Researchers evaluate the association between Trypanosoma cruzi infection and strongyloidiasis in a cohort of Latin American (LA) migrants screened for both infections in a non-endemic setting.

Case-control study including LA individuals who were systematically screened for Tcruziinfection and strongyloidiasis between January 2013 and April 2015. Individuals were included as cases if they had a positive serological result for Strongyloides stercoralis.

Controls were randomly selected from the cohort of individuals screened for Tcruzi infection that tested negative for Sstercoralis serology. The association between Tcruzi infection and strongyloidiasis was evaluated by logistic regression models.

During the study period, 361 individuals were screened for both infections. 52 (14.4%) individuals had a positive serological result for strongyloidiasis (cases) and 104 participants with negative results were randomly selected as controls. 76 (48.7%) individuals had a positive serological result for Tcruzi.

Factors associated with a positive Tcruzi serology were Bolivian origin (94.7% vs 78.7%; p = 0.003), coming from a rural area (90.8% vs 68.7%; p = 0.001), having lived in an adobe house (88.2% vs 70%; p = 0.006) and a referred contact with triatomine bugs (86.7% vs 63.3%; p = 0.001).

There were more patients with a positive S.stercoralis serology among those who were infected with Tcruzi (42.1% vs 25%; p = 0.023). Epidemiological variables were not associated with a positive strongyloidiasis serology. 

Tcruziinfection was more frequent among those with strongyloidiasis (61.5% vs 42.3%; p = 0.023). In multivariate analysis, Tcruzi infection was associated with a two-fold increase in the odds of strongyloidiasis (OR 2.23; 95% CI 1.07–4.64; p = 0.030).

Trypanosoma cruzi infection and strongyloidiasis are neglected tropical diseases, sharing a similar epidemiological burden in Latin America and producing life-long infections, leading to high morbidity and mortality. Researchers conducted a case-control study in a non-endemic setting to evaluate a possible relationship between both infections.

High prevalence of both diseases was found and importantly, Tcruzi infection was associated with a two-fold increase in the likelihood of strongyloidiasis even after adjusting for epidemiological variables.

A possible explanation is that these two infections share an epidemiological burden where they are highly prevalent, but also the fact that both diseases are strongly influenced by socio-economical factors such as soil contamination, barefoot walking or poor healthcare systems. Moreover, immune alterations produced by Sstercoralis may predispose to Tcruzi infection.

As long as screening for Chagas disease in asymptomatic Latin American adults living in Europe has shown to be cost-effective and in light of the high prevalence of strongyloidiasis found in Tcruziinfected patients, a combined screening should be considered.

The potential strongyloidiasis related complications and the benefits from ivermectin therapy are additional reasons to introduce systematic screening in susceptible populations.

Tcruzi infection was associated with strongyloidiasis in LA migrants attending a tropical diseases unit even after adjusting for epidemiological variables. These findings should encourage physicians in non-endemic settings to implement a systematic screening for both infections in LA individuals.