Strongyloideshyperinfection syndrome in British veterans

Abstract

Strongyloides hyperinfection syndrome is a rare but serious and often fatal complication of strongyloidiasis, usually precipitated by immune suppression (frequently caused by corticosteroidal drugs). Infections with Strongyloides stercoralis are known to occur in British veterans who served in South-east Asia during the Second World War, particularly in those held as prisoners of war by the Japanese. No information on the frequency of disseminated strongyloidiasis in these men is, however, available. A multi-source enquiry designed to detect the cases of Strongyloides hyperinfection syndrome that occurred, in the U.K., in the 60 years following the end of the Second World War was therefore initiated. The relevant data were collected from death certificates, searches of the medical literature, enquiries with veterans' organizations, and questionnaires sent to all the units of infectious and tropical disease in the U.K.. Overall, 25 cases of hyperinfection in the U.K. were detected but only two involved veterans of the Second World War (one British ex-Far East prisoner of war and a British former soldier who had been involved with the evacuation of Singapore in 1945). Although the risk of hyperinfection in veterans appears small, information from the literature and veterans' organizations indicates that there are still probably 300-400 such veterans who remain alive in Britain and have Strongyloides infections. Attempts at the detection and eradication of the infections in the surviving veterans are recommended.

Management of severe strongyloidiasis attended at reference centers in Spain

“…Robson et al sought cases of S . stercoralis hyperinfection syndrome diagnosed in the United Kingdom after the Second World War to our date and described the largest series outside endemic areas [ 13 ]. Other recent studies on this topic are case reports, or hospital case-series describing any type of strongyloidiasis regardless of its severity [ 6 , 14 – 16 ].…”

Methylprednisolone acetate induces, and Δ7-dafachronic acid suppresses,Strongyloides stercoralishyperinfection in NSG mice

“…The NSG mouse model also has the potential to be humanized, reconstituted with human hematopoietic stem cells, enabling the study of the human immune response to S. stercoralis infection (17). S. stercoralis infections in humans are extremely long-lived (2,31), through a process of autoinfection, whereby L1 develop in the intestine into L3a that penetrate the wall of the lower ileum, colon, or the skin of the perianal region, whereby L3a enter the circulation, travel to the lungs, as well as other routes, and then to the small intestine, thus repeating the life cycle. This maintains the parasite for decades in the human host, with infection levels moderated to limit pathogenicity.…”

StrongyloidesHyperinfection Syndrome Combined with Cytomegalovirus Infection

“…This longevity of Strongyloides is related to its unique and complex life cycle with its alternation between free-living and parasitic cycles and the propensity for autoinfection and multiplication within the infected host [ 2 ]. A review on prisoners of World War II from the United Kingdom indicated that there are still probably 300–400 veterans who remain alive in Britain and have Strongyloides infections [ 3 ]. Although infection is mild in immunocompetent patients, a severe and fatal disseminated disease tends to occur in immunocompromised patients.…”