{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T19:52:10Z","timestamp":1791748330732,"version":"4.3.4"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014252","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000}}],"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Strongyloidiasis is a neglected tropical infection that can progress to life-threatening disease in immunocompromised hosts. However, predictors of severe disease and mortality remain incompletely defined, particularly in endemic regions. We aimed to identify clinical predictors of severe strongyloidiasis and 30-day mortality among hospitalized patients in southern Thailand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a 16-year retrospective cohort study of hospitalized patients aged \u226513 years with laboratory-confirmed\n                      <jats:italic>Strongyloides stercoralis<\/jats:italic>\n                      infection at a tertiary-care hospital between 2009 and 2025. Severe strongyloidiasis was defined by larval detection in extraintestinal or respiratory specimens or compatible clinical manifestations involving multiple organ systems with infectious complications. Multivariable logistic regression was used to identify predictors of severe disease and mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 735 patients, 47 (6.4%) had severe strongyloidiasis. Corticosteroid exposure within 60 days was independently associated with severe disease (adjusted odds ratio [aOR] 3.25, 95% CI 1.65\u20136.73), whereas eosinophilia (absolute eosinophil count \u2265500 cells\/\u00b5L) was associated with lower odds (aOR 0.41, 95% CI 0.19\u20130.82). Bacteremia was more frequent in severe cases (38.3% vs 4.1%, p\u2009&lt;\u20090.001), predominantly due to gram-negative organisms. Severe strongyloidiasis was associated with higher 30-day mortality (38.3% vs 14.0%, p\u2009&lt;\u20090.001). In multivariable analysis, increasing age (aOR 1.22 per 10-year increase), higher National Early Warning Score (aOR 1.41 per point), and bacteremia (aOR 3.38) were independently associated with mortality, whereas eosinophilia was associated with lower odds of death and severe strongyloidiasis itself was not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Corticosteroid exposure was the strongest predictor of severe strongyloidiasis, while eosinophilia was protective. Mortality was driven primarily by bacteremia and physiologic instability. Early recognition and treatment are essential to improve outcomes in endemic settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014252","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:58:31Z","timestamp":1776707911000},"page":"e0014252","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of severe strongyloidiasis and mortality in hospitalized patients from Southern Thailand"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8115-3955","authenticated-orcid":true,"given":"Sorawit","family":"Chittrakarn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nonthanat","family":"Tongsengkee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nattapat","family":"Sangkakul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siripen","family":"Kanchanasuwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"issue":"1","key":"pntd.0014252.ref001","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.idc.2018.10.006","article-title":"Strongyloidiasis: A Neglected Tropical Disease","volume":"33","author":"A Krolewiecki","year":"2019","journal-title":"Infect Dis Clin North Am"},{"issue":"7","key":"pntd.0014252.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002288","article-title":"Strongyloides stercoralis: Global Distribution and Risk Factors","volume":"7","author":"F Sch\u00e4r","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014252.ref003","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1038\/s41572-023-00490-x","article-title":"Strongyloidiasis","volume":"10","author":"CA Gordon","year":"2024","journal-title":"Nat Rev Dis Primers"},{"key":"pntd.0014252.ref004","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/1471-2334-13-78","article-title":"Severe strongyloidiasis: a systematic review of case reports","volume":"13","author":"D Buonfrate","year":"2013","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pntd.0014252.ref005","first-page":"35","article-title":"Hemoptysis in the Immunocompromised Patient: Do Not Forget 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Human T-lymphotropic retrovirus type-1 in Thailand. Southeast Asian J Trop Med Public Health. 2000;31 Suppl 1: 143\u20135."},{"issue":"4","key":"pntd.0014252.ref017","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciae129","article-title":"Unintended Consequences: Risk of Opportunistic Infections Associated With Long-term Glucocorticoid Therapies in Adults","volume":"78","author":"DB Chastain","year":"2024","journal-title":"Clin Infect Dis"},{"key":"pntd.0014252.ref018","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1476-7961-4-8","article-title":"Intestinal strongyloidiasis and hyperinfection syndrome","volume":"4","author":"RS Vadlamudi","year":"2006","journal-title":"Clin Mol Allergy"},{"issue":"6","key":"pntd.0014252.ref019","first-page":"663","article-title":"Thiabendazole for the prophylaxis of strongyloidiasis in immunosuppressed patients with hematological diseases: a randomized double-blind placebo-controlled study","volume":"87","author":"R 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