Prevalence of Strongyloides stercoralis in haemodialysis patients in Vienna

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BACKGROUND AND HYPOTHESIS: Strongyloides stercoralis is a neglected parasitic infection endemic to tropical regions, with rising prevalence in Europe. In kidney transplant (KTX) recipients, high-dose corticosteroids can induce a hyperinfection syndrome, which carries high mortality but is preventable with anthelminthic therapy. Screening for S. stercoralis is currently not included in pre-KTX protocols in Europe. This study assessed the prevalence of S. stercoralis among all haemodialysis patients in Vienna. METHODS: All consenting haemodialysis patients in Vienna (n = 704) underwent enzyme-linked immunosorbent assay testing for S. stercoralis immunoglobulin G (IgG). A detailed questionnaire captured soil exposure, medical and transplant history, travel, symptoms and immunosuppressive therapy. Positive serologies were confirmed at the Austrian reference centre for parasitology and in case of positivity followed by stool examination for larvae. RESULTS: Of 704 patients, 50 (7.1%) were seropositive for S. stercoralis IgG, including 4 with prior KTX; stool examination showed larvae in one case. Male sex [odds ratio (OR) 6.18, 95% confidence interval (CI) 1.44-26.54], absolute or relative eosinophilia (≥0.19 × 10⁹/L, ≥1.95%; area under the curve = 0.87 and 0.84), and birth in the Middle East and North Africa (OR 4.75, 95% CI 1.26-17.93) were independently associated with seropositivity, while birth in Western Europe was protective (OR 0.51, 95% CI 0.29-0.91; P = .023). Males were more likely to report occupational soil exposure (P = .002). Travel history, pet ownership, soil contact, gastrointestinal symptoms, pruritus, C-reactive protein and immunosuppression were not associated with seropositivity. CONCLUSIONS: Relevant S. stercoralis seroprevalence was found in a Central European haemodialysis population. Implementation of targeted screening for S. stercoralis should be considered in pre-KTX protocols in Europe.