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- Title
Chronic Strongyloides stercoralis infection in former British Far East prisoners of war.
- Authors
G.V. Gill; E. Welch; J.W. Bailey; D.R. Bell; N.J. Beeching
- Abstract
Background: Chronic infections with the nematode worm Strongyloides stercoralis can occur in former WWII Far East prisoners of war (FEPOWs). The condition may be asymptomatic, but frequently causes a characteristic urticarial larva currens rash. Under conditions of immunosuppression (particularly systemic corticosteroid treatment) potentially fatal dissemination of larvae (hyperinfection) may occur.Aim: To review our total experience of strongyloidiasis in former FEPOWs, and investigate its prevalence, characteristics and risk factors.Design: Retrospective case series.Methods: We reviewed 2072 records of all FEPOWs seen at the Liverpool School of Tropical Medicine, 19682002. Cases with strongyloidiasis were compared with non-infected controls.Results: There were 248 (12%) with strongyloidiasis. Diagnostic features included larva currens rash (70%), eosinophilia (66%), positive faecal culture (30%), positive faecal microscopy (26%), and positive serology (64%). Mean (SD) age of cases was 65 7 years, and as expected, their blood eosinophil counts were significantly higher than controls (775 vs. 238 106/l, p < 0.001). Captivity on the Thai-Burma Railway (vs. elsewhere) was significantly associated with strongyloidiasis (78% cases vs. 40% controls, OR 4.19, CI 2.706.81, p < 0.001). In terms of prevalence, strongyloidiasis occurred in 166/1032 men imprisoned on the Burma Railway (16.1%). Malaria (88% vs. 69%, p < 0.001) and tropical ulcer (53% vs. 42%, p < 0.02) were more common amongst cases than controls, probably because these diseases were very common on the Burma Railway.Discussion: S. stercoralis infection is common amongst ex-FEPOWs, particularly those from the Thai-Burma Railway project. It is usually characterized by a larva currens rash and marked eosinophilia. The condition is eminently treatable, and continued diagnostic surveillance is needed, if cases of potentially fatal hyperinfection are to be avoided.
- Subjects
EOSINOPHIL disorders; IMMUNOREGULATION; MEDICAL research; PRISONERS of war
- Publication
QJM: An International Journal of Medicine, 2004, Vol 97, Issue 12, p789
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hch133