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SEROEPIDEMIOLOGY OF STRONGYLOIDIASIS IN THE PERUVIAN AMAZON

A stool and serosurvey for Strongyloides stercoralis was conducted in a community in the Peruvian Amazon region. Strongyloidiasis stercoralis was identified in the stool of 69 (8.7%) of 792 participants. Six hundred nine sera were tested using by an enzyme-linked immunosorbent assay (ELISA), which had a sensitivity of 92% and a specificity of 94%; 442 (72%) were positive. In multivariable logistic regression models, having S. stercoralis in stool was associated with hookworm in the same specimen (odds ratio [OR] = 4.44, 95% confidence interval [CI] = 2.02–9.79), occasionally or never wearing shoes (OR = 1.89, 95% CI = 1.10–3.27), and increasing age (OR = 1.012 for each one-year increase, 95% CI = 1.00–1.03). Similarly, occasionally or never wearing shoes (OR = 1.54, 95% CI = 1.01–2.37) and increasing age (OR = 1.04 for each one-year increase, 95% CI = 1.02–1.06) were associated with an increased risk of a positive S. stercoralis ELISA result. The ELISA had a negative predictive value of 98% and is an excellent screening test for strongyloidiasis.

Received June 13, 2005. Accepted for publication August 17, 2005.

Acknowledgments: We thank Hermman Silva for his interest and collaboration in the current project, Franklin Neva for the provision of L3 extract and protocol for its use, Patrick J. Lammie for advice in the interpretation of serologic testing, M. A. Single for providing input and support on early versions of the work, and S. T. Unt for a critical revision of the final manuscript.

Financial support: Margaret Kosek was supported by Fogarty International Center International Research Scientist Development Award KO1TW005717. The project received additional support from grants T35AI107646 and Tropical Medicine Research Center Grant P01AI52976-01.

^* Address correspondence to Margaret Kosek, Department of International Health, Johns Hopkins School of Public Health, 615 North Wolfe Street, Room 5515, Baltimore, MD 21205. E-mail: mkosek{at}jhsph.edu

Authors’ addresses: Pablo P. Yori, Julianna Cordova, Cesar Banda Chavez, Maribel Paredes Olortegui, Carmen Montalvan, Graciela Meza Sanchez, Bevelle Worthen, James Worthen, Fay Leung, and Carlos Vidal Oré, Asociacion Benéfica PRISMA, Morona 452, Iquitos, Maynas, Peru, Telephone and Fax: 51-6-524-2226, E-mail: iqtlab{at}jhsph.edu. Margaret Kosek and Robert H. Gilman, Department of International Health, Johns Hopkins School of Public Health, 615 North Wolfe Street, Room 5515, Baltimore, MD 21205, Telephone: 410-995-4195, Fax: 410-510-1284, E-mails: mkosek{at}jhsph.edu and gilmanbob{at}yahoo.com. Caryn Bern, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway NE, Atlanta, GA 30341, Telephone: 770-488-7654, Fax: 770-488-7761, E-mail: cbern{at}cdc.gov.

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