Infectious Diseases Department, Royal Darwin Hospital, Northern Territory, Australia.
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Intern Med J. 2021 Aug;51(8):1286-1291. doi: 10.1111/imj.14884.
Strongyloides stercoralis is a soil-transmitted helminth, endemic 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.
To measure the prevalence of symptoms potentially attributable to S. stercoralis infection and their association with seropositivity.
This retrospective matched case-control study reviewed records of primary healthcare presentations for symptoms in the 12 months before and after an ivermectin mass drug administration (MDA) in a remote Aboriginal community.
One hundred and seventy-five S. stercoralis seropositive cases were matched with 175 seronegative controls. The most frequently reported symptom overall in the 12 months prior to the MDA was cough followed by abdominal pain, weight loss/malnutrition, diarrhoea and pruritis. Seropositive cases were not more likely than matched controls to have symptoms typically attributed to strongyloidiasis. In the seropositive cohort, we found no difference in symptoms in the 12 months before and after an ivermectin MDA despite a reduction in seroprevalence.
We found no evidence to suggest that S. stercoralis seropositivity was associated with increased symptoms when compared to matched seronegative controls. Treatment with ivermectin did not reduce symptoms in seropositive cases. Without evidence to support that population-based screening or treatment programmes reduce symptoms, the emphasis must remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life-threatening hyperinfection.
粪类圆线虫是一种土壤传播的蠕虫，在澳大利亚北部偏远的原住民和托雷斯海峡岛民社区流行，患病率高达 60%。免疫抑制患者的重度感染是一种罕见但已被广泛认识的严重疾病和死亡原因。然而，慢性无症状感染相关的发病率尚未得到充分描述。
测量可能与粪类圆线虫感染相关的症状的患病率，并分析其与血清阳性的关系。
这项回顾性病例对照研究，对在偏远原住民社区进行伊维菌素群体药物治疗（MDA）前后 12 个月内，因症状而在初级保健机构就诊的记录进行了回顾。
175 例粪类圆线虫血清阳性病例与 175 例血清阴性对照相匹配。在 MDA 前 12 个月，报告的最常见症状是咳嗽，其次是腹痛、体重减轻/营养不良、腹泻和瘙痒。血清阳性病例出现通常归因于类圆线虫病的症状的可能性并不比匹配的对照组更高。在血清阳性队列中，尽管血清阳性率有所下降，但在伊维菌素 MDA 前后的 12 个月内，我们没有发现症状有任何差异。
与匹配的血清阴性对照组相比，我们没有发现粪类圆线虫血清阳性与症状增加有关的证据。伊维菌素治疗并未减轻血清阳性病例的症状。如果没有证据表明基于人群的筛查或治疗方案可以减轻症状，那么重点必须放在识别和管理那些少数存在免疫抑制的个体，这些个体容易发生潜在危及生命的重度感染。
