Strongyloidiasis is a widespread parasitic disease that can be life-threatening in immunosuppressed people. In the Mediterranean basin, autochthonous cases coexist with imported ones. We aimed to assess the utility of different screening methods, along with the frequency of strongyloidiasis and its associated risk factors in migrants and the native population. This cross-sectional study took place from 2019 to 2022 in the area of the Vega Baja Hospital in Alicante, Spain. Screening was performed in people who were immunosuppressed, at risk of immunosuppression, with blood asymptomatic eosinophilia, and in asymptomatic people from highly endemic countries. Screening methods were serological techniques (ELISA), stool parasitological tests (fecal concentration methods and agar plate culture), and a stool molecular test (PCR). Of the 168 participants (62.5% males, 53.0% migrants, 36.3% immunosuppressed, median age 57 years), 14 (8.3%) had confirmed strongyloidiasis, where 6 were confirmed by serology, 4 by PCR, and 4 by both methods. Overall, 9% of the migrants and 7.6% of the native-born patients were infected. Elevated IgE and hemoglobin and Latin American origin were associated with strongyloidiasis diagnosis. Screening with serology alone would have missed 28.6% of cases. We conclude that strongyloidiasis prevalence is high in our population, both in native and migrant groups, and stool PCR is a useful tool to increase case detection.

Background: Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. Methods: Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. Results: We included 36 patients (21 men) with a mean age of 60.8 years ±17.6; 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs. 53.3 years; p = 0.002), male sex (odds ratio (OR) 5.33; 95% confidence interval (CI) 1.15–24.68; p = 0.041), and agricultural activity (OR 13.5; 95% CI 2.4–73.7; p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs. 75%; p = 0.207), treatment received, or clinical response (85.7% vs. 88.9% cured; p = 1). Conclusion: In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed.

Strongyloidiasis affects an estimated 600 million people worldwide, especially in tropical and subtropical areas. Single-dose ivermectin treatment has shown to be effective among immunocompetent patients with uncomplicated strongyloidiasis. Here, we present the protocol of the ImmunoStrong study, a prospective observational study aiming to evaluate the effectiveness and safety of a single-dose ivermectin for treatment of uncomplicated strongyloidiasis in immunosuppressed patients. The secondary objectives are to assess accuracy of molecular techniques for the follow-up of these patients and to determine the population pharmacokinetics of ivermectin. The information retrieved by this study will cover relevant information gaps in the strongyloidiasis management among immunosuppressed patients.

Immunoregulatory networks may have a role in controlling parasitemia in the chronic phase of human Chagas disease. The aim was to describe the serum cytokine profile of Trypanosoma cruzi in chronically infected patients and to evaluate its relationship with parasitemia and Chagas cardiomyopathy.This prospective observational study included adult patients with chronic Chagas disease. Demographic and clinical data were collected, and peripheral blood samples were used to perform T. cruzi real-time polymerase chain reaction (RT-PCR) and determine the serum cytokine profile.Fifty-eight patients were included; 17 (29.3%) had positive RT-PCR results. This group had a higher median concentration of TNF-α (p = 0.003), IL-6 (p = 0.021), IL-4 (p = 0.031), IL-1β (p = 0.036), and IL-17A (p = 0.043) than those with a negative RT-PCR. Patients with cardiac involvement had a higher median concentration of IL-5 (p = 0.016) than those without.These results reinforce the key role that cytokines play in Chagas disease patients with parasitemia and cardiac involvement.

Background: Strongyloidiasis is a neglected tropical disease caused by the nematode Strongyloides stercoralis. In immunosuppressed patients, it may progress to hyperinfection syndrome (HIS) and disseminated strongyloidiasis (DS), both of which are associated with high mortality rates. We reviewed cases of HIS and DS in a Spanish hospital located in an area with endemic strongyloidiasis. Methods: All of the patients who met the HIS or DIS criteria between 1999 and 2023 at the Vega Baja Hospital in Orihuela (Alicante, Spain) were included. Results: Five patients were identified, four of them autochthonous (median age 72 years, 80% male), with three cases of HIS and two cases of DS in the form of meningitis, due to E. faecalis and E. coli. The most common risk factor, observed in three patients, was corticosteroid use. Two patients died. Conclusions: This case series highlights the severity of infections in immunocompromised patients in an endemic area of Spain, emphasizing the need to establish screening protocols for patients at risk of immunosuppression, including both locals and migrants.

Strongyloidiasis, caused by the soil-transmitted helminth Strongyloides stercoralis, is estimated to infect around 600 million people worldwide. Ivermectin is the current first-line treatment. This prospective study evaluated long-term treatment response in patients with chronic strongyloidiasis. Conducted from 2019 to 2022 at Vega Baja Hospital in Alicante, Spain, this study enrolled 28 patients diagnosed with S. stercoralis infection. Patients received ivermectin at a dosage of 200 mcg/kg for one or two days and were followed for at least 12 months, with evaluations at 3, 6, 12, and 18 months post-treatment. Assessments included hemogram, IgE, Strongyloides serology, larvae culture and direct visualization and Strongyloides PCR in stool. Twenty-three patients completed at least 12 months of follow-up. Twenty-one patients (91.3%) achieved treatment response. Two patients (8.6%) experienced parasitological treatment failure, with detectable Strongyloides stercoralis DNA during follow-up. Ivermectin is highly effective in treating strongyloidiasis, with serology aiding in monitoring treatment efficacy. However, PCR detected an additional case of persistent infection, underscoring its complementary role.