title: Strongyloidiasis: a review of the evidence for Australian practitioners.
abstract: OBJECTIVE
  To summarise the available evidence concerning the prevalence, clinical manifestations, diagnosis and management of strongyloidiasis in Northern Australia.
  
  
  METHODS
  We searched Medline, Clinical Evidence and the Cochrane Library using MeSH terms and text words 'strongyloides OR strongyloidiasis'. For Australian studies we included text words '(parasite* OR parasitic OR helminth*) AND Australia*'. We examined references contained in retrieved studies or identified from direct contact with researchers. Studies consistent with our objective that described their methods were eligible for inclusion.
  
  
  RESULTS
  The prevalence in some tropical Aboriginal communities is high. Infection can be asymptomatic, cause a range of clinical syndromes or death. It may become chronic. Infected patients are at risk of developing severe disseminated disease particularly with immune compromise. There is little information about the relative frequency of different clinical outcomes. Available diagnostic tools are imperfect. Stool examination has a low sensitivity. Serology may have a low specificity in high prevalence populations and has not been evaluated in Aboriginal populations. Antihelmintic drugs are relatively safe and effective. Community programs based on treatment of stool-positive cases have been associated with a reduced prevalence of strongyloidiasis. We found no studies examining alternative public health interventions.
  
  
  CONCLUSIONS
  There is a high prevalence in many Aboriginal communities. Strongyloides infection should be excluded prior to commencing immunosuppressive therapies in patients from endemic areas. Further studies examining the public health impact of strongyloidiasis, the role of the enzyme-linked immuno-sorbent assay serological test and population-based approaches to management of the disease in endemically infected Australian populations are needed.
authors.affiliation: Centre for Remote Health, Northern Territory, Australia. fay.johnston@cdu.edu.au
authors.forename: Fay H
authors.initials: FH
authors.lastname: Johnston
authors.forename: Peter S
authors.initials: PS
authors.lastname: Morris
authors.forename: Richard
authors.initials: R
authors.lastname: Speare
authors.forename: James
authors.initials: J
authors.lastname: McCarthy
authors.forename: Bart
authors.initials: B
authors.lastname: Currie
authors.forename: Dan
authors.initials: D
authors.lastname: Ewald
authors.forename: Wendy
authors.initials: W
authors.lastname: Page
authors.forename: Karen
authors.initials: K
authors.lastname: Dempsey
mesh_terms: D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D000947:Antigens, Helminth / Q000097:blood; D002648:Child; D003140:Communicable Disease Control / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D005243:Feces / Q000469:parasitology; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use; D015876:Northern Territory / Q000453:epidemiology; D015995:Prevalence; D013321:Strongyloides / Q000276:immunology / Q000302:isolation & purification; D013322:Strongyloidiasis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D000947:Antigens, Helminth; D007559:Ivermectin; D015766:Albendazole