Strongyloides
stercoralis, a Neglected Tropical Disease, is
prevalent among particular Indigenous communities in remote areas of Australia.
Strongyloidiasis, in many areas is
a hyperendemic, prevalence rates have been known to be above 40%, and is more
prevalent in parts of Australia than in the worst affected third world
countries.
Strongyloidiasis is a gastrointestinal parasitic nematode infection that can
persist in the hosts for decades, enter the body through intact skin and be transmitted
via fecal matter. S stercoralisis is
autoinfective, meaning that infective larvae can form in the human body and
re-infect the host. This unique feature has a few important health implications.
Without treatment the autoinfective nature of strongyloidiasis results in lifelong infection. The
larvae re-entering the body can also result in large quantities of worms building
up and causing hyperinfection. Re-entry of larvae can carry enteric bacteria
into other organs causing a range of septic events such as septicaemia or
pneumonia. Individuals with poor immune health run a high risk of having a
hyperinfection, if hyperinfection occurs it has a fatality rate over 60%. The
persistence and ease of fecal infection along with the high mortality rates
associated with hyperinfection make the infection a serious threat to the
public health. Co-infection from HTLV-1, found among 77% of hyperinfected strongyloidiasis cases, is associated with resistance to treatment, development of
T-cell leukaemia and higher mortality rates.
Strongyloidiasis
is non-existent in urban areas of Australia highlighting the poor conditions
that some citizens live in. Strongyloidiasis, being both curable and a
significant health issue, must have new and innovative strategies to resolve
the issue.
Research suggests
3 key barriers to treating strongyloidiasis in Indigenous areas:
1) Health status,
both past and present
2) Socioeconomic
status and the associated issues of their living conditions
3) Heath care
literacy such as failure to recognise symptoms, lack of communication and treatment
non-compliance
It is important to
address these barriers in order to effectively control the infections. Research
suggests that better protocols of reporting cases, more widespread testing,
better education for health care professionals, increased health literacy in
Indigenous communities as well as improved measurement, reporting and subsequent action will help remove the barriers to strongyloidiasis treatment. An
example of such action, which fits the opinions of some researchers, is that
adding strongyloidiasis to Australia’s National Notifiable Diseases Surveillance
System (NNDSS) will help to assist in widespread public health action, as
management of individual patients hasn’t appeared to sufficiently address the
issue and greater information is required for a targeted approach.
It is important to
address the issues of strongyloidiasis so that it is no longer neglected, and
one step further towards taking the neglect out of NTDs.
References
Adams, M, Page, W, & Speare, R 2003. 'Strongyloidiasis: an issue in Aboriginal communities', Rural and remote health. Vol.3, no. 1, pp.152. Available from: https://www.researchgate.net/publication/7864410_Strongyloidiasis_an_issue_in_Aboriginal_communities
Kearns, TM, Andrews, R, Speare, R, Cheng, A, McCarthy, J, Carapetis, J,
Currie, B, Page, W & Shield, J, 'Prevalence of scabies and strongyloidiasis
before and after MDA in a remote Aboriginal community in Northern Territory,
Australia', International Journal of
Infectious Diseases, vol. 21, p. 252. Available from: http://dx.doi.org/10.1016/j.ijid.2014.03.944
http://www.ijidonline.com/article/S1201-9712(14)01003-0/pdf.
[2017/02/21].
Miller, A, Smith, ML, Judd, JA &
Speare, R 2014, 'Strongyloides stercoralis: Systematic Review of Barriers to
Controlling Strongyloidiasis for Australian Indigenous Communities', PLOS Neglected Tropical Diseases, vol.
8, no. 9, p. e3141. Available from: http://dx.doi.org/10.1371%2Fjournal.pntd.0003141
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