Funding: This study received funding from the Northern Territory Rural Clinical School, which is an initiative of the Australian Government through the Department of Health and Aging.Potential conflicts of interest: None
Strongyloides stercoralis: a cause of morbidity and mortality for indigenous people in Central Australia
Article first published online: 26 OCT 2008
© 2008 The Authors Journal compilation © 2008 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 38, Issue 9, pages 697–703, September 2008
How to Cite
Einsiedel, L. and Fernandes, L. (2008), Strongyloides stercoralis: a cause of morbidity and mortality for indigenous people in Central Australia. Internal Medicine Journal, 38: 697–703. doi: 10.1111/j.1445-5994.2008.01775.x
- Issue published online: 26 OCT 2008
- Article first published online: 26 OCT 2008
- Received 25 September 2007; accepted 2 December 2007.
- Indigenous health;
- human T-cell lymphotropic virus type 1
Background: Strongyloides stercoralis may cause a complicated infection in immunocompromised patients, which has a high case fatality rate. Death generally results from sepsis with enteric pathogens. Globally, infection with the human T-cell lymphotropic virus type 1 (HTLV-1) is a major risk factor for this syndrome. Both S. stercoralis and HTLV-1 are endemic to Central Australia.
Aims: The aim of the study was to determine whether complicated strongyloidiasis occurs in association with HTLV-1 infection in Central Australia.
Methods: A retrospective audit of all cases of complicated strongyloidiasis presenting to Alice Springs Hospital between January 2000 and December 2006 was carried out. Diagnosis was defined as definite or probable according to whether diagnosis was made by faecal studies or serology respectively. The medical records, investigations and outcomes of patients who met predetermined criteria for a diagnosis of complicated strongyloidiasis were reviewed.
Results: Eighteen indigenous patients met the criteria for complicated strongyloidiasis (definite 9, probable 9). Seven of 11 patients tested were HTLV-1 seropositive. At diagnosis, no treatment was documented for nine patients (definite 4, probable 5), three received a single dose of ivermectin and one a single dose of albendazole. Fifteen patients (83%) died because of sepsis (definite 7, probable 8). Pathogens isolated and their foci of infection included Klebsiella pneumoniae pneumonia (4), bloodstream infection with Enterococcus spp. (2), K. pneumoniae peritonitis (1) and streptococcal meningitis (1).
Conclusion: Complicated strongyloidiasis occurs in association with HTLV-1 infection in central Australia. This finding has significant implications for the management of S. stercoralis in the region.