Morbidity Associated with Chronic Strongyloides stercoralis Infection: A Systematic Review and Meta-Analysis

Francesca Tamarozzi IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy;

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Elisa Martello Department of Veterinary Sciences, University of Turin, Turin, Italy;

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Giovanni Giorli IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy;

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Andrea Fittipaldo IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy;

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Silvia Staffolani Ospedali Riuniti di Ancona, Ancona, Italy;

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Antonio Montresor WHO, Geneva, Switzerland;

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Zeno Bisoffi IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy;
Università degli Studi di Verona, Verona, Italy

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Dora Buonfrate IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy;

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Strongyloides stercoralis, a worldwide-distributed soil-transmitted helminth, causes chronic infection which may be life threatening. Limitations of diagnostic tests and nonspecificity of symptoms have hampered the estimation of the global morbidity due to strongyloidiasis. This work aimed at assessing S. stercoralis–associated morbidity through a systematic review and meta-analysis of the available literature. MEDLINE, Embase, CENTRAL, LILACS, and trial registries (WHO portal) were searched. The study quality was assessed using the Newcastle–Ottawa scale. Odds ratios (ORs) of the association between symptoms and infection status and frequency of infection-associated symptoms were calculated. Six articles from five countries, including 6,014 individuals, were included in the meta-analysis—three were of low quality, one of high quality, and two of very high quality. Abdominal pain (OR 1.74 [CI 1.07–2.94]), diarrhea (OR 1.66 [CI 1.09–2.55]), and urticaria (OR 1.73 [CI 1.22–2.44]) were associated with infection. In 17 eligible studies, these symptoms were reported by a large proportion of the individuals with strongyloidiasis—abdominal pain by 53.1% individuals, diarrhea by 41.6%, and urticaria by 27.8%. After removing the low-quality studies, urticaria remained the only symptom significantly associated with S. stercoralis infection (OR 1.42 [CI 1.24–1.61]). Limitations of evidence included the low number and quality of studies. Our findings especially highlight the appalling knowledge gap about clinical manifestations of this common yet neglected soil-transmitted helminthiasis. Further studies focusing on morbidity and risk factors for dissemination and mortality due to strongyloidiasis are absolutely needed to quantify the burden of S. stercoralis infection and inform public health policies.

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Author Notes

Address correspondence to Dora Buonfrate, Centre for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Via Don A. Sempreboni No. 5, Negrar 37024, Italy. E-mail: dora.buonfrate@sacrocuore.it

Financial support: This work was supported by the Italian Ministry of Health “Fondi Ricerca Corrente - Linea 2, progetto 4” to IRCCS Sacro Cuore Don Calabria Hospital.

Authors’ addresses: Francesca Tamarozzi, Giovanni Giorli, and Dora Buonfrate, Center for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Verona, Italy, E-mails: francesca.tamarozzi@sacrocuore.it, giovanni.giorlisacrocuore.it, and dora.buonfrate@sacrocuore.it. Elisa Martello, Department of Veterinary Sciences, University of Turin, Turin, Italy, E-mail: martello.elisa@gmail.com. Andrea Fittipaldo, IRCCS Mario Negri Institute of Pharmacological Reserach, Milan, Italy, E-mail: vafittipaldo@hotmail.it. Silvia Staffolani, Unit of Emerging Infectious Diseases and of the Immunodepressed, Ospedali Riuniti di Ancona, Ancona, Italy, E-mail: silvia.staffolani@ospedaliriuniti.marche.it. Antonio Montresor, Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland, E-mail: montresora@who.int. Zeno Bisoffi, Center for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Verona, Italy, and Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy, E-mail: zeno.bisoffi@sacrocuore.it.

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