Strongyloides stercoralis infectionBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4610 (Published 30 July 2013) Cite this as: BMJ 2013;347:f4610
All rapid responses
Greaves et al provide a valuable overview of the pathophysiology, clinical manifestations, and current approaches to the diagnosis and treatment of Strongyloides stercoralis infection.1 Inexplicably they neglect to address the measures necessary for interrupting its diabolical transmission cycle; ensuring that faeces is disposed of safely. Possibly this is due to a sense of embarrassment at our tardy global progress towards meeting the sanitation component of Millennium Development Goal 7.
The World Health Organization appears to have thrown its arms up in despair with a defeatist: ”No public health strategies for controlling the disease are active at the global level.”2 And thus it is hardly surprising that this soil-transmitted helminth infection is now considered by some as the most neglected of the neglected tropical diseases, infecting up to 100 million people worldwide.3
Preventive chemotherapy approaches are now being advocated but are we overlooking the obvious. Time-honoured public health tradition argues that the cycle of transmission could be interrupted by simply wearing footwear. This has been supported by compelling scientific evidence from high risk environments.4
The considerable recent investment in neglected tropical disease diagnostic and therapeutic research should extend to providing culturally appropriate education and protective footwear in high risk communities.
1. Greaves D, Coggle S, Pollard C, Aliyu SH, Moore EM. Strongyloides stercoralis infection. BMJ 2013;347:f4610 doi: 10.1136/bmj.f4610.
2. World Health Organization. Neglected tropical diseases. Strongyloidiasis. http://www.who.int/neglected_diseases/diseases/strongyloidiasis/en/ Accessed 8 August 2013
3. Olsen A, van Lieshout L, Marti H, Polderman T, et al. Strongyloidiasis--the most neglected of the neglected tropical diseases? Trans R Soc Trop Med Hyg 2009; 103: 967-72.
4. Krolewiecki AJ, Lammie P, Jacobson J, Gabrielli A-F, et al. A public health response against Strongyloides stercoralis: time to look at soil-transmitted helminthiasis in full. PLoS Negl Trop Dis 2013; 7: e2165.
5. Yori PP, Kosek M, Gilman RH, Cordova J, et al. Seroepidemiology of strongyloidiasis in the Peruvian Amazon. Am J Trop Med Hyg 2006; 74: 97-102.
Competing interests: No competing interests