Screening for strongyloidiasis among selected populations in Taiwan: Prevalence, associated factors, and outcomes
Background: When and how to screen for strongyloidiasis in high-income countries remain to be elucidated. This study aimed to investigate the prevalence, associated factors, and outcome of strongyloidiasis in Taiwan and proposed clinical criteria for serological screening. Methods: Adults who were i...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Travel Medicine and Infectious Disease |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1477893925000729 |
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| Summary: | Background: When and how to screen for strongyloidiasis in high-income countries remain to be elucidated. This study aimed to investigate the prevalence, associated factors, and outcome of strongyloidiasis in Taiwan and proposed clinical criteria for serological screening. Methods: Adults who were immunocompromised or about to undergo iatrogenic immunosuppression (proactive-screening cohort) and those with clinical presentations suggesting strongyloidiasis (diagnosis-driven cohort) were prospectively enrolled at five hospitals in Taiwan. Serum anti-Strongyloides IgG was determined by two enzyme-linked immunosorbent assays (ELISAs). Stool samples were obtained for microscopy and cultures. Prevalence of confirmed/probable strongyloidiasis, as defined by identification of characteristic larvae from stool or testing positive for both ELISAs, was calculated. Factors associated with strongyloidiasis were identified in multivariable analysis. Six-month mortality was compared between participants with and without strongyloidiasis using Cox proportional hazards model. Results: From January 2021 to June 2024, confirmed/probable cases of strongyloidiasis were identified in 1.9 % and 4.8 % of the participants in proactive-screening and diagnosis-driven cohorts, respectively. Multivariable analysis revealed that skin and skin structure infection (adjusted odds ratio [aOR] 3.180), gastrointestinal bleeding of unknown causes (aOR 3.229), and hemoglobin <10 g/dl (aOR 4.300) were independently associated with strongyloidiasis. Six-month mortality was 33.3 % in participants with confirmed/probable strongyloidiasis, higher than that in those without strongyloidiasis (11.4 %), but not statistically significant after adjusting for age, sex, and clinical severity (p = 0.09). Conclusions: Strongyloidiasis continued to occur among at-risk populations in Taiwan. Screening strategies are needed to improve the detection of this neglected parasitic infection in Taiwan and other high-income countries. |
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| ISSN: | 1873-0442 |