Morbidity associated with strongyloides seropositivity: A retrospective case-control study in remote northern Australia

Morbidity associated with strongyloides seropositivity: A retrospective case-control study in remote northern Australia Journal Article

Internal Medicine Journal

• Author(s): Hansen, Martin, Kearns, Therese, Currie, Bart
• Published: 2020
• Volume: 50
• ISBN: 1444-0903

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Abstract: Background: Strongyloides stercoralis is a soil-transmitted helminth, hyperendemic 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, including in the remote Aboriginal community context. Aim: To determine the morbidity associated with Strongyloides seropositivity in a hyperendemic remote community. Methods: This retrospective case-control study measured the prevalence of symptoms potentially attributable to Strongyloides infection and their association with seropositivity. Records of primary healthcare presentations were reviewed for symptoms in the 12 months before and after an anti-helminth mass drug administration (MDA) in a remote Australian Aboriginal community. Conditional logistic regression was used to determine whether symptoms in the 12 months prior to MDA were associated with Strongyloides seropositivity. McNemar's test was then used to compare the prevalence of symptoms within the seropositive group before and after the MDA to assess whether treatment had any effect. Results: One hundred and seventy-five Strongyloides seropositive cases were matched with 175 seronegative controls. The prevalence of cough (16% vs 23%), abdominal pain (5% vs 6%), weight loss/malnutrition (4% vs 4%) diarrhoea (3% vs 3%) and urticaria (2% vs 3%) were similar among cases and controls. There was no association between Strongyloides seropositivity and any symptom. Among seropositive participants, the prevalence of symptoms was not reduced after MDA despite a reduction in seroprevalence from 21% to 5%. Conclusion: Within the limits of this investigation, Strongyloides seropositivity does not appear to be associated with significant morbidity in this population. There is no evidence to support population-based screening or treatment programs to reduce morbidity in the general community population. Emphasis must still remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life-threatening hyperinfection.

• Urls: https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.1_14846