Johnston Fay H, Morris Peter S, Speare Richard, McCarthy James, Currie Bart, Ewald Dan, Page Wendy, Dempsey Karen
Centre for Remote Health, Northern Territory, Australia.
Aust J Rural Health. 2005 Aug;13(4):247-54. doi: 10.1111/j.1440-1584.2005.00710.x.
To summarise the available evidence concerning the prevalence, clinical manifestations, diagnosis and management of strongyloidiasis in Northern Australia.
We searched Medline, Clinical Evidence and the Cochrane Library using MeSH terms and text words 'strongyloides OR strongyloidiasis'. For Australian studies we included text words '(parasite* OR parasitic OR helminth*) AND Australia*'. We examined references contained in retrieved studies or identified from direct contact with researchers. Studies consistent with our objective that described their methods were eligible for inclusion.
The prevalence in some tropical Aboriginal communities is high. Infection can be asymptomatic, cause a range of clinical syndromes or death. It may become chronic. Infected patients are at risk of developing severe disseminated disease particularly with immune compromise. There is little information about the relative frequency of different clinical outcomes. Available diagnostic tools are imperfect. Stool examination has a low sensitivity. Serology may have a low specificity in high prevalence populations and has not been evaluated in Aboriginal populations. Antihelmintic drugs are relatively safe and effective. Community programs based on treatment of stool-positive cases have been associated with a reduced prevalence of strongyloidiasis. We found no studies examining alternative public health interventions.
There is a high prevalence in many Aboriginal communities. Strongyloides infection should be excluded prior to commencing immunosuppressive therapies in patients from endemic areas. Further studies examining the public health impact of strongyloidiasis, the role of the enzyme-linked immuno-sorbent assay serological test and population-based approaches to management of the disease in endemically infected Australian populations are needed.
总结有关澳大利亚北部地区类圆线虫病的患病率、临床表现、诊断及管理的现有证据。
我们使用医学主题词（MeSH）及文本词“类圆线虫属或类圆线虫病”检索了医学文献数据库（Medline）、临床证据数据库（Clinical Evidence）和考科蓝图书馆（Cochrane Library）。对于澳大利亚的研究，我们纳入文本词“（寄生虫或寄生的或蠕虫）和澳大利亚*”。我们查阅了检索到的研究中包含的参考文献，或通过与研究人员直接联系确定的参考文献。符合我们的目标且描述了其方法的研究有资格纳入。
在一些热带原住民社区患病率很高。感染可能无症状，可导致一系列临床综合征或死亡，也可能转为慢性。感染患者有发生严重播散性疾病的风险，尤其是在免疫功能低下时。关于不同临床结局的相对频率信息很少。现有的诊断工具并不完善。粪便检查敏感性低。血清学检测在高患病率人群中特异性可能较低，且尚未在原住民人群中进行评估。抗蠕虫药物相对安全有效。基于对粪便阳性病例进行治疗的社区项目与类圆线虫病患病率降低有关。我们未发现研究其他公共卫生干预措施的研究。
许多原住民社区患病率很高。对于来自流行地区的患者，在开始免疫抑制治疗前应排除类圆线虫感染。需要进一步研究类圆线虫病对公共卫生的影响、酶联免疫吸附试验血清学检测的作用以及在澳大利亚地方性感染人群中基于人群的疾病管理方法。
