Department of Medicine, The University of Calgary, Calgary, Alberta, Canada.
Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada.
BMC Infect Dis. 2020 Jan 28;20(1):76. doi: 10.1186/s12879-020-4779-4.
Following migration from Schistosoma and Strongyloides endemic to non-endemic regions, people remain at high risk for adverse sequelae from these chronic infections. HIV co-infected persons are particularly vulnerable to the serious and potentially fatal consequences of untreated helminth infection. While general screening guidelines exist for parasitic infection screening in immigrant populations, they remain silent on HIV positive populations. This study assessed the seroprevalence, epidemiology and laboratory characteristics of these two parasitic infections in a non-endemic setting in an immigrant/refugee HIV positive community.
Between February 2015 and 2018 individuals born outside of Canada receiving care at the centralized HIV clinic serving southern Alberta, Canada were screened by serology and direct stool analysis for schistosomiasis and strongyloidiasis. Canadian born persons with travel-based exposure risk factors were also screened. Epidemiologic and laboratory values were analyzed using bivariate logistic regression. We assessed the screening utility of serology, direct stool analysis, eosinophilia and hematuria.
253 HIV positive participants were screened. The prevalence of positive serology for Schistosoma and Strongyloides was 19.9 and 4.4%, respectively. Age between 40 and 50 years (OR 2.50, 95% CI 1.13-5.50), refugee status (3.55, 1.72-7.33), country of origin within Africa (6.15, 2.44-18.60), eosinophilia (3.56, 1.25-10.16) and CD4 count < 200 cells/mm (2.46, 1.02-5.92) were associated with positive Schistosoma serology. Eosinophilia (11.31, 2.03-58.94) was associated with positive Strongyloides serology. No Schistosoma or Strongyloides parasites were identified by direct stool microscopy. Eosinophilia had poor sensitivity for identification of positive serology. Hematuria was not associated with positive Schistosoma serology.
Positive Schistosoma and Strongyloides serology was common in this migrant HIV positive population receiving HIV care in Southern Alberta. This supports the value of routine parasitic screening as part of standard HIV care in non-endemic areas. Given the high morbidity and mortality in this relatively immunosuppressed population, especially for Strongyloides infection, screening should include both serologic and direct parasitological tests. Eosinophilia and hematuria should not be used for Schistosoma and Strongyloides serologic screening in HIV positive migrants in non-endemic settings.
移民到非流行地区的血吸虫和类圆线虫后，人们仍然面临这些慢性感染的不良后果的高风险。HIV 合并感染者特别容易受到未治疗的寄生虫感染的严重和潜在致命后果的影响。虽然存在针对移民人群寄生虫感染筛查的一般筛查指南，但它们对 HIV 阳性人群仍保持沉默。本研究评估了在一个非流行环境中移民/难民 HIV 阳性人群中这两种寄生虫感染的血清流行率、流行病学和实验室特征。
2015 年 2 月至 2018 年，在加拿大艾伯塔省南部为接受集中 HIV 护理的非加拿大出生的个体通过血清学和直接粪便分析筛查血吸虫病和类圆线虫病。还对有旅行相关暴露危险因素的加拿大出生的个体进行了筛查。使用双变量逻辑回归分析流行病学和实验室值。我们评估了血清学、直接粪便分析、嗜酸性粒细胞增多症和血尿的筛查效用。
共筛查了 253 名 HIV 阳性参与者。血吸虫和类圆线虫阳性血清学的患病率分别为 19.9%和 4.4%。40 至 50 岁年龄组（OR 2.50，95%CI 1.13-5.50）、难民身份（3.55，1.72-7.33）、原籍国在非洲（6.15，2.44-18.60）、嗜酸性粒细胞增多症（3.56，1.25-10.16）和 CD4 计数<200 个细胞/mm（2.46，1.02-5.92）与血吸虫血清学阳性相关。嗜酸性粒细胞增多症（11.31，2.03-58.94）与类圆线虫血清学阳性相关。直接粪便显微镜检查未发现血吸虫或类圆线虫寄生虫。嗜酸性粒细胞增多症对阳性血清学的敏感性较差。血尿与血吸虫血清学阳性无关。
在艾伯塔省南部接受 HIV 护理的移民 HIV 阳性人群中，血吸虫和类圆线虫的阳性血清学很常见。这支持在非流行地区将常规寄生虫筛查作为标准 HIV 护理的一部分的价值。鉴于在这个相对免疫抑制的人群中，尤其是类圆线虫感染的发病率和死亡率较高，筛查应包括血清学和直接寄生虫学检查。在非流行地区的 HIV 阳性移民中，嗜酸性粒细胞增多症和血尿不应用于血吸虫和类圆线虫的血清学筛查。
