학술논문
Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort.
Document Type
Academic Journal
Author
Cutfield T; Department of Infectious Diseases, Te Whatu Ora Counties Manukau, Auckland, New Zealand.; Motuhifonua SK; Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Grafton, Auckland, New Zealand.; Blakiston M; Department of Microbiology, Labtests Auckland, Mount Wellington, Auckland, New Zealand.; Bhally H; Department of Infectious Diseases, Te Whatu Ora Waitematā, Takapuna, Auckland, New Zealand.; Duffy E; Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Grafton, Auckland, New Zealand.; Department of Infectious Diseases, Te Whatu Ora Te Toka Tumai Auckland, Grafton, Auckland, New Zealand.; Lane R; Department of Infectious Diseases, Te Whatu Ora Te Toka Tumai Auckland, Grafton, Auckland, New Zealand.; Otte E; Department of Microbiology, Canterbury Health Laboratories, Hagley Avenue, Christchurch Central City, Christchurch, New Zealand.; Swager T; LabPLUS Auckland, Auckland City Hospital, Grafton, Auckland.; Taylor AM; Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Grafton, Auckland, New Zealand.; Playle V; Department of Infectious Diseases, Te Whatu Ora Counties Manukau, Auckland, New Zealand.; Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Grafton, Auckland, New Zealand.; LabPLUS Auckland, Auckland City Hospital, Grafton, Auckland.
Source
Publisher: Public Library of Science Country of Publication: United States NLM ID: 101291488 Publication Model: eCollection Cited Medium: Internet ISSN: 1935-2735 (Electronic) Linking ISSN: 19352727 NLM ISO Abbreviation: PLoS Negl Trop Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Strongyloides stercoralis is not endemic in Aotearoa New Zealand (AoNZ). However, approximately one third of Auckland residents are born in endemic countries. This study aimed to describe the epidemiology and management of strongyloidiasis in Auckland, with a focus on migrants from Pacific Island Countries and Territories.
Methods: This study retrospectively reviewed clinical, laboratory and pharmacy records data for all people diagnosed with strongyloidiasis in the Auckland region between July 2012 and June 2022. People with negative Strongyloides serology were included to estimate seropositivity rate by country of birth.
Findings: Over ten years, 691 people were diagnosed with strongyloidiasis. Most diagnoses were made by serology alone (622, 90%). The median age was 63 years (range 15-92), 500 (72%) were male, and the majority were born in Polynesia (350, 51%), Fiji (130, 19%) or were of Pasifika ethnicity (an additional 7%). Twelve participants (1.7%) had severe strongyloidiasis at diagnosis. The total proportion treated with ivermectin was only 70% (484/691), with no differences between immunocompromised and immunocompetent participants, nor by ethnicity. The outcome of treatment (based on a combination of serology and/or eosinophilia and/or stool microscopy) could only be determined in 50% of the treated cohort. One participant failed treatment with ivermectin, experiencing recurrent strongyloidiasis, and another participant died in association with severe strongyloidiasis. The rate of 'positive' Strongyloides serology was highest among participants born in Samoa (48%), Fiji (39%), and Southeast Asian countries (34%).
Interpretation: Strongyloidiasis was common and under-treated in Auckland during the study period. Clinicians should have a low threshold for considering strongyloidiasis in migrants from endemic countries, including Polynesia and Fiji.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Cutfield et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Methods: This study retrospectively reviewed clinical, laboratory and pharmacy records data for all people diagnosed with strongyloidiasis in the Auckland region between July 2012 and June 2022. People with negative Strongyloides serology were included to estimate seropositivity rate by country of birth.
Findings: Over ten years, 691 people were diagnosed with strongyloidiasis. Most diagnoses were made by serology alone (622, 90%). The median age was 63 years (range 15-92), 500 (72%) were male, and the majority were born in Polynesia (350, 51%), Fiji (130, 19%) or were of Pasifika ethnicity (an additional 7%). Twelve participants (1.7%) had severe strongyloidiasis at diagnosis. The total proportion treated with ivermectin was only 70% (484/691), with no differences between immunocompromised and immunocompetent participants, nor by ethnicity. The outcome of treatment (based on a combination of serology and/or eosinophilia and/or stool microscopy) could only be determined in 50% of the treated cohort. One participant failed treatment with ivermectin, experiencing recurrent strongyloidiasis, and another participant died in association with severe strongyloidiasis. The rate of 'positive' Strongyloides serology was highest among participants born in Samoa (48%), Fiji (39%), and Southeast Asian countries (34%).
Interpretation: Strongyloidiasis was common and under-treated in Auckland during the study period. Clinicians should have a low threshold for considering strongyloidiasis in migrants from endemic countries, including Polynesia and Fiji.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Cutfield et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)