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Strongyloides stercoralis Infection at Different Altitudes of the Cusco Region in Peru

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  • 1 Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center–Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru;
  • | 2 School of Medicine, University of Texas Medical Branch, Galveston, Texas;
  • | 3 Division of Infectious Diseases, Department of Medicine, University of Texas Medical Branch, Galveston, Texas;
  • | 4 Sede Administrativa de la Red de Servicios de Salud Cusco Norte, Ministerio de Salud, Cusco, Peru;
  • | 5 Centro de Salud de Putucusi, Red de Servicios de Salud Cusco Norte, Ministerio de Salud, Cusco, Peru
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Strongyloides stercoralis affects 30–100 million people worldwide. The burden is underestimated because of the paucity of studies, limited geographical areas surveyed, and poor quality of diagnostic tests. This study aimed at determining the epidemiology of strongyloidiasis using sensitive microscopy testing in rural populations living at different altitudes in Cusco, Peru. Data were collected from subjects aged > 3 years living in Quellouno (elevation 2,600 ft) and Limatambo (elevation 8,379 ft) districts. Subjects provided one fresh stool sample and answer a standardized questionnaire. Fresh stool was tested on site using the Baermann’s test and agar plate culture. Formalin-preserved stool was tested by rapid sedimentation. Eighty percent (585/715) of eligible subjects consented to participate; after excluding subjects with missing data, 65% (462/715) were included. Fifty-five percentage were female; the median age was 33 years (interquartile range 13–52), and 72% had government health insurance. Half had intestinal parasites, and Strongyloides was the most common (24.5%) followed by Giardia (15.5%), Blastocystis (14.9%), and hookworm (11.5%). The agar plate culture detected more cases of Strongyloides than Baermann’s or sedimentation tests. Strongyloides infection was more common at low altitude (26.4%) than at high altitude (18.6%), but the difference was not statistically significant (P = 0.08). Older age, walking barefoot, bathing in rivers/streams, and using municipal sewage were associated with strongyloidiasis. Strongyloides was the most prevalent parasite in the areas studied and was associated with demographic, socioeconomic, and sanitary factors.

Author Notes

Address correspondence to Miguel Mauricio Cabada, Division of Infectious Diseases, Department of Medicine, University of Texas Medical Branch, 301 University Blvd., RT 0435, Galveston, TX 77555. E-mail: micabada@utmb.edu

Financial support: This study was supported in part by the Institute for Translational Sciences at the University of Texas Medical Branch, supported by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences, National Institutes of Health. Partial support was also provided by the Center for Tropical Diseases from the University of Texas Medical Branch. M. M. C. was supported by the National Institute for Allergy and Infectious Diseases at the National Institutes of Health (grant 1R01AI104820-01).

Authors’ addresses: Maria Luisa Morales, Martha Lopez, Martha Vanessa Fernandez-Baca, Angela Maria Valdivia-Rodriguez, Frecia Maribel Mamani-Licona, and Benicia Baca-Turpo, UPCH-UTMB Collaborative Research Center–Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru, E-mails: malu.morales.fernandez@upch.pe, martlop2000@gmail.com, vane4950@gmail.com, amariavalrod@hotmail.com, frecia95@hotmail.com, and beniciabacat@gmail.com. Priscilla Ly, School of Medicine, University of Texas Medical Branch, Galveston, TX, E-mail: priscillaly92@gmail.com. Seher Anjum and Miguel Mauricio Cabada, Division of Infectious Diseases, Department of Medicine, University of Texas Medical Branch, Galveston, TX, E-mails: seanjum@utmb.edu and micabada@utmb.edu. Nedhy Farfan-Gonzales, Sede Administrativa de la Red de Servicios de Salud Cusco Norte, Ministerio de Salud, Cusco, Peru, E-mail: nedhy10@hotmail.com. Yeshica Chaman-Illanes, Centro de Salud de Putucusi, Red de Servicios de Salud Cusco Norte, Ministerio de Salud, Cusco, Peru, E-mail: yecka212@hotmail.com.

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