Lynn Mary K, Morrissey Josephine A, Conserve Donaldson F
Laboratory of Vector-Borne and Zoonotic Diseases, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC USA.
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA.
Curr Trop Med Rep. 2021;8(1):32-42. doi: 10.1007/s40475-020-00221-2. Epub 2021 Jan 30.
The aim of this review is to present a comprehensive look at five intestinal soil-transmitted helminths (STHs) of global health importance that may continue to plague low-income and rural areas of the USA and argue the need for enhanced surveillance of these infections, which primarily affect the nation's most vulnerable groups.
Human STH infections in middle- and high-income countries are at particular risk for being undiagnosed; as common symptoms are non-specific, differentials require a high index of clinical suspicion, and cases are concentrated in areas of poverty where access to care is limited. Although autochthonous STHs are thought to be rare in the USA, infections were once common in the American South and Appalachia and robust epidemiologic surveillance is limited post 1980s. However, recent community studies and case reports from small-scale farms and areas of high rural or inner-city poverty reveal the potential for persisting helminth infections in distinct populations of the country.
STHs are among the most common neglected tropical diseases globally causing significant morbidity in underserved communities and contributing to the continuation of cycles of poverty within vulnerable populations. Due to possible severe disease sequalae and their ability to perpetuate poverty and poverty-associated health outcomes within already vulnerable groups, it is vital that surveillance for these infections is enhanced to bolster health equity in the USA.
本综述旨在全面审视对全球健康具有重要意义的五种肠道土源性蠕虫，这些蠕虫可能继续困扰美国的低收入和农村地区，并论证加强对这些感染进行监测的必要性，因为这些感染主要影响美国最脆弱的群体。
中高收入国家的人体土源性蠕虫感染尤其容易被漏诊；由于常见症状不具特异性，鉴别诊断需要高度的临床怀疑，而且病例集中在医疗服务受限的贫困地区。虽然在美国本土土源性蠕虫被认为较为罕见，但这类感染曾在美国南部和阿巴拉契亚地区很常见，且20世纪80年代后强有力的流行病学监测有限。然而，最近来自小规模农场以及农村或城市贫困高发地区的社区研究和病例报告显示，在美国不同人群中存在持续性蠕虫感染的可能性。
土源性蠕虫是全球最常见的被忽视的热带病之一，在医疗服务不足的社区造成严重发病，并导致弱势群体的贫困循环持续存在。由于可能出现严重的疾病后遗症，以及它们在本已脆弱的群体中使贫困及与贫困相关的健康后果持续存在的能力，加强对这些感染的监测对于促进美国的健康公平至关重要。
