Strongyloides stercoralis infection in the UK: A systematic review and meta-analysis of published cases

Abstract

Strongyloidiasis is a helminth infection where symptoms vary, and asymptomatic presentation is common. Chronic strongyloidiasis can cause a high mortality ‘hyper-infection’ in immunocompromised states. Understanding at risk populations and symptomology can guide screening and early treatment to reduce hyper-infection risk.A systematic review of studies describing patients in the UK with strongyloidiasis pooled a total of 1,308 patients. Weighted pooled prevalence (WPP) of asymptomatic cases was 27.7% (95% CI 17.1–39.5%, I2 = 92%, p < 0.01). At-risk populations included migrants, returning travellers and armed forces personnel. The most common symptoms reported were abdominal pain (WPP 32.1% (95% CI 20.5–44.8%), I2 = 93%, p < 0.01), rashes (WPP 38.4% (95% CI 13.1–67.7%), I2 = 99%, p < 0.01) and diarrhoea (WPP 12.6% (95% CI 6.7–19.9%), I2=70%, p = 0.03). Symptomatology varied with cohort characteristics.Although asymptomatic presentation is common, patients may present with abdominal pain, diarrhoea or rashes. A low threshold for screening symptomatic individuals in at-risk groups is required.

Keywords

• Strongyloides
• Parasites
• Helminths
• United Kingdom
• Systematic review