R Revista Peruana deP P Parasitología Volumen 18 - Número 2 - Año 2010 ISSN 2219-0848 (Versión Electrónica) Artículos Originales/Original Articles Distribution of prevalence of Strongyloides stercoralis in Peru (1981-2010): an exploratory study Distribución de la prevalencia de Strongyloides stercoralis en el Perú (1981-2010): un estudio exploratorio a,b c,d e b b Luis A. Marcos R , Rufino Cabrera , Jorge D. Machicado , Marco Canales , Angélica Terashima . a. Infectious Diseases Department, Forrest General Hospital, Hattiesburg, MS, USA. b. Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú. c. Grupo Temático de Enfermedades Metaxénicas, Dirección General de Epidemiología, Ministerio de Salud. Lima, Perú d. Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas. Lima, Perú. e. Internal Medicine Department, University of Texas Health Science, Houston, TX, USA Resumen Abstract La estrongiloidosis es endémico en regiones tropicales y subtropicales de Latinoamérica. En Perú, el impacto de Strongyloides stercoralis en salud pública es desconocido. El objetivo del presente estudio es describir la distribución espacial y temporal de la prevalencia de S. stercoralis en Perú entre 1981 y 2010; y las poblaciones más afectadas. Se realizó una búsqueda de los estudios epidemiológicos en las base de datos de LIPECS, LILACs, Scielo Peru, MEDLINE y Google Scholar. Los estudios incluidos en el estudio fueron aquellos que reportaban prevalencia de S. stercoralis usando cualquier técnica parasitológica. Entre 1981 y 2010, la tasa de prevalencia global fue 6,3 %. Un total de 3 695 personas fueron reportadas con S. stercoralis en durante los 30 años. De 1981 a 2001, un total de 3 013 sujetos tuvieron S. stercoralis en heces que representa una prevalencia global de 6,6 %. De 2002 a 2010, un total de 676 sujetos tuvieron S. stercoralis en heces, representando una tasa de prevalencia global de 5,1 %. Se notó una reducción en la prevalencia global durante los 30 años excepto en la región de la costa, hallazgo que merece mayor investigación. En conclusión, S. stercoralis es hiperendémico en varias zonas de la selva del Perú con menor grado en la costa y sierra. Futuros estudios epidemiológicos deben usar técnicas diagnosticas altamente sensibles para la detección de larvas de S. stercoralis tales como la técnica de Baermann modificada en copa o el cultivo de agar en placa para evitar la subestimación de esta parasitosis. Strongyloidiasis is endemic in tropical and subtropical regions of Latin America. In Peru, the impact of Strongyloides stercoralis in public health is unknown. The objective of the present study is to describe the spatial and temporal distribution of the prevalence of S. stercoralis in Peru between 1981 and 2010, and the most affected populations. A search for epidemiological studies was performed in the database of LIPECS, LILACs, Scielo Peru, MEDLINE and Google Scholar. The studies that reported prevalence of S. stercoralis by using any parasitological technique were included. Between 1981 and 2010, the global prevalence rate was 6.3 %. A total of 3,695 people were reported with S. stercoralis in stools during the last 30 years. From 1981 to 2001, a total of 3,013 subjects had S. stercoralis in stools that represents a global prevalence rate of 6.6 %. From 2002 to 2010, a total of 676 subjects had S. stercoralis in stools that represents a global prevalence rate of 5.1 %. A global reduction of prevalence was noted during the last 30 years except in the Coastal region, which deserves further research. In conclusion, S. stercoralis is hyperendemic in many areas of the rainforest of Peru into a lesser extent in the coast and Andean region. Future epidemiological studies should use highly sensitive diagnostic techniques for S. stercoralis larvae detection such as Modified Baermann's Technique or Agar-plate Culture to avoid underestimating this parasitosis. Key words: Strongyloidiasis│ Strongyloidiasis/epidemiology│ Strongyloidiasis/ prevention & control │ Strongyloides stercoralis │ Peru. Palabras clave: Estrongiloidiasis │ Estrongiloidiasis/epidemiología │ Strongyloidiasis/ prevención & control │ Strongyloides stercoralis │ Perú. Suggested citation: Marcos LA, Cabrera R, Machicado JD, Canales M, Terashima A. Distribution of prevalence of Strongyloides stercoralis in Peru (1981-2010): an exploratory study. Rev peru parasitol. 18(2): e39- e40. 39 stercoralis.Año 2010 ISSN 2219-0848 (Versión Electrónica) Introduction (14) Peru in 2000.3) made when larvae are found in fresh stools. will undoubtedly contribute in the development of prevention and control measures. A search for epidemiological studies was performed in the following databases: LIPECS http://www. but an unequivocal diagnosis of S. 18 (2) Acceso gratuito en línea a texto completo.pe http://www. “Peru”. S.pe/vrinve/dugic/ MEDLINE http://www. et al. A manual search was carried out for the non-electronic publications.(3) Serological tests by antibody detection may indicate an old or past infection. The filariform larvae can migrate from the intestine throughout multiple organs causing the hyperinfection syndrome and dissemination and it can cause high morbidity and mortality (~69 %) especially in the immunocompromised host.Artículo Original Marcos L. “stercoralis”. Prevalence of Strongyloides stercoralis in Peru.Número 2 . stercoralis is (1. stercoralis”.scielo.(13) first reported in Rev peru parasitol 2010. risk factors for acquiring the infection are frequent bathing in rivers and walking barefoot mainly. Material and methods Search strategy. but its diagnosis still remains a challenge. little evidence is available about S. stercoralis in Peru. pre-screening of people from Latin America for strongyloidiasis was suggested because profound immunosuppression is required after transplantation.(12) This syndrome can also be caused by S. Important advancements in diagnosis and immunology of S. endemic in Peru.pe/vrinve/dugic/ LILACs http://lilacs. “Prevalencia/Prevalence”. with some additional references.(15) Endemic areas are present in developing countries.(11) Moreover. fuelleborni.edu.org.bvsalud.com/ Disclosing endemic areas and the most susceptible populations affected by S. Preserved stool samples may decrease sensitivity because alive larvae are required to migrate in water or agar culture. stercoralis. It is well known the association between severe strongyloidiasis and those coinfected with the human T-cell-lymphotropic virus 1 (HTLV-1). Revista Peruana de Parasitología Volumen 18 . After finding 6 % of 83 Latin-American patients before organ transplantation with positive serology for S.upch.google. stercoralis and its public health impact in Peru.(4) Several methods have been described for detection of S. HTLV-1 is highly frequent in patients who develop S.9) strongyloidiasis is ivermectin. In endemic areas.(7) The drug of choice for (8.(1)An estimate of 30-100 million people are infected in tropical and (2) subtropical regions worldwide. The objective of the present study is to report the spatial and temporal distribution of prevalence along with the most affected populations by S. but cases have also been reported in industrialized (3. The combined terms used in Spanish or English for the searching were “S.pubmed. and book abstracts from local meetings. replication of the adult form into the intestines allowing perpetual infection.(17) S trongyloides stercoralis is a nematode that can infect humans by causing the disease strongyloidiasis. "Strongyloidosis/Strongyloidiasis". stercoralis have evolved in the last years in Peru.edu.6) Baermann's technique (MBT).16) countries due to immigrations. stercoralis in the United States.(3) To the best of our knowledge. The most sensitive parasitological techniques are the agar plate culture and modified (5. It can survive in humans for years under a singular mechanism called autoinfection.org/ Scielo Peru http://www. as an alternative. stercoralis hyperinfection in Peru.upch. or thiabend(10) azole. stercoralis has unique features in both pathogenesis and life cycle. The studies from 1981 to 2001 were included from a previous publication(18).com Google scholar http://scholar. thesis.(19-21) 40 . 3 45. stercoralis in all regions was 6. given the variability of diagnostic techniques used among studies per region and the need to reduce selection and misclassification bias.4) and in the rainforest.0001 Tota l 6.02 Andean 1.1 0.2 % (n=26 173. and carried out in a specific geographic location.1 2. 95 % CI =13. 95 % Confidence Interval (CI) =6.14. 95 % CI =3. Figure 1). The global prevalence of S. the prevalence rate in the coast was 4. stercoralis in humans using any parasitological technique.45). a total of 12. Comparison of Table 1.653 6. Prevalence of Strongyloides stercoralis in Peru. In order to minimize potential misclassification bias of endemic areas into low or high endemic regions.5). Prevalence from 1981 to 2001. Overall. A total of 683 cases had stercoralis in Peru by cross-sectional studies published between 1981 and 2010.2 23.685 1.6 %.01 0.7 %.Número 2 .234 1. stercoralis in the stools.3 5. 41 . and. the study with the highest prevalence rate was considered for the final stratification analysis. Results Statistical analysis.999 5.05 was considered level of significance. Revista Peruana de Parasitología Volumen 18 . Prevalence from 2002 to 2010.6.1 .6 11.0001 Coast ‡ = Dates from References 18-21 Rev peru parasitol 2010. A sub analysis was carried out to compare prevalence rates per region according to the diagnostic technique used. ranging from 0. direct communication to authors was performed when needed. The results of one study with one or more communities were assumed to represent to the rest of the districts in a province.1 .25 % (n total = 59 268.9 4. iii) hypoendemic < 1 %. 95 % CI =1. The global prevalence rate was 6. This stratification according to the prevalence rates was performed with at least one study in children or adults or both.Año 2010 ISSN 2219-0848 (Versión Electrónica) Furthermore.1 % to 61.Artículo Original Marcos L. Global prevalence rates of S.6 12. ii) mesoendemic between 1 to 10 %. In addition.48 0.923 5.999 subjects in 35 studies from 14 departments were included in the present study (22—51) (Table 1.842 8. A total of 3 013 subjects had larvae of S. under the hypothesis that the prevalence was similar in the rest of the province. Data from this period was analyzed from a report performed by the Ministry of Health in Peru in 2003.18 4. Inclusion Criteria.2 0.1 . in the Andean region was 1.6 % (n= 17 763. When more than one study within a province or between neighbor provinces independently of the year were present. and given the variability in the detection rate of diagnostic tools as well as number of stool samples that could potentially affect prevalence rates. 1981-2010 Geographi c region Prevalence between 1981 and 2010. Epidemiological studies published from 1981-2010 that had prevalence data of S. Results of prevalence rates per region between periods of 1981-2001 and 2002-2010 are showed in Table 1.3 10. In this period.(18) and other studies included in this period were added.(19-21) A total of 45 653 subjects in 93 studies from 20 departments were included. proportions was performed using Chi-square. a comparison of the global prevalence per region and by diagnostic techniques was performed. We only included original studies performed in the general population independently of age. 18 (2) Acceso gratuito en línea a texto completo.3 % (n=15 332. we arbitrarily nominated the endemic areas (provinces) in three groups separated by a large range of percentages: i) hyperendemic ≥ 10 %. et al.921 16.27 Rainforest 13.1.047 4. ‡ 1981-2001 2002-2010 Global preva lence (%) Sam ple (n) Global pre val ence (%) Sampl e (n) Gl oba l pr eva lence p-va lue 4. A p-value < 0.1). 13. 001). Mapping S.2 %. Overall prevalence rate in children was 1. and in the rainforest. S. In the Andean region. The geographic distribution of S. and in the general population.9 %. A summary of the studies from 2002 to 2010 is presented in Table 2. Additional information. Prevalence of Strongyloides stercoralis in Peru.Año 2010 ISSN 2219-0848 (Versión Electrónica) Code 19 20 5 6 14 LEGEND PROVINCES 16 Hypoendemic Mesoendemic 10 Hyperendemic 7 Information not avialable 3 1 21 9 13 22 8 17 18 Lima 15 23 12 4 24 11 2 Figure 1. 1.2 % (p>0. From a reference of (21) the period 1981-2001. stercoralis larvae in stools with prevalence rates ranging from 0. 8.Artículo Original Marcos L. Revista Peruana de Parasitología Volumen 18 . prevalences ranged from 0.52) Out of 4 124 people included in these studies. Stratification of endemic areas of S. 6. Rev peru parasitol 2010. a sub analysis of the prevalence rates stratified by diagnostic technique in each region was performed. this subanalysis could be the best approach to reality given the limitations in each study and heterogeneity among them. Stratification of endemic areas of Strongyloides in this period is presented in Figure 1.2 % (n=6 511). 18 (2) Acceso gratuito en línea a texto completo. the prevalence rates by direct smear test was 4. stercoralis in Peru. 5. Prevalence by diagnostic techniques.5 % (n=4 234). the prevalence rates by direct smear test was 2. including spontaneous sedimentation technique in tube (SSTT).(21. and by MBT was 5.Número 2 . additional information was included as supplemental data containing 13 studies during the period 1962-1975 (Table 3).1 % (n=5 842) (p<0. In the studies that described the general population both children and adults together. 39. Global prevalence for this period was 5.96 % (n=3 054). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 42 . adults or general population. The population described in these studies was as follows: children. stercoralis larvae in stools by MBT. et al.1 %. Most of these studies were applied in the rainforest. Out of the studies collected from the period 20022010. by other techniques. Andean region. it was not possible to analyze the data stratified by age.3 % to 39 % in Peru.6 % to 96. By assuming each region has similar risk for transmission.0 % (n=2 923).05). 6. Province Anta Arequipa Asunción Azángaro Alto Amazonas Bagua Cajabamba Callao Chanchamayo Chiclayo Cusco Huamanga Huaral Jaén Jauja Lamas La Convención Lima Maynas Morropón Oxapampa Oyón Sandia Víctor Fajardo stercoralis in Peru (2002-2010).5 %. stercoralis in Peru for the period 2002-2010 by endemicity per region was: in the coast. In the coast.4 % had S.4 % (n=3 434). in adults. 2 2 38 8 1.2 35 20 07 47 O xa pam pa Harada-Mori 98 1 .Año 2010 ISSN 2219-0848 (Versión Electrónica) Table 2.3 15 Gener al 20 02 40 14 2 7.1 2 Children 20 07 26 Ancas h A sunción 70 6 0. Rev peru parasitol 2010.2 2 Children 20 02 35 13 2 0.9 15 Adults 20 06 24 Lim a MBT 205 6 6.2 Jauja SST T 96 1. Depart ment Coast P rovince Callao C allao Lambayeque C hicla yo Lima stercoralis in Peru by cross-sectional studies published from 2002 to 2010.5 42 Gener al population Gener al population 20 05 49 Adults 20 09 50 Gener al 20 02 51 Puno S andia MBT 72 1. et al.1 5 Children 20 07 38 Rainforest Am azonas Bagua Teleman 104 9 0.8 1 20 08 36 63 4.8 3 Gener al population Children 20 05 37 23 6 2. Prevalence of S.4 1 San Martín Lam as RST 26 4 0.5 1 Total 13 5 26 692 Gener al population population SSTT: spontaneous sedimentation technique in tube. Revista Peruana de Parasitología Volumen 18 .0 10 20 06 41 11 3 2 1.8 13 Children 20 05 39 Cusco La Convención Direct s mear 112 0 1. Prevalence of Strongyloides stercoralis in Peru.9 71 Maynas MBT 41 2 4.3 2 27 A requipa 17 5 0.6 1 Gener al population 20 07 Arequipa Direct s mear tes t 20 02 28 Andean Ayacucho Cajamarca Huam anga SST T V íct or Fa jardo Rit chie 67 14 9 31 2 0 . For additional geographic information of studies between 1981 and 2001.9 10 La Convención Junín Loreto Pas co C hancham ayo tes t SST T population Children Gener al population Children 20 04 43 Gener al population 20 09 44 Gener al population 20 09 44 Adults 20 02 45 Maynas MBT 79 2 8. see reference 15-20.7 2 C hancham ayo MBT 40 0 1 4.5 6 populat ion Children Re ference 22 20 02 23 Lim a MBT 21 7 6.6 24 20 03 42 C hancham ayo MBT/A gar plat e MBT 54 3.0 123 Adults 20 09 25 Huara l MBT 17 3 1.1 1 C ajabamba Cusco Junín RST C usco Jauja SST T Lima O yon Piura Morropon Direct s mear tes t Puno A zángaro Direct s mear tes t MBT Gener al population Children 20 02 29 Gener al population 20 05 30 20 03 31 Adults 20 09 32 2 Children 20 07 33 2 Gener al population 20 02 34 Children 20 02 35 Gener al population 92 2.32 A nta Teleman/RST 14 3 1.Artículo Original Marcos L.8 59 C hancham ayo MBT 64 7 1 0.32 1 Jaén Direct s mear tes t 200 0 7.02 1 20 04 48 O xa pam pa Culture 10 9 3 8. MBT: modified Baermann's technique. 18 (2) Acceso gratuito en línea a texto completo. 43 .7 69 Adults 20 06 46 A lto Am azonas MBT/Cult ure 20 3 1 7.Número 2 . Diagnos tic test Direct sm ear/RST MBT S ample (n) P revale nce (%) Nº persons inf ect ed Population Y ear Ge ner al 20 02 89 2.3 146 Direct s mear tes t 25 6 0. RST: rapid sedimentation technique.8 2 Teleman 63 1 0 . Impact of diagnostic technique on distribution of S. the prevalence rates by direct smear test was 1.001) (Figure 2).1 % (p>0.73 36.4 Nº persons infected 1 118 7 205 29 11 122 191 1 115 83 3 729 1 615 Population Year General population General population General population General population General population Children General population General population General population General population General population General population General population 1965 1964 1970 1964 1970 1964 1975 1964 1964 1963 1962 1964 1964 Data was obtained from references 21 and 51. stercoralis was also found from 11. MBT/Agar culture stercoralis according to the prevalence studies from 2002-2010 . In Peru.6 % and by MBT was 11.3 %.05). The global prevalence of S. Revista Peruana de Parasitología Volumen 18 . after analyzing studies 12 Percentage 10 e 8 g a t n 6 e rc e P Coast Andean 4 Rainforest 2 0 Direct Smear Test Other techniques Figure 2.5 % was reported. Prevalence of Strongyloides stercoralis in Peru. In another study. In the rainforest.3 %).3 % throughout Peru during the period 1981-2010. Rev peru parasitol 2010. Ritchie's method and RST was 1.5 5. 18 (2) Acceso gratuito en línea a texto completo.Artículo Original Marcos L. Portillo Azángaro Rioja MBT MBT MBT MBT MBT MBT MBT MBT MBT MBT MBT MBT MBT 150 240 39 498 89 188 254 198 483 263 226 281 1215 4 124 0.72 1 60 39. 44 . a decreased trend in the prevalence of S.16 32. Prevalence of S. Department Ancash Cuzco Huánuco Junín Lima Loreto Madre de Dios Moquegua Pasco Ucayali Puno San Martin Total stercoralis in Peru by cross-sectional studies published from 1962 to 1975 (Supplemental data) Province Diagnostic test Sample (n) Prevalence (%) Pallasca La Convención Leoncio Prado Chanchamayo Chanchamayo Lima Maynas Tambopata Mariscal Nieto Oxapampa Cnel.1 %) than 1981-2001 (16.7 % during 1970-1985.03 96.Año 2010 ISSN 2219-0848 (Versión Electrónica) Table 3.9 41.2 %.5 0. from 1990 to 2009 a global prevalence rate of (53) 5. six provinces were classified as hyperendemic areas and were located in the rainforest except one in the Andean region. by other techniques (including SSTT and RST) was 1. improvements in sanitary. and by MBT was 2. hygienic and socioeconomic conditions may explain the lower rates.66 49 17. Perhaps.2 43.8 % (p<0. et al. stercoralis in the rainforest is statistically lower in the period 2002-2010 (8. stercoralis of 6.Número 2 . which is higher than other similar studies performed in other countries in Latin America. to 6 % during Discussion We have found a global prevalence rate of S.8 48. In Brazil. 6 %). and up to 96.2 % of vegetables (celery. which may be a risk factor for acquiring S. Among the number of diverse climate and microclimates present in Peru.55) In another multicentric study from the rainforest. because it is cold. larvae in about 63 % of lettuce in large markets in Lima city (59). because it is humid. leeks. Strongyloides larvae and careful attention should be paid to avoid misinterpretation. hot and rainy.(7) Factors including number of stools and sample preservation or transportation may be entertained as confounders. Sepahua y Nauta) from the Amazonic basin than those located at a higher altitude (700 meters above sea level) (Satipo and Rioja). MBT showed higher statistically significant prevalence rates than other techniques in the rainforest or hyperendemic areas. Rhabditis (Rhadbitiella) axei is very similar to S.4 % in the rainforest. the rate of endemicity can be invariably modified in proportion to the burden of larvae into the environment. stercoralis was found in the coast in this study. In contrast. the prevalence of S. A mesoendemic area for S. Immigration from Andean to rainforest region is usually between rainy season (January-March) associated to (58) agricultural activities. but this is not a breakthrough finding.5 %. stercoralis while working Rev peru parasitol 2010. its prevalence can reach up to 70 % even in these low-level altitude rainforest areas. As expected. Variability of prevalence rates may be explained by differences in sensitivity among the parasitological techniques applied in each study. Last. stercoralis about 39.(18) In fact. closer to the Andean region. 1990-1997.48 %). Poor hygienic conditions may enable establishing a favorable microenvironment for larval stage development where parasite may become in closer proximity to humans and so keeping it infectious. dry and less rainy. If unexpected climatological events cause high rainy seasons such as ENSO (El Niño Phenomenon). Small modifications to the Baermann's Technique can increase the sensitivity to detect (61) S. Interestingly. highest ever reported. stercoralis larvae. stercoralis in the coast was significantly higher in recent than remote years (from 4 % to 5 %). One of the most important is the heterogeneity of the studies regarding the diagnostic 45 .(18. stercoralis life cycle.Año 2010 ISSN 2219-0848 (Versión Electrónica) in the rainforest and then returning to the place of origin after agriculture season is finished. without improving sanitary conditions or changing human behavior. S. Prevalence of Strongyloides stercoralis in Peru. in a subanalysis we found that prevalence rates varied significantly in the rainforest when different techniques were applied (p < 0. Also. et al. but this difference was not significant in low-prevalent regions such as the coast and highlands. In fact. (54) In our study.3 %) in this study when compared to the coast (4. Revista Peruana de Parasitología Volumen 18 .4 %.18 % to 1. 18 (2) Acceso gratuito en línea a texto completo. Hypoendemic areas are widely distributed throughout the Andean region. These findings confirm the results from other studies which also showed that S. MBT was used in all the 14 studies and the overall prevalence rate was 39.2 %) and rainforest (13.Artículo Original Marcos L. ranging from 17. the rainforest seems to have an optimal environment for the development of S.(57) Conversely. in particular those located closer to the Pacific coast. spinach.(61) Several limitations are present in this study.(56) Nonetheless. lower prevalence rates were found in the Andean region (1.9 % to 96. stercoralis development than those in the Andean region. in the period of 1962-1975.Número 2 . and in 20. Another factor in the dissemination of infectious diseases is mobilization of population between regions. among others) designated to Lima city(60). those prevalence rates between 1981-2001 and 2002-2010 periods in the Andean region did not change significantly (from 1. the Andean region may not have an optimal climate for the development of larval stages. stercoralis prevalence was higher even in villages (Puerto Maldonado. supplemental data (period 1962-1975) showed a global prevalence of S.5 %.05). a study found Strongyloides spp. Climatological conditions in the coast are more environmentally optimal for S. stercoralis is widely hyperendemic in the rainforest. Genta RM. 2011. Marcos LA. 7. Herrera J. En: Guerrant RL. stercoralis endemic areas as an exploratory study for future projects. Factores asociados a la infección por Strongyloides stercoralis en individuos de una zona endémica en el Perú. Terashima A. along with its unique characteristics of perpetual infection. Analyzed the data: LM.(7) Other limitations are small sample size. Métodos de diagnóstico para . Brooker S. 6. pathogens. MC. population heterogeneity and disproportional number of studies per region. RC. 2006. 2006. AT. Hotez PJ. which deserves further investigation. and hookworm. Evaluación de la “Técnica de 46 Baermann modificada en copa” en el estudio de la strongyloidosis. S. Critically revised the manuscript for intellectual content: LM. Revista Peruana de Parasitología Volumen 18 . 3. 32(334): 119-26. Marcos L. Soil-transmitted helminth infections: ascariasis. Rev Gastroenterol Peru. Strongyloidiasis. RC. p. & practice. trichuriasis. Ideally. AT. the objective of this study was to try developing a mapping for assessment of S. eds. 13(1): 35-46. Rev peru parasitol 2010. The use of the direct smear test underestimates the prevalence rates of S. stercoralis when compared to the MBT or agar plate at a population-based level reduces the prevalence rates in about 58 %-88 %. 4. Técnicas de diagnóstico de enfermedades causadas por enteroparásito s. PA: Churchill Livingstone. Loukas A. Canales M. Terashima A. Terashima A.Artículo Original Marcos L. future studies might be needed to verify our results which remains informative. MC. Gotuzzo E. 5. Philadelphia. Alvarez H. we found that the use of direct smear as screening test for S. Walker DH. stercoralis in Peru may be considered to address this question. Gotuzzo E. Canales M. Marcos RL.Año 2010 ISSN 2219-0848 (Versión Electrónica) parasitological technique. a trend of the prevalence rates along the years should be performed in the same population in each village. Finally. Bethony J. Samalvides F. place S. A systematic review of prevalence studies about S. Rev Méd Peru. Lancet. RC. 18 (2) Acceso gratuito en línea a texto completo. JM. AT. 1999. direct smear underestimates the prevalence rates. et al. Weller PF. Drafted the manuscript: LM. A significant increase in prevalence rates was observed in the coast. In fact. Curr Infect Dis Rep. Unfortunately. RC. and therefore the routine use of highly sensitive techniques are recommended when possible. hyperendemic in the rainforest. The reason behind to include all studies. Update on strongyloidiasis in the immunocompromised host. 26(4): 357-62. Tropical infectious diseases: principles. Albonico M. Strongyloidiosis: I. was to analyze in detail the differences in prevalence rates by region (Figure 2) and to estimate the expected proportion of underestimation for S. In addition. stercoralis. References 1. the occurrence of S. Canales M. Geiger SM. 1963. Interpreted the data: LM. RC.Número 2 . Lumbreras H. using the same diagnostic parasitological technique in stools and stratified by age groups. lack of randomization methods. Prevalence of Strongyloides stercoralis in Peru. stercoralis throughout Peru and the potential adaptability of the parasite to other non-tropical regions. and less endemic in the Andean and coastal regions. independently of the stool-based technique applied. 975-84. invasion to multiple organs into the host and challenging diagnostic approaches. Data collection: LM. Nevertheless. 39(4): 197-8. stercoralis into a new dimension among the neglected tropical diseases of the world but in particular within Peru. In conclusion. Conflict of interest: None declared Author's Contributions Designed the study: LM. Tello R. stercoralis in the rainforest from 2002-2010 period was significantly lower than previous years. 2. Diemert D. Diagnóstico 2000. stercoralis throughout Peru. One could argue that the use of different parasitological techniques could be a limitation to compare studies or regions. stercoralis is endemic in all regions of Peru. 367(9521): 1521-32. JM. The prevalence of S. 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