Authors

Alejandro J Krolewiecki, Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta, Oran, Argentina; Instituto de Patología Experimental/CONICET, Salta, Argentina
Patrick Lammie, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
Julie Jacobson, Bill & Melinda Gates Foundation, Seattle, Washington
Albis-Francesco Gabrielli, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
Bruno Levecke, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
Eugenia Socias, Fundación Mundo Sano, Buenos Aires, Argentina
Luis M Arias, Ministerio de Salud Pública de la Provincia de Salta, Salta, Argentina
Nicanor Sosa, Ministerio de Salud Pública de la Provincia de Salta, Salta, Argentina
David Abraham, Department of Microbiology and Immunology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PennsylvaniaFollow
Ruben Cimino, Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta, Oran, Argentina
Adriana Echazú, Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta, Oran, Argentina
Favio Crudo, Subsecretaría de Salud, Municipalidad de Zárate, Zárate, Argentina
Jozef Vercruysse, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
Marco Albonico, Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Italy; Ivo de Carneri Foundation (IdCF), Milan, Italy

Document Type

Article

Publication Date

5-1-2013

Comments

This article has been peer reviewed. It was published in: Plos Neglected Tropical Diseases.

Volume 7, Issue 5, May 2013, Article numbere2165.

The published version is available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649958/ DOI: 10.1371/journal.pntd.0002165

Copyright © 2013 Krolewiecki et al.

Abstract

Strongyloides stercoralis infections have a worldwide distribution with a global burden in terms of prevalence and morbidity that is largely ignored. A public health response against soil-transmitted helminth (STH) infections should broaden the strategy to include S. stercoralis and overcome the epidemiological, diagnostic, and therapeutic challenges that this parasite poses in comparison to Ascaris lumbricoides, Trichuris trichiura, and hookworms. The relatively poor sensitivity of single stool evaluations, which is further lowered when quantitative techniques aimed at detecting eggs are used, also complicates morbidity evaluations and adequate drug efficacy measurements, since S. stercoralis is eliminated in stools in a larval stage. Specific stool techniques for the detection of larvae of S. stercoralis, like Baermann's and Koga's agar plate, despite superiority over direct techniques are still suboptimal. New serologies using recombinant antigens and molecular-based techniques offer new hopes in those areas. The use of ivermectin rather than benzimidazoles for its treatment and the need to have curative regimens rather than lowering the parasite burden are also unique for S. stercoralis in comparison to the other STH due to its life cycle, which allows reproduction and amplification of the worm burden within the human host. The potential impact on STH of the benzimidazoles/ivermectin combinations, already used for control/elimination of lymphatic filariasis, should be further evaluated in public health settings. While waiting for more effective single-dose drug regimens and new sensitive diagnostics, the evidence and the tools already available warrant the planning of a common platform for STH and S. stercoralis control.

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