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Zainol DA, Anuar NS, Abdul Halim NSS, Kaur M, Noordin R, Rahumatullah A. Systematic Review of Strongyloides stercoralis Infection Diagnosis in Southeast Asia: Insights from Parasitological, Molecular, and Serological Approaches. Am J Trop Med Hyg 2024; 111:724-735. [PMID: 39137756 PMCID: PMC11448514 DOI: 10.4269/ajtmh.23-0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/13/2024] [Indexed: 08/15/2024] Open
Abstract
Accurate diagnosis of strongyloidiasis is crucial for effective treatment and prevention of complications. We reviewed the current landscape of diagnostic assays used in detecting Strongyloides infection in Southeast Asia. A literature search was performed using Scopus, PubMed, and Web of Science databases spanning the last three decades. Based on the exclusion and inclusion criteria, 52 papers were included in this review. We outlined the diagnostic methods used and their advantages and drawbacks. Insensitive parasitological methods were commonly used, thus underscoring the underestimation of Strongyloides infection rates in Southeast Asia. A combination of diagnostic methods (i.e., microscopy, molecular techniques, and serology) is preferred because it leads to more effective detection and higher prevalence rates. New approaches have been developed, including urine ELISAs and rapid lateral flow tests. Improving and standardizing diagnostics and making them more accessible can improve Strongyloides prevalence estimates and facilitate control efforts.
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Affiliation(s)
- Dinie Adila Zainol
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Nor Suhada Anuar
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Nur Shuhaidatul Sarmiza Abdul Halim
- Neurorehabilitation Engineering and Assistance Systems Research (NEAR), School of Mechanical Engineering, Engineering Campus, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Mansheender Kaur
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Rahmah Noordin
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Anizah Rahumatullah
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Penang, Malaysia
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Tandem Use of OvMANE1 and Ov-16 ELISA Tests Increases the Sensitivity for the Diagnosis of Human Onchocerciasis. Life (Basel) 2021; 11:life11121284. [PMID: 34947815 PMCID: PMC8703281 DOI: 10.3390/life11121284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 12/19/2022] Open
Abstract
The current serological test for human onchocerciasis relies on IgG4 reactivity against the parasite Ov-16 antigen, with reported sensitivities of only 60–80%. As control programs move from control to elimination, it is imperative to identify novel molecules that could improve the serodiagnosis reliability of this disease. In this study we compared the sensitivity of total IgG against OvMANE1—a chimeric antigen previously identified as a potential biomarker of human onchocerciasis—with that of an Ov-16 antibody test to detect an Onchocerca volvulus infection in persons presenting with microfilaria in skin snips. One hundred and ninety serum samples were obtained from persons with epilepsy in an onchocerciasis-endemic area at Ituri in the Democratic Republic of Congo where ivermectin has never been distributed. Fifty-nine (31.1%) samples were from individuals with a positive skin snip test; 41 (69.5%) of these 59 samples were positive with the OvMANE1 test and 41 (69.5%) with the Ov-16 test; 30 (50.8%) samples were positive for both tests and in 52 (88.1%) at least one of the tests was positive. Testing the 131 sera from persons with a negative skin snip result revealed that 63 (48.1%) were positive exclusively with the OvMANE1 test, 13 (9.9%) exclusively with the Ov-16 test and 25 (19.1%) with both tests. Nine European samples from individuals without past travel history in onchocerciasis endemic zones and 15 samples from Rwanda, a hypoendemic country for onchocerciasis were all negative for the OvMANE1 and Ov-16 tests. However, the specificity of both tests was difficult to determine due to the lack of a gold standard for antibody tests. In conclusion, the tandem use of OvMANE1 and Ov-16 tests improves the sensitivity of detecting Onchocerca volvulus seropositive individuals but, the OvMANE1 test needs to be further evaluated on samples from a population infected with other helminths to cautiously address its specificity.
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Vini V, Antony S, Jacob T, Sasimohan A, Jacob AM, Idikula MJ, Cherian J. A fatal combination of disseminated strongyloidiasis with two bacterial infections in an immunocompromised host. Access Microbiol 2021; 3:000246. [PMID: 34595397 PMCID: PMC8479966 DOI: 10.1099/acmi.0.000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Strongyloides stercoralis is an intestinal nematode that is endemic in tropical countries. It can have a variable presentation ranging from asymptomatic eosinophilia in immunocompetent hosts to disseminated disease with sepsis in immunocompromised hosts. Case report We report a case of chronic diarrhoea and decreased appetite in a 53-year-old man. He was a chronic alcoholic with diabetes, hypertension and dyslipidaemia and had earlier been treated for pulmonary tuberculosis. He was treated symptomatically for loose stools at a primary health care facility without relief. Following referral to our tertiary care centre, microscopic examination of the stool showed numerous larvae and a few eggs of Strongyloides stercoralis. Additionally, Aeromonas sobria was isolated from stool culture. The patient was discharged following improvement with a combination therapy of ivermectin, albendazole and ciprofloxacin. However, within 3 days, he was readmitted and succumbed to Escherichia coli sepsis. Conclusion Strongyloidiasis can be diagnosed easily using a very simple but often neglected investigation, namely stool microscopy. This provides an early diagnosis, based on which prompt treatment with the appropriate antihelminthics can be started, thereby reducing the probability of disseminated infection. Disseminated strongyloidiasis is a medical emergency with a poor prognosis, especially in an immunocompromised state. Such patients should be treated aggressively with antihelminthics. They must be monitored for sufficient duration in the hospital for early signs of complication. Their discharge from hospital should be planned based on a negative stool microscopy report in addition to clinical improvement, so as to decrease the mortality reported for both untreated and treated individuals.
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Affiliation(s)
- Vineeta Vini
- Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Sherly Antony
- Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
- *Correspondence: Sherly Antony,
| | - Teena Jacob
- Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Archana Sasimohan
- Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Aneeta Mary Jacob
- Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Mercy John Idikula
- Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
| | - Jacob Cherian
- Department of Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
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Hailu T, Nibret E, Amor A, Munshea A. Strongyloidiasis in Africa: Systematic Review and Meta-Analysis on Prevalence, Diagnostic Methods, and Study Settings. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2868564. [PMID: 33274200 PMCID: PMC7683116 DOI: 10.1155/2020/2868564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Strongyloidiasis is an intestinal parasitic infection mainly caused by Strongyloides stercoralis. Although it is a predominant parasite in tropics and subtropics where sanitation and hygiene are poorly practiced, the true prevalence of strongyloidiasis is not known due to low-sensitivity diagnostic methods. OBJECTIVE This systematic review and meta-analysis is aimed at determining the pooled prevalence of strongyloidiasis in African countries, stratified by diagnostic methods, study settings, and patients. METHODS Cross-sectional studies on strongyloidiasis published in African countries from the year 2008 up to 2018 in PubMed and Google Scholar databases and which reported at least one Strongyloides spp. infection were included. Identification and screening of eligible articles were also done. Articles whose focus was on strongyloidiasis in animals, soil, and foreigners infected by Strongyloides spp. in Africa were excluded. The random effects model was used to calculate the pooled prevalence of strongyloidiasis across African countries as well as by diagnostic methods and study settings. The heterogeneity between studies was also computed. RESULT A total of 82 studies were included. The overall pooled prevalence of strongyloidiasis was 2.7%. By individual techniques, the pooled prevalence of strongyloidiasis was 0.4%, 1.0%, 3.4%, 9.3%, 9.6%, and 19.4% by the respective direct saline microscopy, Kato-Katz, formol ether concentration, polymerase chain reaction, Baermann concentration, and culture diagnostic techniques. The prevalence rates of strongyloidiasis among rural community, school, and health institution studies were 6.8%, 6.4%, and 0.9%, respectively. The variation on the effect size comparing African countries, diagnostic methods, study settings, and patients was significant (P ≤ 0.001). CONCLUSIONS This review shows that strongyloidiasis is overlooked and its prevalence is estimated to be low in Africa due to the use of diagnostic methods with low sensitivity. Therefore, there is a need for using a combination of appropriate diagnostic methods to approach the actual strongyloidiasis rates in Africa.
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Affiliation(s)
- Tadesse Hailu
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar City, Ethiopia P.O. Box 79
| | - Endalkachew Nibret
- Biology Department, Science College, Bahir Dar University, Bahir Dar City, Ethiopia P.O. Box 79
| | | | - Abaineh Munshea
- Biology Department, Science College, Bahir Dar University, Bahir Dar City, Ethiopia P.O. Box 79
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Dawaki S, Al-Mekhlafi HM, Ithoi I. The burden and epidemiology of polyparasitism among rural communities in Kano State, Nigeria. Trans R Soc Trop Med Hyg 2020; 113:169-182. [PMID: 30551211 DOI: 10.1093/trstmh/try128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/23/2018] [Accepted: 11/18/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Parasitic infections constitute a major public health problem worldwide, particularly among underprivileged communities in developing countries including Nigeria. The present study aimed to determine the epidemiology of polyparasitism (multiple parasitic infections) among rural communities in Kano State, North Central Nigeria. METHODS A total of 551 individuals were screened for the presence of intestinal, urogenital and blood parasites by using different diagnostic techniques. Demographic, socioeconomic, household and behavioural characteristics were collected using a pre-tested questionnaire. RESULTS Overall, 84.0% (463/551) of the participants were found to be infected with at least one parasite species, with 51.2% (282/551) of them having polyparasitism. The most prevalent parasites were Plasmodium falciparum (60.6%) followed by Blastocystis sp. (29.2%) and hookworm (15.4%). No significant association was found between malaria and helminth infections (p>0.05). Univariate and multivariate analyses showed that the presence of other family members who had intestinal polyparasitism (adjusted odds ratio [AOR]=4.12; 95% CI=2.72, 6.24), walking barefoot outside (AOR=1.70; 95% CI=1.09, 2.63) and being male (AOR=1.74; 95% CI=1.14, 2.66) were the significant risk factors of intestinal polyparasitism among the population studied. CONCLUSION Polyparasitism is highly prevalent among rural communities in Kano State. Therefore, effective, sustainable and integrated control measures should be identified and implemented to significantly reduce the burden and consequences of these infections in rural Nigeria.
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Affiliation(s)
- Salwa Dawaki
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,School of Health Technology, Club Road, Nassarawa, Kano, Kano State, Nigeria
| | - Hesham M Al-Mekhlafi
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia.,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Init Ithoi
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Strong-LAMP Assay Based on a Strongyloides spp.-Derived Partial Sequence in the 18S rRNA as Potential Biomarker for Strongyloidiasis Diagnosis in Human Urine Samples. DISEASE MARKERS 2020; 2020:5265198. [PMID: 32566039 PMCID: PMC7281818 DOI: 10.1155/2020/5265198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/24/2020] [Indexed: 01/14/2023]
Abstract
Human strongyloidiasis a soil-transmitted infection caused by Strongyloides stercoralis is one of the most neglected amongst the so-called Neglected Tropical Diseases (NTDs). S. stercoralis is a nematode, which is distributed worldwide; it has been estimated that it could affect millions of people, mainly in tropical and subtropical endemic regions. The difficulties of diagnosis lead to infection rates being underreported. Asymptomatic patients have chronic infections that can lead to severe hyperinfection syndrome or disseminated strongyloidiasis in immunocompromised patients. Strongyloidiasis can easily be misdiagnosed because conventional faecal-based techniques lack of sensitivity for the morphological identification of infective larvae in faeces. None of the currently used molecular methods have used urine samples as an alternative to faecal samples for diagnosing strongyloidiasis. This study was thus aimed at comparing, for the first time, the use of a new loop-mediated isothermal amplification (LAMP) molecular assay (Strong-LAMP) to traditional methods on patients' urine samples. Twenty-four urine samples were taken from patients included in a study involving two Spanish hospitals for strongyloidiasis screening using parasitological and serological tests. Strongyloides larvae were found in 11 patients' faecal samples, thereby ascertaining that they had the disease. Other patients had high antibody titres but no larvae were found in their faeces. All urine samples were analysed by PCR and Strong-LAMP assay. No amplification occurred when using PCR. Strong-LAMP led to detecting S. stercoralis DNA in urine samples from patients having previously confirmed strongyloidiasis by parasitological tests and/or a suspicion of being infected by serological ones. The Strong-LAMP assay is a useful molecular tool for research regarding strongyloidiasis in human urine samples. After further validation, the Strong-LAMP assay could also be used for complementary and effective diagnosis of strongyloidiasis in a clinical setting.
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Morales ML, Lopez M, Ly P, Anjum S, Fernandez-Baca MV, Valdivia-Rodriguez AM, Mamani-Licona FM, Baca-Turpo B, Farfan-Gonzales N, Chaman-Illanes Y, Cabada MM. Strongyloides stercoralis Infection at Different Altitudes of the Cusco Region in Peru. Am J Trop Med Hyg 2020; 101:422-427. [PMID: 31264557 DOI: 10.4269/ajtmh.18-0568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Strongyloides stercoralis affects 30-100 million people worldwide. The burden is underestimated because of the paucity of studies, limited geographical areas surveyed, and poor quality of diagnostic tests. This study aimed at determining the epidemiology of strongyloidiasis using sensitive microscopy testing in rural populations living at different altitudes in Cusco, Peru. Data were collected from subjects aged > 3 years living in Quellouno (elevation 2,600 ft) and Limatambo (elevation 8,379 ft) districts. Subjects provided one fresh stool sample and answer a standardized questionnaire. Fresh stool was tested on site using the Baermann's test and agar plate culture. Formalin-preserved stool was tested by rapid sedimentation. Eighty percent (585/715) of eligible subjects consented to participate; after excluding subjects with missing data, 65% (462/715) were included. Fifty-five percentage were female; the median age was 33 years (interquartile range 13-52), and 72% had government health insurance. Half had intestinal parasites, and Strongyloides was the most common (24.5%) followed by Giardia (15.5%), Blastocystis (14.9%), and hookworm (11.5%). The agar plate culture detected more cases of Strongyloides than Baermann's or sedimentation tests. Strongyloides infection was more common at low altitude (26.4%) than at high altitude (18.6%), but the difference was not statistically significant (P = 0.08). Older age, walking barefoot, bathing in rivers/streams, and using municipal sewage were associated with strongyloidiasis. Strongyloides was the most prevalent parasite in the areas studied and was associated with demographic, socioeconomic, and sanitary factors.
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Affiliation(s)
- Maria Luisa Morales
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Martha Lopez
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Priscilla Ly
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Seher Anjum
- Division of Infectious Diseases, Department of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Martha Vanessa Fernandez-Baca
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Angela Maria Valdivia-Rodriguez
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Frecia Maribel Mamani-Licona
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Benicia Baca-Turpo
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Nedhy Farfan-Gonzales
- Sede Administrativa de la Red de Servicios de Salud Cusco Norte, Ministerio de Salud, Cusco, Peru
| | - Yeshica Chaman-Illanes
- Centro de Salud de Putucusi, Red de Servicios de Salud Cusco Norte, Ministerio de Salud, Cusco, Peru
| | - Miguel Mauricio Cabada
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru.,Division of Infectious Diseases, Department of Medicine, University of Texas Medical Branch, Galveston, Texas
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Van De N, Minh PN, Van Duyet L, Mas-Coma S. Strongyloidiasis in northern Vietnam: epidemiology, clinical characteristics and molecular diagnosis of the causal agent. Parasit Vectors 2019; 12:515. [PMID: 31685003 PMCID: PMC6829963 DOI: 10.1186/s13071-019-3776-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background Strongyloidiasis is a health problem in Vietnam, but appropriate information is still limited. The aim of this study was to determine the prevalence, geographical distribution, epidemiological aspects, symptoms and other health indicators of Strongyloides stercoralis infections in patients from 27 provinces of northern Vietnam attending the Hanoi Medical University Hospital during 2016 and 2017. Methods Blood samples of 2000 patients were analyzed for S. stercoralis infection with an IgG ELISA test. Seroprevalence was analyzed by gender, age group, locality of origin (rural or urban areas) and symptoms. Stools from the seropositive patients were examined for the detection of worms which were subsequently used for species identification by morphology and rDNA ITS1 sequencing. Results A seroprevalence of 20% was detected, showing an increasing prevalence from young to older age groups but without significant gender difference. Seroprevalence was higher in rural areas than in urban areas, both in general and individually in all provinces without exception, and lower in the mountainous areas than in the large valley lowlands. The follow-up of the 400 patients showed eosinophilia in 100% of cases, diarrhoea in 64.5%, digestion difficulties in 58.0%, stomachache in 45.5%, stomach and duodenal ulcers in 44.5%, itching in 28.0% and fever in 9.5%. The prevalence of symptoms and signs were also higher in older age groups than in younger age groups. Worms were detected in stools of 10.5% of the patients. Sequencing of a 501-bp nuclear ribosomal DNA ITS1 fragment allowed for the verification of infection by Strongyloides stercoralis. Conclusions To our knowledge, this study is the largest survey of human strongyloidiasis in Vietnam so far and the first molecular identification of this nematode species in this country. Long-term chronicity may probably be usual in infected subjects, mainly in the older age groups.
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Affiliation(s)
- Nguyen Van De
- Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam.
| | - Pham Ngoc Minh
- Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam
| | - Le Van Duyet
- National Hospital of Tropical Diseases 78 Giai Phong, Hanoi, Vietnam
| | - Santiago Mas-Coma
- Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Av. Vicent Andrés Estellés s/n, Burjassot, 46100, Valencia, Spain
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Prevalence and risk factors of Strongyloides stercoralis infection among Orang Asli schoolchildren: new insights into the epidemiology, transmission and diagnosis of strongyloidiasis in Malaysia. Parasitology 2019; 146:1602-1614. [PMID: 31303180 DOI: 10.1017/s0031182019000945] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This cross-sectional study aimed to determine the prevalence and risk factors of S. stercoralis infection among 1142 Orang Asli primary schoolchildren in six different states of Peninsular Malaysia. Fecal samples were examined using direct smear, formalin-ether sedimentation (FES), agar plate culture (APC) and PCR techniques. Overall, 15.8% of the children were found to be infected with S. stercoralis. The prevalence was 0.2, 1.3, 15.2 and 13.7% by direct smear, FES, APC and PCR, respectively. Multivariate analysis showed that an age of >10 years, being male, belonging to a Proto-Malay tribe, belonging to the Senoi tribe, indiscriminate defecation, using an unimproved water source for drinking water and not wearing shoes when outside were the significant risk factors of infection among these children. In conclusion, we provide new evidence on the occurrence of S. stercoralis in Malaysia to show that there is a relatively high prevalence of infection among Orang Asli schoolchildren. Therefore, the use of specific methods for detecting S. stercoralis should be considered when screening these children for intestinal parasites. Moreover, prevention and control measures specific to S. stercoralis should be integrated into the intestinal parasitic infections control programme in Malaysia.
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