Epidemiology
Strongyloides infection occurs in tropical and subtropical regions worldwide. It is also endemic in the Appalachia region of the US and certain Mediterranean regions such as Catalonia, Spain.[2] Estimates of global prevalence are between 30 and 100 million.[3][4] Migrants and refugees from developing countries are at greatest risk with rates of 5% to 10% in newly arrived migrants to the US.[5][6] The highest rates are in southeast Asians. Initial human infection is via larvae living in infected soil penetrating the skin, typically the feet. Those with soil contact, such as subsistence farmers and agricultural workers, are at greater risk.[7] Therefore, men are at an approximately two- to threefold higher risk than women.[8] Short-term international travellers are generally at low risk, unless they have barefoot exposure to infected soil or sand. Military veterans who served in southeast Asia during the World War II, Korean, or Vietnam conflicts are at risk; the risk is especially high in prisoners of war.[9]
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