How common is strongyloidiasis in the US?

Updated: Jun 20, 2019
  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The true prevalence of S stercoralis is likely underestimated, because infection is often subclinical. Strongyloidiasis is uncommon in the United States, although endemic foci exist in rural areas of the southeastern states and the Appalachia region (especially in eastern Tennessee, Kentucky, and West Virginia) and Puerto Rico, [19] with prevalence rates close to 4%. Populations in whom strongyloidiasis is more prevalent include patients in long-term institutionalized care (mental health facilities, prisons), immigrants or refugees from tropical and subtropical countries (eg, Southeast Asia, Africa, Middle East), [20] and persons who were stationed in Southeast Asia during World War II [21] and the Vietnam War.

In one study, Southeast Asian immigrants living in Washington, DC, were found to have a 38% incidence of infection. [22] Similarly, a Canadian epidemiology study of Southeast Asian immigrants to Canada demonstrated infection in 11.8% in the Vietnamese population and a 76.6% seroprevalence in Cambodian immigrants. [23] Sudanese Lost Boys and Girls and Somali Bantu refugees demonstrated 46% and 23% respective seropositive rate. [24] Five percent of Vietnam veterans reporting mild symptoms demonstrated S stercoralis infection.

Infections acquired in the United States, while not usually associated with larva currens, are not clinically silent; the infected individuals usually have a chronic relapsing illness of mild to moderate severity. Among veterans of the US military forces who served in Southeast Asia, the prevalence of larva currens in those with confirmed strongyloidiasis is high, with studies showing a range of 30% to 90%. [25, 26]


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