Is there autochthonous strongyloidiasis in Spanish children?

Strongyloidiasis, a neglected helminthiasis, is more prevalent in tropical/subtropical areas. However, sporadic autochthonous cases have been described around the Mediterranean coast. We performed a retrospective descriptive study in a referral Spanish Center for Pediatric Tropical diseases. All patients below 18 years of age diagnosed with probable strongyloidiasis between January 2014 and December 2019, born in Spain and with no history of travel abroad, were included. Epidemiological, clinical, and follow-up data were recorded, as well as all microbiology results. Five children met the inclusion criteria and were included in the study. Three males and two females, with a median age of 6.7 years (IQR: 5.8-9.1). All patients had previous medical conditions and used to spend holidays on the Mediterranean coast of Spain. All but one were mildly symptomatic at diagnosis but only four presented peripheral eosinophilia, which was the main reason for referral. First-line treatment was ivermectin in all but one, who was treated with albendazole. Reinfection was suspected in two during follow-up. At 12 months of follow-up 3/5 (60%) children presented negative serology.

Conclusion

Although more prevalent in tropical areas, strongyloidiasis should be included among differential diagnosis in children presenting with eosinophilia. Screening for strongyloidiasis should be considered in all children candidate to immunosuppressive therapy. What is Known: • Strongyloidiasis is more prevalent in tropical/subtropical areas. • Strongyloidiasis can be life-threatening in immunosuppressed patients What is New: • Spanish children can be affected by autochthonous strongyloidiasis. • Screening for strongiloidiasis should be performed in all candidates to immunosuppresive therapies, including children.