Epidemiology and risk factors of Strongyloides stercoralis infection in Papua, Indonesia: a molecular diagnostic study

Strongyloides stercoralis is a parasitic worm that is of considerable clinical relevance. Indeed, it may persist
asymptomatically for many years, but can lead to potentially fatal dissemination when the host's immune status
is impaired. As commonly employed stool microscopy techniques (e.g. Kato-Katz thick smear) fail to detect
S. stercoralis, the epidemiology is poorly understood. In 2013, we conducted a cross-sectional household survey
in the district of Mimika in Papua, Indonesia. A total of 331 individuals, aged 1 month to 44 years, had a single
stool sample subjected to real-time polymerase chain reaction (PCR) for S. stercoralis diagnosis. The prevalence
of S. stercoralis infection was 32.0% (106/331 individuals); higher than any of the three main soil-transmitted
helminths (Ascaris lumbricoides, 23.9%; Trichuris trichiura, 18.4%; and hookworm, 17.2%). Amongst the
S. stercoralis-infected individuals, 73.6% were concurrently infected with another helminth, with hookworm
being the most frequent co-infection (27.4%). Fourteen percent of the S. stercoralis infections had low cycle
threshold values on real-time PCR, which may indicate a higher infection intensity. Multivariate logistic re-
gression analysis revealed that age ≥5 years (adjusted odds ratio (OR) 5.8, 95% confidence interval (CI): 3.1-
10.8) was significantly associated with S. stercoralis infection. There is a need for in-depth clinical and diagnostic studies to elucidate the public health impact of S. stercoralis infection in Indonesia.