Soil-transmitted helminth infections among migrants and travelers: a 10-year retrospective study
BACKGROUND:
Soil-transmitted helminth (STH) infections, caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms, are widely distributed in tropical regions and significantly contribute to morbidity and mortality. These parasites share similar life cycles, and treatment is primarily based on benzimidazoles. This study aims to describe the clinical and epidemiological characteristics of STH cases among migrants and travelers who attended the Vall d'Hebron-Drassanes International Health Unit between 2014 and 2024, the treatments administered, and their efficacy.
METHODS:
This retrospective descriptive study reviewed STH cases associated with migration or travel during the period 2014-2024. Diagnosis was established either through identification of eggs or larvae in stool samples or through the detection of adult Ascaris lumbricoides worms in digestive samples, always associated with a migratory process or international travel. Clinical and epidemiological data were collected and analyzed using SPSS.
RESULTS:
A total of 361 STH cases were identified, with a mean age of 32 years. Of these, 77% were migrants, 15.7% were travelers visiting friends and relatives (VFR), and 7.2% were travelers. Hookworm infection was diagnosed in 126 cases, Trichuris trichiura in 113 cases, Ascaris lumbricoides in 87 cases, and 35 patients presented with multiple STH infections. Forty-six (12.7%) were symptomatic, predominantly with gastrointestinal symptoms, and 38% presented with eosinophilia. Ninety-five percent of patients received benzimidazole-based treatment, and therapeutic failure was observed in 7.8% of cases. Cure rates were highest for A. lumbricoides (nearly 100%) and remained above 90% for T. trichiura, whereas hookworm infections showed lower rates, ranging from 83% with albendazole to 92% with mebendazole. Multiple STH infections showed, proportionally, higher rates of therapeutic failure.
CONCLUSIONS:
Most STH cases were diagnosed in asymptomatic migrants and VFRs, highlighting the importance of screening for imported diseases in migrant populations. The observed increase in therapeutic failure with commonly used regimens highlights the need to standardize treatment protocols and consider the incorporation of new drugs and combination therapies.