A Public Health Response against Strongyloides stercoralis : Time to Look at Soil-Transmitted Helminthiasis in Full

KROLEWIECKI AJ; LAMMIE P,; JACOBSON J; GABRIELLI AF; LEVECKE B; SOCIAS M; ARIAS LM; SOSA N; ABRAHAM D; CIMINO RO; ECHAZÚ A; CRUDO F; VERCRUYSSE J; ALBONICO M

PLOS NEGLECTED TROPICAL DISEASES

PUBLIC LIBRARY SCIENCE

Lugar: San Francisco; Año: 2013 vol. 7 p. 1 - 7

1935-2735

Strongyloides stercoralis infections have aworldwide distribution with a global burden in terms ofprevalence and morbidity that is largely ignored. A publichealth 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 incomparison to Ascaris lumbricoides, Trichuris trichiura, andhookworms. The relatively poor sensitivity of single stoolevaluations, which is further lowered when quantitativetechniques aimed at detecting eggs are used, alsocomplicates morbidity evaluations and adequate drugefficacy measurements, since S. stercoralis is eliminated instools in a larval stage. Specific stool techniques for thedetection of larvae of S. stercoralis, like Baermann?s andKoga?s agar plate, despite superiority over direct techniques are still suboptimal. New serologies using recombinant antigens and molecular-based techniques offernew hopes in those areas. The use of ivermectin ratherthan benzimidazoles for its treatment and the need tohave curative regimens rather than lowering the parasiteburden are also unique for S. stercoralis in comparison tothe other STH due to its life cycle, which allowsreproduction and amplification of the worm burdenwithin the human host. The potential impact on STH ofthe benzimidazoles/ivermectin combinations, alreadyused for control/elimination of lymphatic filariasis, shouldbe further evaluated in public health settings. Whilewaiting for more effective single-dose drug regimens andnew sensitive diagnostics, the evidence and the toolsalready available warrant the planning of a commonplatform for STH andS. stercoralis control.