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Colt Foundation 2025 Abstracts
1 Opening a can of worms: gastrointestinal parasite infections in at-risk UK armed forces populations
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  1. William Nevin1,2,3,
  2. Jake Melhuish4,
  3. Rebecca Wakefield4,
  4. Jayne Jones5,
  5. Lucas Cunningham6,
  6. Kunal Bhanot4,
  7. Ed Nicol7,8,
  8. Mark Dermont9,
  9. Simon Guest4,
  10. George Vargha4,
  11. Joanne Cable11,
  12. Andrew Gough4,
  13. Edward Scanlon4,
  14. Max Smith4,
  15. Nicholas Beeching1,
  16. Lucy Lamb2,3,
  17. Matthew O’Shea11,12 and
  18. Thomas Fletcher1
  1. 1Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2Department of Infectious Diseases, Imperial College London, London, UK
  3. 3Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  4. 4Headquarters Army Medical Services, Camberley, UK
  5. 5Clinical Diagnostic Parasitology Laboratory, Liverpool School of Tropical Medicine, Liverpool, UK
  6. 6Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
  7. 7Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  8. 8School of Biomedical Engineering and Imaging Science. King’s College, London, UK
  9. 9Defence Public Health Unit, Research and Clinical Innovation Directorate, Defence Medical Service, Lichfield, UK
  10. 10Defence Primary Healthcare, Lichfield, UK
  11. 11Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
  12. 12Institute of Immunology and Immunotherapy, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK

Abstract

Background Gastrointestinal parasite (GIP) infections are of major military importance. They have been frequently diagnosed post-deployment and can have debilitating sequelae.1–4 Some, such as Strongyloides, are often asymptomatic before presenting as severe disease, which has been fatal in veterans.5 6Whilst the UK Armed Forces recruit many personnel from endemic countries, few are offered testing. Furthermore, despite extensive Defence activity in endemic areas, data on post deployment prevalence is scarce.

Methods A total of 437 participants were recruited from three groups: 250 personnel from Fiji, 119 recently returned from jungle training in Brunei (tested at 2- and 12-weeks post-return), and 68 with historical deployments to Brunei. Participants were tested for GIP using serum for Strongyloides serology, full blood counts, and faeces for microscopy, culture, and qPCR.

Results High GIP infection rates, particularly Strongyloides, were observed across all groups. Amongst Fijian migrants, 35.1% (87/248) had positive Strongyloides serology and 18.9% (14/74) had GIP in faeces. In personnel recently returned from Brunei, 56.0% (65/116) had a positive faecal test for GIP, with 47.4% (55/116) positive for Strongyloides. Serological testing in this group was insensitive (16%), and sequencing revealed infection with Strongyloides fuelleborni and callosciureus. In Group 3, 17.6% (12/68) had a positive Strongyloides result, with the longest infection lasting over 5 years.

Conclusions The novel findings of this project have uncovered a high GIP burden in Armed Forces personnel. The prevalence of Strongyloides found in this first ever study of Fijian migrants has significant public health implications and has prompted steps to offer testing to all Fijian personnel. This study is also the first globally on imported S. fuelleborni infection, revealing previously unknown limitations of serology, and is the first to identify human infection with S. callosciureus. The stark findings demonstrate the uniquely military risk these parasites present and have immediately impacted clinical practice and policy.

References

  1. Bailey M, Thomas R, Green A, Bailey J, Beeching N. Helminth infections in British troops following an operation in Sierra Leone. Transactions of the Royal Society of Tropical Medicine and Hygiene 2006;100(9):842–6.

  2. Genta RM, Weesner R, Douce RW, Huitger-O’Connor T, Walzer PD. Strongyloidiasis in US veterans of the Vietnam and other wars. JAMA 1987;258(1):49–52.

  3. Gill GV, Bell DR. Strongyloides stercoralis infection in former Far East prisoners of war. Br Med J. 1979;2(6190):572–4.

  4. Lee VJ, Ong A, Lee NG, Lee WT, Fong KL, Lim PL. Hookworm infections in Singaporean soldiers after jungle training in Brunei Darussalam. Trans R Soc Trop Med Hyg. 2007;101(12):1214–8.

  5. Gill G, Beeching N, Khoo S, Bailey J, Partridge S, Blundell J, et al. A British second world war veteran with disseminated strongyloidiasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 2004;98(6):382–6.

  6. Hakim SZ, Genta RM. Fatal disseminated strongyloidiasis in a Vietnam War veteran. Arch Pathol Lab Med. 1986;110(9):809–12.

https://doi.org/10.1136/bmjmilitary-2025-colt.1

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