Suffering Silently: Addressing Parasitic Infections in Immigrant Populations

Posted in GUMC Stories

April 5, 2017 – Strongyloidiasis is a gastrointestinal parasitic infection that can be life-threatening in certain cases and is endemic in parts of Latin America, making it a potential health concern for the 40 million Latin American immigrants living in the US. Understanding how many people may be infected with gastrointestinal parasites will inform the work of public health professionals and physicians, helping them identify, diagnose and treat affected individuals.

As director of the Immigrant Health Initiative at Georgetown University Medical Center, Graciela Ostera, PhD, has studied the prevalence of strongyloidiasis in immigrant populations. In the department of microbiology and immunology at GUMC, Ostera also serves as course director of Interdisciplinary Global Infectious Diseases, which explores the biology and international health policy issues related to neglected tropical infectious diseases and other infectious agents.   

“Even the CDC does not know precisely the prevalence of this condition in immigrants living in the US,” Ostera said about strongyloidiasis. “We wanted to assess the prevalence of this condition in individuals who have to suffer silently.”

A treatable infection that can kill

A neglected tropical disease, strongyloidiasis affects as many as 100 million people worldwide and is more common in areas with little access to clean water and inadequate sanitation systems. People with strongyloidiasis are often asymptomatic. However, if they become immunosuppressed, which sometimes can happen in the course of a treatment for other medical conditions, it can lead to hyperinfection and parasite dissemination, a serious condition with a high mortality rate.

“This infection is not difficult to treat,” Ostera said. “The risk of this infection is that it’s a chronic infection. If it’s not treated, the person can be infected indefinitely.”

The Immigrant Health Initiative, striving to identify chronic parasitic conditions in foreign-born individuals living in the US, partnered with Mary’s Center, a community health center in Washington, DC, to conduct a pilot study on the prevalence of strongyloidiasis. The study was conducted in collaboration with the National School of Tropical Medicine at Baylor College of Medicine, which supported the cost of diagnostic studies and treatment for infected individuals.

Study participants were familiar with the concept of stomach parasites.

To identify potential study participants, patients at Mary’s Center were first asked if they were born abroad, then asked about their familiarity with gastrointestinal parasites. “For this population, the anecdotal knowledge about gastrointestinal parasites was very high,” Ostera said.

Some study participants surveyed about gastrointestinal parasites said that they had family members who had gastrointestinal parasites. Others said that they experienced abdominal pain on a daily basis, yet they were at the clinic for different reasons. “Individuals who have this condition assume this is the way it is,” Ostera said. “Some of them self medicate or they try to self treat, which is not successful because the methods they try really do not get rid of the parasite.”

After determining that the potential study participant was born abroad, they were invited to participate in the study. Of 119 study participants, five tested positive for strongyloidiasis. The study also identified one patient with a different gastrointestinal parasitic infection and another patient who had two parasitic infections.   

Future research in question

Ostera’s strongyloidiasis study was published in the Journal of Helminthology in April 2016. While she would like to conduct additional research on the subject, the current political environment may make it more difficult to recruit research participants.

“They may be a little bit shy about speaking with an individual who is asking them questions about their country of origin,” Ostera said about the population she studied. “That was without any kind of conversation about possible deportation. We’re sensing that right now, that will be a lot more difficult to do.”

“They only go to seek medical attention when the condition that affects them is fairly severe and poses a real problem for them to go to work every day,” she said. “My concern is that it would take a lot more for them to come to the clinic, to come forward and identify themselves for fear of possible deportation.”

Kat Zambon
GUMC Communications