Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta, Oran, Argentina.
PLoS Negl Trop Dis. 2013 May 9;7(5):e2165. doi: 10.1371/journal.pntd.0002165. Print 2013.
Strongyloides stercoralis infections have a worldwide distribution with a global burden in terms of prevalence and morbidity that is largely ignored. A public health response against soil-transmitted helminth (STH) infections should broaden the strategy to include S. stercoralis and overcome the epidemiological, diagnostic, and therapeutic challenges that this parasite poses in comparison to Ascaris lumbricoides, Trichuris trichiura, and hookworms. The relatively poor sensitivity of single stool evaluations, which is further lowered when quantitative techniques aimed at detecting eggs are used, also complicates morbidity evaluations and adequate drug efficacy measurements, since S. stercoralis is eliminated in stools in a larval stage. Specific stool techniques for the detection of larvae of S. stercoralis, like Baermann's and Koga's agar plate, despite superiority over direct techniques are still suboptimal. New serologies using recombinant antigens and molecular-based techniques offer new hopes in those areas. The use of ivermectin rather than benzimidazoles for its treatment and the need to have curative regimens rather than lowering the parasite burden are also unique for S. stercoralis in comparison to the other STH due to its life cycle, which allows reproduction and amplification of the worm burden within the human host. The potential impact on STH of the benzimidazoles/ivermectin combinations, already used for control/elimination of lymphatic filariasis, should be further evaluated in public health settings. While waiting for more effective single-dose drug regimens and new sensitive diagnostics, the evidence and the tools already available warrant the planning of a common platform for STH and S. stercoralis control.
全世界都有鞭虫感染，其流行率和发病率带来的全球负担在很大程度上被忽视了。针对土壤传播性蠕虫（STH）感染的公共卫生应对措施应扩大策略范围，将鞭虫包括在内，并克服与蛔虫、鞭虫和钩虫相比，该寄生虫在流行病学、诊断和治疗方面带来的挑战。单次粪便评估的敏感性相对较差，当使用旨在检测虫卵的定量技术时，这种敏感性会进一步降低，这也使发病率评估和充分的药物疗效测量变得复杂，因为鞭虫在粪便中以幼虫阶段被消除。用于检测鞭虫幼虫的特定粪便技术，如贝曼氏和小川琼脂平板，尽管优于直接技术，但仍不够理想。使用重组抗原和基于分子的新技术的新血清学检测方法在这些领域带来了新的希望。与其他 STH 相比，由于其生命周期允许在人体宿主内繁殖和增加虫体负担，因此伊维菌素而非苯并咪唑类药物用于治疗以及需要有治愈方案而不是降低寄生虫负担也是鞭虫的独特之处。已经用于控制/消除淋巴丝虫病的苯并咪唑类药物/伊维菌素联合用药对 STH 的潜在影响应在公共卫生环境中进一步评估。在等待更有效、单剂量的药物治疗方案和新的敏感诊断方法的同时，现有的证据和工具证明有必要为 STH 和鞭虫控制规划一个共同的平台。
