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Schistosoma and Strongyloides screening in migrants initiating HIV Care in Canada: a cross sectional study.
BMC Infect Dis. 2020 Jan 28; 20(1):76.BI

Abstract

BACKGROUND

Following migration from Schistosoma and Strongyloides endemic to non-endemic regions, people remain at high risk for adverse sequelae from these chronic infections. HIV co-infected persons are particularly vulnerable to the serious and potentially fatal consequences of untreated helminth infection. While general screening guidelines exist for parasitic infection screening in immigrant populations, they remain silent on HIV positive populations. This study assessed the seroprevalence, epidemiology and laboratory characteristics of these two parasitic infections in a non-endemic setting in an immigrant/refugee HIV positive community.

METHODS

Between February 2015 and 2018 individuals born outside of Canada receiving care at the centralized HIV clinic serving southern Alberta, Canada were screened by serology and direct stool analysis for schistosomiasis and strongyloidiasis. Canadian born persons with travel-based exposure risk factors were also screened. Epidemiologic and laboratory values were analyzed using bivariate logistic regression. We assessed the screening utility of serology, direct stool analysis, eosinophilia and hematuria.

RESULTS

253 HIV positive participants were screened. The prevalence of positive serology for Schistosoma and Strongyloides was 19.9 and 4.4%, respectively. Age between 40 and 50 years (OR 2.50, 95% CI 1.13-5.50), refugee status (3.55, 1.72-7.33), country of origin within Africa (6.15, 2.44-18.60), eosinophilia (3.56, 1.25-10.16) and CD4 count < 200 cells/mm3 (2.46, 1.02-5.92) were associated with positive Schistosoma serology. Eosinophilia (11.31, 2.03-58.94) was associated with positive Strongyloides serology. No Schistosoma or Strongyloides parasites were identified by direct stool microscopy. Eosinophilia had poor sensitivity for identification of positive serology. Hematuria was not associated with positive Schistosoma serology.

CONCLUSION

Positive Schistosoma and Strongyloides serology was common in this migrant HIV positive population receiving HIV care in Southern Alberta. This supports the value of routine parasitic screening as part of standard HIV care in non-endemic areas. Given the high morbidity and mortality in this relatively immunosuppressed population, especially for Strongyloides infection, screening should include both serologic and direct parasitological tests. Eosinophilia and hematuria should not be used for Schistosoma and Strongyloides serologic screening in HIV positive migrants in non-endemic settings.

Authors+Show Affiliations

Department of Medicine, The University of Calgary, Calgary, Alberta, Canada. jessica.mclellan@albertahealthservices.ca.Department of Medicine, The University of Calgary, Calgary, Alberta, Canada. Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada.Department of Medicine, The University of Calgary, Calgary, Alberta, Canada. Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada.Department of Medicine, The University of Calgary, Calgary, Alberta, Canada. Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31992216

Citation

McLellan, Jessica, et al. "Schistosoma and Strongyloides Screening in Migrants Initiating HIV Care in Canada: a Cross Sectional Study." BMC Infectious Diseases, vol. 20, no. 1, 2020, p. 76.
McLellan J, Gill MJ, Vaughan S, et al. Schistosoma and Strongyloides screening in migrants initiating HIV Care in Canada: a cross sectional study. BMC Infect Dis. 2020;20(1):76.
McLellan, J., Gill, M. J., Vaughan, S., & Meatherall, B. (2020). Schistosoma and Strongyloides screening in migrants initiating HIV Care in Canada: a cross sectional study. BMC Infectious Diseases, 20(1), 76. https://doi.org/10.1186/s12879-020-4779-4
McLellan J, et al. Schistosoma and Strongyloides Screening in Migrants Initiating HIV Care in Canada: a Cross Sectional Study. BMC Infect Dis. 2020 Jan 28;20(1):76. PubMed PMID: 31992216.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Schistosoma and Strongyloides screening in migrants initiating HIV Care in Canada: a cross sectional study. AU - McLellan,Jessica, AU - Gill,M John, AU - Vaughan,Stephen, AU - Meatherall,Bonnie, Y1 - 2020/01/28/ PY - 2019/06/20/received PY - 2020/01/08/accepted PY - 2020/1/30/entrez PY - 2020/1/30/pubmed PY - 2020/3/26/medline KW - Eosinophilia KW - HIV KW - Immigrant KW - Schistosoma KW - Screening KW - Seroprevalence KW - Strongyloides SP - 76 EP - 76 JF - BMC infectious diseases JO - BMC Infect Dis VL - 20 IS - 1 N2 - BACKGROUND: Following migration from Schistosoma and Strongyloides endemic to non-endemic regions, people remain at high risk for adverse sequelae from these chronic infections. HIV co-infected persons are particularly vulnerable to the serious and potentially fatal consequences of untreated helminth infection. While general screening guidelines exist for parasitic infection screening in immigrant populations, they remain silent on HIV positive populations. This study assessed the seroprevalence, epidemiology and laboratory characteristics of these two parasitic infections in a non-endemic setting in an immigrant/refugee HIV positive community. METHODS: Between February 2015 and 2018 individuals born outside of Canada receiving care at the centralized HIV clinic serving southern Alberta, Canada were screened by serology and direct stool analysis for schistosomiasis and strongyloidiasis. Canadian born persons with travel-based exposure risk factors were also screened. Epidemiologic and laboratory values were analyzed using bivariate logistic regression. We assessed the screening utility of serology, direct stool analysis, eosinophilia and hematuria. RESULTS: 253 HIV positive participants were screened. The prevalence of positive serology for Schistosoma and Strongyloides was 19.9 and 4.4%, respectively. Age between 40 and 50 years (OR 2.50, 95% CI 1.13-5.50), refugee status (3.55, 1.72-7.33), country of origin within Africa (6.15, 2.44-18.60), eosinophilia (3.56, 1.25-10.16) and CD4 count < 200 cells/mm3 (2.46, 1.02-5.92) were associated with positive Schistosoma serology. Eosinophilia (11.31, 2.03-58.94) was associated with positive Strongyloides serology. No Schistosoma or Strongyloides parasites were identified by direct stool microscopy. Eosinophilia had poor sensitivity for identification of positive serology. Hematuria was not associated with positive Schistosoma serology. CONCLUSION: Positive Schistosoma and Strongyloides serology was common in this migrant HIV positive population receiving HIV care in Southern Alberta. This supports the value of routine parasitic screening as part of standard HIV care in non-endemic areas. Given the high morbidity and mortality in this relatively immunosuppressed population, especially for Strongyloides infection, screening should include both serologic and direct parasitological tests. Eosinophilia and hematuria should not be used for Schistosoma and Strongyloides serologic screening in HIV positive migrants in non-endemic settings. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/31992216/Schistosoma_and_Strongyloides_screening_in_migrants_initiating_HIV_Care_in_Canada:_a_cross_sectional_study_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-4779-4 DB - PRIME DP - Unbound Medicine ER -