Clinical presentation and diagnosis of imported strongyloidiasis at a tertiary hospital, Stockholm, Sweden

• Published in: Travel Medicine and Infectious Disease
• Main Authors: Ana Requena-Méndez, Emilia Roos, Suzanne D. van der Werff, Katja Wyss, Leigh Davidsson, Pontus Naucler, Anna Färnert, Hilmir Asgeirsson
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2023
• Subjects: Strongyloides; Sweden; Migrants; Travellers; Serology; PCR; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1016/j.tmaid.2023.102666; https://doaj.org/article/8a1f2ef129e0409fb18688054207567b

Background: Since Strongyloides can persist in its host for decades, and cause life threatening infections data on prevalence, the burden and risk factors for infection is crucial in migrant populations. Methods: In this observational retrospective cohort study, we describe the epidemiological, clinical, and microbiological characteristics of imported strongyloidiasis diagnosed at the Karolinska University Hospital, Stockholm, Sweden, during 2010–2021. Results: We identified 98 individuals with strongyloidiasis, 89 (90.8%) born in endemic and 9 (9.2%) in non-endemic countries. Sub-Saharan Africa was the most common origin among the group born in endemic countries (62, 69.7%), (p < 0.005). There were 22 individuals with an underlying immunosuppressive condition.Gastrointestinal symptoms (53/98, 54.1%) were the symptoms most frequently described, and were more frequent in adults (57.0%) vs children (0%) (p = 0.013). Eosinophilia was detected in 74 (75.5%), being more frequent in the endemic-borne group (79.8% vs 33.3%, p = 0.002). Eight persons developed complications of strongyloidiasis because of either hyperinfection or disseminated disease. No people living with HIV with CD4 <500/mm3 (n = 6) developed severe strongyloidiasis. Conclusion: A limited number of strongyloidiasis cases was identified, with few complicated cases in immunosuppressed patients. Further studies focusing on identifying and exploring the risk of complicated strongyloidiasis in immunosuppressed patients are needed.