Strongyloides stercoralis Infection and Spirometry-Defined Airway Obstruction in Children with Sickle Cell Disease: A Species-Specific Multicentre Cross-Sectional Study in French Guiana

Background/Objectives: Strongyloides stercoralis may persist through autoinfection and is clinically important before corticosteroid exposure, but its relationship with airway obstruction in children with sickle cell disease (SCD) is uncertain. We examined whether routine-detected S. stercoralis infection was associated with spirometry-defined airway obstruction in children with SCD in French Guiana. Methods: This multicentre cross-sectional secondary analysis used an availability-based sample from a routine respiratory screening database. Eligible children aged 5–17 years had SCD, spirometry, and stool parasitology documented during routine care. The primary outcome was FEV1/FVC < 80%. Logistic regression adjusted for age, sex, genotype, hydroxyurea treatment, previous acute chest syndrome, and atopy. Results: Stool parasitology was available for 160 children; 26 (16.2%) had S. stercoralis detected. Among 138 children with complete spirometry and covariate data, 45 (32.6%) had obstruction. S. stercoralis was not associated with obstruction in univariable analysis (OR 0.75, 95% CI 0.30–1.91) or after adjustment (adjusted OR 1.02, 95% CI 0.37–2.86; p = 0.964). Male sex was independently associated with obstruction (adjusted OR 2.32, 95% CI 1.11–4.83). Conclusions: Routine-detected S. stercoralis infection was not an independent correlate of airway obstruction. The wide confidence interval, limited exposure ascertainment, and small infected subgroup mean that clinically important protective or harmful associations cannot be excluded.