Colorectal Cancer Associated with Strongyloides stercoralis Colitis

Abstract

Strongyloides stercoralis colitis is a severe but easily curable disease with a high mortality rate if left untreated. Strongyloidiasis can persist up to several decades and may lead to a chronic colitis similar to that seen in inflammatory bowel disease (IBD), and the two are often confused. Chronic colitis from IBD is associated with an increased risk of colorectal cancer, so it is plausible that chronic colitis from strongyloidiasis may carry a similar risk. Our case report associates chronic Strongyloides colitis and colorectal cancer.

Colorectal Cancer Related to Chronic Strongyloides stercoralis Infection

“…Autoinfection is characterized by the ability of rhabditiform larvae in the large intestine to transform into infectious filariform larvae, then penetrate the intestinal mucosa, and migrate to other organs including the lungs, restarting the cycle [ 4 ]. Another peculiarity of S. stercoralis is its capacity to cause hyperinfection syndrome, as a result of uncontrolled overproliferation of filariform larvae in stool and sputum, leading to the clinical manifestation of larval migration with development or exacerbation of gastrointestinal and pulmonary symptoms [ 3 ]. Hyperinfection syndrome primarily occurs in immunocompromised individuals and can have a high mortality rate (approaching 100%) if not diagnosed and treated [ 13 ].…”

“…A case report describing a Korean patient presenting with both S. stercoralis infection and early gastric adenocarcinoma showed S. stercoralis adults and eggs associated with gastric adenocarcinoma and adenoma tissues suggesting a possible causative role of S. stercoralis infection [ 8 ]. Another case report identified S. stercoralis in a duodenal biopsy from a patient found to have colorectal cancer, which also suggests a potential correlation between S. stercoralis and cancer development [ 3 ]. An association between colorectal cancer with chronic S. stercoralis has also been reported in a Columbian patient case report [ 18 ].…”

“…Strongyloidiasis is caused by S. stercoralis , a soil-transmitted helminth, endemic in tropical and subtropical regions including Latin America, sub-Saharan Africa, and Southeast Asia [ 1 – 3 ]. Worldwide, between 30 and 100 million people are infected.…”

“…Multiple studies have reported that S. stercoralis may be a cofactor in HTLV-1-related T-cell lymphoma in endemic areas [ 6 , 7 ]. In addition, a number of case reports have described the occurrence of gastrointestinal cancer with S. stercoralis infection, suggesting that the parasite may be a risk factor for gastrointestinal malignancy [ 3 , 5 , 8 , 9 ]. Contrary to this, some hypothesize that gastrointestinal malignancy is a risk for infection.…”

Spirocerca lupi Proteomics and Its Role in Cancer Development: An Overview of Spirocercosis-Induced Sarcomas and Revision of Helminth-Induced Carcinomas

“…Neoplasia development involves restorative hyperplasia due to the direct mucosal damage caused by the adult stages, eggs and, possibly, some secreted products of the parasite [ 103 ]. Chronic infection with this nematode in the gut and colon is related to gastrointestinal and colorectal cancer [ 103 , 104 ], and strongyloidiasis in the biliary intestinal tract may promote pancreatic and hepatic carcinogenesis [ 105 ]. The prevalence of S. stercoralis infections was higher in patients with cancer compared to control groups of infected individuals without cancer, with no significant association with a specific type of malignancy [ 106 ].…”