Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort.
<h4>Background</h4>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...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2024-03-01
|
| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0012045&type=printable |
| _version_ | 1797209629861609472 |
|---|---|
| author | Tim Cutfield Soana Karuna Motuhifonua Matthew Blakiston Hasan Bhally Eamon Duffy Rebekah Lane Erik Otte Terri Swager Amanda Maree Taylor Veronica Playle |
| author_facet | Tim Cutfield Soana Karuna Motuhifonua Matthew Blakiston Hasan Bhally Eamon Duffy Rebekah Lane Erik Otte Terri Swager Amanda Maree Taylor Veronica Playle |
| author_sort | Tim Cutfield |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Methods</h4>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.<h4>Findings</h4>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%).<h4>Interpretation</h4>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. |
| first_indexed | 2024-04-24T09:57:45Z |
| format | Article |
| id | doaj.art-8594b1467f364982b041ca6568550ec3 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-04-24T09:57:45Z |
| publishDate | 2024-03-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-8594b1467f364982b041ca6568550ec32024-04-14T05:32:09ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352024-03-01183e001204510.1371/journal.pntd.0012045Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort.Tim CutfieldSoana Karuna MotuhifonuaMatthew BlakistonHasan BhallyEamon DuffyRebekah LaneErik OtteTerri SwagerAmanda Maree TaylorVeronica Playle<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Findings</h4>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%).<h4>Interpretation</h4>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.https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0012045&type=printable |
| spellingShingle | Tim Cutfield Soana Karuna Motuhifonua Matthew Blakiston Hasan Bhally Eamon Duffy Rebekah Lane Erik Otte Terri Swager Amanda Maree Taylor Veronica Playle Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort. PLoS Neglected Tropical Diseases |
| title | Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort. |
| title_full | Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort. |
| title_fullStr | Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort. |
| title_full_unstemmed | Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort. |
| title_short | Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort. |
| title_sort | strongyloidiasis in auckland a ten year retrospective study of diagnosis treatment and outcomes of a predominantly polynesian and fijian migrant cohort |
| url | https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0012045&type=printable |
| work_keys_str_mv | AT timcutfield strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT soanakarunamotuhifonua strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT matthewblakiston strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT hasanbhally strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT eamonduffy strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT rebekahlane strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT erikotte strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT terriswager strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT amandamareetaylor strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort AT veronicaplayle strongyloidiasisinaucklandatenyearretrospectivestudyofdiagnosistreatmentandoutcomesofapredominantlypolynesianandfijianmigrantcohort |