Imported strongyloidiasis: Data from 1245 cases registered in the plus REDIVI Spanish Collaborative Network (2009-2017)

Background Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients with imported strongyloidiasis in Spain. Methodology This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers. Findings Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34). Conclusions Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions. Author summary Strongyloidiasis, the parasitic disease caused by the nematode Strongyloides stercoralis, is being increasingly diagnosed in immigrant population in Spain. In the present study we describe de clinical, epidemiological and microbiological profile of 1245 cases of imported strongyloidiasis registered in the +REDIVI Spanish Collaborative Network. Patients were mostly immigrants, and the majority of them were coming from South America. Serological tests allowed the diagnosis in most of the cases, and detection of larvae in stool samples was associated with male gender and presence of eosinophilia. Ivermectin was associated with higher probability of cure compared with albendazole. Given the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions.