First evidence of Significant Autochthonous Transmission of Strongyloidiasis in Northern Spain: A Retrospective Study from Asturias, Spain.

Background: Autochthonous strongyloidiasis in Spain has traditionally been considered a recognized but underdiagnosed condition, primarily affecting individuals in agricultural environments along the Mediterranean coast. We describe the first series of autochthonous strongyloidiasis cases diagnosed in Asturias, a region in northern Spain with no previously documented endemic transmission.

Methods: This is a retrospective review of all diagnosed cases of autochthonous strongyloidiasis at the Central University Hospital of Asturias, from 2016 to 2024. Inclusion required no travel history to endemic areas. Clinical records were reviewed for demographic data, symptoms, risk factors, laboratory findings, and treatment outcomes. Diagnosis was based on stool microscopy, S. stercoralis IgG serology, and polymerase chain reaction.

Results: We identified 33 patients (54.5% female, mean age 52 ± 20 years). The primary risk factor was residence in a rural area (63.6%), frequently associated with gardening that was the most common risk factor (57.5%). Symptoms were reported in 78.7% of cases, most commonly abdominal pain (46%) and pruritus (38.4%). Eosinophilia was present in 33.3% of cases. Diagnosis relied primarily on serology (71.4%) and PCR (56.2%). Stool microscopy detected larvae in only two patients (6%). Three patients (9.3%) developed severe forms, including one fatal case.

Conclusions: This study provides strong evidence of ongoing autochthonous transmission of Strongyloides stercoralis in northern Spain, affecting a younger and more gender-balanced population than previously described. Recreational rather than occupational exposure was the predominant risk factor. Routine screening should be considered in autochthonous individuals with eosinophilia or prior to immunosuppressive therapy to prevent severe outcomes.