Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
PLoS Negl Trop Dis. 2019 Jan 17;13(1):e0007028. doi: 10.1371/journal.pntd.0007028. eCollection 2019 Jan.
Strongyloidiasis can be fatal in immunocompromised patients, but few epidemiological studies investigated the burden of this neglected tropical disease among these populations, particularly in low- and middle-income countries such as Bolivia. This study aimed to fill in this gap by estimating prevalence rate and risk factors associated with strongyloidiasis among patients at high risk of complications.
A cross-sectional study was carried out in Santa Cruz (elevation 400 meters, tropical climate) and Cochabamba (elevation 2,500 meters, temperate climate), among patients with cancer, HIV infection and rheumatic or hematologic disease, using four coproparasitological techniques and one serological (ELISA) test.
In total, 1,151 patients participated in this study, including individuals who were HIV-positive (30%) or with rheumatic (29%), oncologic (32%) or hematologic (9%) diseases. The serological and coproparasitological prevalence was 23.0% (95% confidence interval [CI], 20.7-25.5; n = 265/1151) and 7.6% (95% CI, 6.2-9.3; n = 88/1151), respectively, with an estimated actual prevalence of 20.2% (95% CI, 17.9-22.5). Positive serology and positive coproparasitology were associated with younger age and lower education levels. There was no significant difference in prevalence between Cochabamba and Santa Cruz as defined by coproparasitology (6.4% vs. 8.9%; p = 0.11) or serology (24.0% vs. 22.0%; p = 0.4). Among 64 patients in Cochabamba who had never travelled to the tropical lowlands, 5 (7.8%) had a positive coproparasitology.
Strongyloidiasis is widely prevalent in Bolivia among vulnerable patients at increased risk of life-threatening complications. Transmission of the parasite occurs both in tropical lowlands and temperate elevation (≥ 2,500 m). Control strategies to prevent transmission and complications of this serious parasitic disease should be urgently reinforced.
在免疫功能低下的患者中，类圆线虫病可能是致命的，但很少有流行病学研究调查这种被忽视的热带病在这些人群中的负担，特别是在玻利维亚等中低收入国家。本研究旨在通过估计高危并发症患者中类圆线虫病的患病率和相关危险因素来填补这一空白。
在圣克鲁斯（海拔 400 米，热带气候）和科恰班巴（海拔 2500 米，温带气候）进行了一项横断面研究，研究对象为癌症、艾滋病毒感染以及风湿或血液疾病患者，使用了四种粪便寄生虫学技术和一种血清学（ELISA）检测。
共有 1151 名患者参与了这项研究，其中包括艾滋病毒阳性患者（30%）或患有风湿性疾病（29%）、肿瘤（32%）或血液疾病（9%）的患者。血清学和粪便寄生虫学的患病率分别为 23.0%（95%置信区间[CI]，20.7-25.5；n=265/1151）和 7.6%（95%CI，6.2-9.3；n=88/1151），估计实际患病率为 20.2%（95%CI，17.9-22.5）。阳性血清学和阳性粪便寄生虫学与年龄较小和教育水平较低有关。根据粪便寄生虫学（6.4%对 8.9%；p=0.11）或血清学（24.0%对 22.0%；p=0.4），科恰班巴和圣克鲁斯的患病率没有显著差异。在从未前往热带低地的 64 名科恰班巴患者中，有 5 名（7.8%）粪便寄生虫学检测阳性。
在玻利维亚，脆弱的高危患者中类圆线虫病广泛流行，可能导致危及生命的并发症。寄生虫的传播既发生在热带低地，也发生在温带高地（≥2500 米）。应紧急加强控制策略，以预防这种严重寄生虫病的传播和并发症。
