients.
Hyperinfection and disseminated infections can be fatal in
immunosuppressed patients (transplant recipients and those on
corticosteroid treatment). Focusing on HIV infection, the preva-
lence of this co-infection is variable; the most frequently
manifested symptoms are chronic diarrhea, fever, cough, and
unintentional weight loss. S. stercoralis in persons infected with
human T-cell lymphotropic virus type 1 (HTLV-1) is highly
associated with parasite dissemination and the development of
severe strongyloidiasis. These co-infected patients have a modified
immunological responses against parasite antigens.
Several questions remain to be answered related to imported
strongyloidiasis. How common is strongyloidiasis linked to travel?
What countries are the main sources of infection? Should travelers
and immigrants be tested routinely for strongyloidiasis? The main objective of this study was to assess the epidemiological,
laboratory, and clinical features of imported strongyloidiasis in a
tropical medicine referral unit in Madrid. Other goals were to
describe the diagnosis method and to evaluate the differences
between two groups: immunocompetent and immunosuppressed
patients.
Strongyloidiasis is caused by Strongyloides stercoralis, an
intestinal nematode. It is usually acquired by walking barefoot
on infested soil, and is an endemic infection in the tropics and
subtropics. The worldwide prevalence is estimated at between 3
million and 100 million. Autochthonous cases have been reported
in Spain, mainly in the Mediterranean area, but data from cases
in immigrants and travelers are scarce. Other foci in Europe
have also been reported.
Strongyloidiasis is one of the most difficult parasitic diseases to
diagnose, because there is no gold standard for this purpose. It can be suspected in symptomatic patients with digestive, respiratory,
or cutaneous complaints; however asymptomatic eosinophilia and
even ‘silent’ infections have also been described. Traditional
diagnostic methods are based on the visualization of S. stercoralis in
stools and the demonstration of antibodies by serology, but the
sensitivity and specificity can vary in different groups of patients.
Hyperinfection and disseminated infections can be fatal in
immunosuppressed patients (transplant recipients and those on
corticosteroid treatment). Focusing on HIV infection, the preva-
lence of this co-infection is variable; the most frequently
manifested symptoms are chronic diarrhea, fever, cough, and
unintentional weight loss. S. stercoralis in persons infected with
human T-cell lymphotropic virus type 1 (HTLV-1) is highly
associated with parasite dissemination and the development of
severe strongyloidiasis. These co-infected patients have a modified
immunological responses against parasite antigens.
Several questions remain to be answered related to imported
strongyloidiasis. How common is strongyloidiasis linked to travel?
What countries are the main sources of infection? Should travelers
and immigrants be tested routinely for strongyloidiasis? The main objective of this study was to assess the epidemiological,
laboratory, and clinical features of imported strongyloidiasis in a
tropical medicine referral unit in Madrid. Other goals were to
describe the diagnosis method and to evaluate the differences
between two groups: immunocompetent and immunosuppressed
patients.
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