TY - JOUR
T1 - Human strongyloidiasis in Hawaii
T2 - A retrospective review of enzyme-linked immunosorbent assay serodiagnostic testing
AU - Akiyama, Matthew J.
AU - Brown, Joel D.
N1 - Funding Information:
Eosinophilia was defined by our clinical laboratory as a differential white blood cell blood cell count with greater than or equal to 7% eosinophils. Fecal specimens were collected, placed in commercial polyvinyl alcohol containers, and submitted to the hospital laboratory for routine stool ova and parasite studies with formalin concentration and microscopic examination of permanent stained smears. We reviewed the electronic medical records (EMRs) of the seropositive patients for demographic and clinical characteristics. We also reviewed the treatment history and subsequent changes in eosinophil counts and Strongyloides antibody levels following treatment. This study was given expedited approval by the Research and Institutional Review Committee of The Queen’s Medical Center (Protocol RA 2013-028).
Funding Information:
We appreciate the medical record data retrieval contribution by Roxanne Jaudon, coordinator for The Queens Medical Center Department of Information.
Publisher Copyright:
Copyright © 2018 by The American Society of Tropical Medicine and Hygiene.
PY - 2018
Y1 - 2018
N2 - Human strongyloidiasis is widely prevalent in tropical and subtropical regions worldwide but is not endemic in Hawaii. Subclinical, chronic infections may be lifelong; immunosuppressive therapy, particularly with glucocorticoids, may lead to serious or fatal disseminated disease, which is preventable. We performed a retrospective analysis of patients tested for Strongyloides immunoglobulin G antibody in an academic medical center in Honolulu, Hawaii, from 2005 to 2012. Of the 475 patients tested, 78 (16%) were seropositive. The largest proportion of seropositive cases was found among Micronesians (30%), Polynesians (26%), Filipinos (13%), and Southeast Asians (11%). Among the seropositive patients, the most likely reason for clinicians to order testing was blood eosinophilia. Stool parasite examination results were available for 58% of seropositive patients of which 11% were positive for Strongyloides stercoralis larvae. Anti-helminthic therapy, usually ivermectin, was ordered for 71% of patients. After treatment, blood eosinophilia and Strongyloides serology results were reassessed for 76% and 35% of patients, respectively; both tests tended to show improvement. Travelers and immigrants from Strongyloides-endemic areas, including Micronesia and Polynesia, should have serodiagnostic testing for latent strongyloidiasis, and if positive, treated empirically with ivermectin, particularly when corticosteroids or other immunosuppressive therapies are anticipated.
AB - Human strongyloidiasis is widely prevalent in tropical and subtropical regions worldwide but is not endemic in Hawaii. Subclinical, chronic infections may be lifelong; immunosuppressive therapy, particularly with glucocorticoids, may lead to serious or fatal disseminated disease, which is preventable. We performed a retrospective analysis of patients tested for Strongyloides immunoglobulin G antibody in an academic medical center in Honolulu, Hawaii, from 2005 to 2012. Of the 475 patients tested, 78 (16%) were seropositive. The largest proportion of seropositive cases was found among Micronesians (30%), Polynesians (26%), Filipinos (13%), and Southeast Asians (11%). Among the seropositive patients, the most likely reason for clinicians to order testing was blood eosinophilia. Stool parasite examination results were available for 58% of seropositive patients of which 11% were positive for Strongyloides stercoralis larvae. Anti-helminthic therapy, usually ivermectin, was ordered for 71% of patients. After treatment, blood eosinophilia and Strongyloides serology results were reassessed for 76% and 35% of patients, respectively; both tests tended to show improvement. Travelers and immigrants from Strongyloides-endemic areas, including Micronesia and Polynesia, should have serodiagnostic testing for latent strongyloidiasis, and if positive, treated empirically with ivermectin, particularly when corticosteroids or other immunosuppressive therapies are anticipated.
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U2 - 10.4269/ajtmh.18-0157
DO - 10.4269/ajtmh.18-0157
M3 - Review article
C2 - 29943712
AN - SCOPUS:85051067331
VL - 99
SP - 370
EP - 374
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
SN - 0002-9637
IS - 2
ER -