Strongyloidiasis: a review of the evidence for Australian practitioners

Johnston, Fay H., Morris, Peter S., Speare, Richard, McCarthy, James, Currie, Bart, Ewald, Dan, Page, Wendy, and Dempsey, Karen (2005) Strongyloidiasis: a review of the evidence for Australian practitioners. Australian Journal of Rural Health, 13 (4). pp. 247-254.

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Objective: To summarise the available evidence concerning the prevalence, clinical manifestations, diagnosis and management of strongyloidiasis in Northern Australia.

Methods: We searched Medline, Clinical Evidence and the Cochrane Library using MeSH terms and text words 'strongyloides OR strongyloidiasis'. For Australian studies we included text words '(parasite* OR parasitic OR helminth*) AND Australia*'. We examined references contained in retrieved studies or identified from direct contact with researchers. Studies consistent with our objective that described their methods were eligible for inclusion.

Results: The prevalence in some tropical Aboriginal communities is high. Infection can be asymptomatic, cause a range of clinical syndromes or death. It may become chronic. Infected patients are at risk of developing severe disseminated disease particularly with immune compromise. There is little information about the relative frequency of different clinical outcomes. Available diagnostic tools are imperfect. Stool examination has a low sensitivity. Serology may have a low specificity in high prevalence populations and has not been evaluated in Aboriginal populations. Antihelmintic drugs are relatively safe and effective. Community programs based on treatment of stool-positive cases have been associated with a reduced prevalence of strongyloidiasis. We found no studies examining alternative public health interventions.

Conclusion: There is a high prevalence in many Aboriginal communities. Strongyloides infection should be excluded prior to commencing immunosuppressive therapies in patients from endemic areas. Further studies examining the public health impact of strongyloidiasis, the role of the enzyme-linked immuno-sorbent assay serological test and population-based approaches to management of the disease in endemically infected Australian populations are needed.

Item ID: 5947
Item Type: Article (Research - C1)
ISSN: 1440-1584
Keywords: Aboriginal health; diagnosis; public health; Australia Strongloides stercoralis; treatment
Date Deposited: 14 Jan 2010 00:58
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1108 Medical Microbiology > 110803 Medical Parasitology @ 95%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 5%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 90%
92 HEALTH > 9203 Indigenous Health > 920399 Indigenous Health not elsewhere classified @ 5%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920405 Environmental Health @ 5%
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