Study 1 — Time-to-Guideline Lag: Parasitic Causes of Chronic Disease

Study 1 of the Hidden Infections research series. Documents the evidence-to-clinical-guideline lag for four established parasite-disease associations: Strongyloides stercoralis and corticosteroid-associated hyperinfection, Helicobacter pylori and gastric cancer, Toxoplasma gondii and psychiatric sequelae, and Opisthorchis viverrini and cholangiocarcinoma. Across associations, the median evidence-to-guideline lag is 50-58 years. None is adequately addressed in frontline clinical guidelines applicable to Western healthcare settings. Establishes the pattern of institutional lag that motivates the full programme. Methods: Structured literature review of landmark publications and guideline publication dates. Group A: Institutional lag and diagnostic failure. CC0 public domain. AI-assisted draft pre-print.