Abstract:

Strongyloides stercoralis infections have a worldwide distribution with a global burden in terms of prevalence and morbidity that is largely ignored. A public health response against soil-transmitted helminth (STH) infections should broaden the strategy to include S. stercoralis and overcome the epidemiological, diagnostic, and therapeutic challenges that this parasite poses in comparison to Ascaris lumbricoides, Trichuris trichiura, and hookworms. The relatively poor sensitivity of single stool evaluations, which is further lowered when quantitative techniques aimed at detecting eggs are used, also complicates morbidity evaluations and adequate drug efficacy measurements, since S. stercoralis is eliminated in stools in a larval stage. Specific stool techniques for the detection of larvae of S. stercoralis, like Baermann?s and Koga?s agar plate, despite superiority over direct techniques are still suboptimal. New serologies using recombinant antigens and molecular-based techniques offer new hopes in those areas. The use of ivermectin rather than benzimidazoles for its treatment and the need to have curative regimens rather than lowering the parasite burden are also unique for S. stercoralis in comparison to the other STH due to its life cycle, which allows reproduction and amplification of the worm burden within the human host. The potential impact on STH of the benzimidazoles/ivermectin combinations, already used for control/elimination of lymphatic filariasis, should be further evaluated in public health settings. While waiting for more effective single-dose drug regimens and new sensitive diagnostics, the evidence and the tools already available warrant the planning of a common platform for STH and S. stercoralis control.

Author affiliation: Krolewiecki, Alejandro Javier. Universidad Nacional de Salta. Sede Regional Oran. Instituto de Investigación de Enfermedades Tropicales; Argentina;

Author affiliation: Lammie, Patrick. Centers For Disease Control And Prevention. National Center For Infectious Diseases. Division Of Parasitic Diseases; Estados Unidos de América;

Author affiliation: Jacobson, Julie. BILL & MELINDA GATES FOUNDATION;

Author affiliation: Gabrielli, Albis-Francesco. WORLD HEALTH ORGANIZATION;

Author affiliation: Levecke, Bruno. Ghent University. Faculty of Veterinary Medicine. Parasitology and Immunology. Department of Virology, Bélgica;

Author affiliation: Socías, María Guillermina. Fundación Mundo Sano; Argentina;

Author affiliation: Arias, Luis María. Ministerio de Salud Pública de la Provincia de Salta; Argentina;

Author affiliation: Sosa, Nicanor. Ministerio de Salud Pública de la Provincia de Salta; Argentina;

Author affiliation: Abraham, David. Thomas Jefferson University. Department of Microbiology and Immunology. Kimmel Cancer; Argentina;

Author affiliation: Cimino, Rubén Oscar. Universidad Nacional de Salta. Sede Regional Oran. Instituto de Investigación de Enfermedades Tropicales; Argentina;

Author affiliation: Echazú, Adriana. Universidad Nacional de Salta. Sede Regional Oran. Instituto de Investigación de Enfermedades Tropicales; Argentina;

Author affiliation: Crudo, Favio. Municipio de Zárate. Subsecretaría de Salud; Argentina;

Author affiliation: Vercruysse, Josef. Department of Control of Neglected Tropical Diseases; Italia;

Author affiliation: Albonico, Marco. Ivo de Carneri Foundation; Italia;