Otero-Rodriguez Silvia, Casapia-Morales Martin, Pinedo-Cancino Viviana, Mego-Campos Seyer, Villacorta-Pezo Victoria-Ysabel, Parráguez-de-la-Cruz Jorge, Clark Eva H, Merino Esperanza, Ramos-Rincon Jose-Manuel
Infectious Diseases Unit, Alicante General University Hospital, Alicante, Spain.
Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
PLoS Negl Trop Dis. 2025 Jul 15;19(7):e0013231. doi: 10.1371/journal.pntd.0013231. eCollection 2025 Jul.
Strongyloidiasis is an important but underdiagnosed soil-transmitted helminthiasis, particularly in tropical areas and some vulnerable groups.
To assess the parasitological prevalence, seroprevalence and sociodemographic factors of Strongyloides stercoralis infection in patients living with human immunodeficiency virus (PLWH) in an endemic area.
We performed a cross-sectional study of strongyloidiasis in 537 PLWH in two hospitals in Iquitos, Peru, from 20 Oct 2023 to 20 May 2024. We tested patient sera using Strongyloides IgG enzyme-linked immunosorbent assay (ELISA) and stool via the modified Baermann technique and/or charcoal fecal culture as highly sensitive parasitological techniques. We used multivariable logistic regression to identify factors associated with S. stercoralis infection.
Among the 339 PLWH whose stool samples were collected, 82 were positive for S. stercoralis (prevalence 24.2%; 95% confidence interval [CI] 20.0-29.1%). Among the 534 PLWH whose serum samples were collected, 227 were positive (seroprevalence: 42.5%; 95% CI 38.1-47.5%). The kappa value for charcoal culture and Baermann technique was 0.69. ELISA showed a sensitivity of 92.6% and a negative predictive value of 96.9%. Significant risk factors for stool positivity included living in a rural (unpaved) area (adjusted OR: 1.86), whereas significant risk factors for both stool and seropositivity included living in a poor house (made of wood/leaves) (adjusted odds ratio (ORs): 2.18 and 2.48, respectively), in the Loreto Regional Hospital catchment area (adjusted ORs: 5.66 and 5.37, respectively), or being infected by hookworms in stool (adjusted ORs: 23.88 and 9.78, respectively). Having a low level of studies was associated with seropositivity (adjusted OR 2.42).
The prevalence of S. stercoralis is high among PLWH in Iquitos, especially among those living in conditions of socioeconomic vulnerability or co-infected with hookworms. The negative predictive value of the S. stercoralis ELISA was high, although this result should be taken with caution in severe immunosuppression.
类圆线虫病是一种重要但诊断不足的土壤传播蠕虫病，在热带地区和一些弱势群体中尤为如此。
评估流行地区感染人类免疫缺陷病毒（PLWH）的患者中粪类圆线虫感染的寄生虫学患病率、血清学患病率及社会人口学因素。
2023年10月20日至2024年5月20日，我们在秘鲁伊基托斯的两家医院对537名PLWH进行了类圆线虫病横断面研究。我们使用类圆线虫IgG酶联免疫吸附测定（ELISA）检测患者血清，并通过改良贝曼技术和/或木炭粪便培养检测粪便，这两种方法是高度敏感的寄生虫学检测技术。我们使用多变量逻辑回归来确定与粪类圆线虫感染相关的因素。
在收集粪便样本的339名PLWH中，82人粪类圆线虫检测呈阳性（患病率24.2%；95%置信区间[CI]20.0 - 29.1%）。在收集血清样本的534名PLWH中，227人呈阳性（血清学患病率：42.5%；95%CI 38.1 - 47.5%）。木炭培养和贝曼技术的kappa值为0.69。ELISA显示敏感性为92.6%，阴性预测值为96.9%。粪便检测呈阳性的显著危险因素包括居住在农村（未铺砌）地区（调整后的OR：1.86），而粪便和血清检测均呈阳性的显著危险因素包括居住在条件较差的房屋（由木材/树叶制成）（调整后的比值比[ORs]分别为2.18和2.48）、在洛雷托地区医院的服务区域内（调整后的ORs分别为5.66和5.37）或粪便中感染钩虫（调整后的ORs分别为23.88和9.78）。受教育程度低与血清检测呈阳性有关（调整后的OR 2.42）。
伊基托斯的PLWH中粪类圆线虫患病率很高，尤其是那些生活在社会经济脆弱条件下或合并感染钩虫的人。粪类圆线虫ELISA的阴性预测值很高，尽管在严重免疫抑制情况下该结果应谨慎对待。
