Overlapping Infection by Strongyloides spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature

Abstract

Strongyloides and cytomegalovirus co-infections are rarely reported, even though they are distinguished by high morbidity and mortality, especially in immunocompromised hosts. We narratively reviewed the literature on reported cases of Strongyloides and CMV co-infections in immunosuppressed patients. Most cases occurred in males with a median age of 47 (IQR, 37–59). Strongyloides/CMV co-infections occurred among immunocompromised hosts, especially in solid organ transplants and hematological or rheumatological diseases. Most of the patients underwent a course of steroid treatment before the diagnosis of co-infections. Other common immunomodulatory agents were tacrolimus and mycophenolate. The first clinical manifestations of co-infections were mainly gastrointestinal, followed by respiratory symptoms. CMV was, in most patients, co-infected with an isolated reactivation, although Strongyloides manifested especially as hyperinfection syndrome. Ganciclovir and ivermectin are the mainstays of CMV and Strongyloides treatment. However, the treatment mortality reported in this narrative review is around 52.4%. Interestingly secondary bacterial infections are common in CMV/Strongyloides-infected patients.

Influence of tides on the dissemination and related health risks of intestinal helminths along the Kribi beaches (Atlantic Coast, Southern Cameroon)

“…is a nematode responsible for Strongyloidosis or anguillulosis or "cutaneous larva migrans". It causes skin lesions at the point of larval entry, possible inflammatory pulmonary reaction with dry cough during larval migration, enteritis with abdominal pain, and diarrhoea (Schär et al 2013;Lupia et al 2023). Ascaris sp.…”

Massive Airway Bleeding Caused by Pulmonary Strongyloidiasis in a Patient with a Transplanted Kidney

“…For kidney transplant recipients presenting mainly with gastrointestinal and respiratory symptoms, vigilance for co-infection with Strongyloides stercoralis and cytomegalovirus is necessary. 15 Although this co-infection is rare, its treatment mortality rate reaches 52.4%. 15 , 16 Co-infection with cytomegalovirus may further suppress the immune system, exacerbating Strongyloides stercoralis infection.…”

“… 15 Although this co-infection is rare, its treatment mortality rate reaches 52.4%. 15 , 16 Co-infection with cytomegalovirus may further suppress the immune system, exacerbating Strongyloides stercoralis infection. 17 Therefore, when treating these patients, co-infection with pathogens like cytomegalovirus should be considered, with appropriate diagnostic and therapeutic measures taken.…”

Presumptive pulmonary toxocariasis in a patient affected by acute myeloid leukemia and Hodgkin lymphoma: case report and review of the literature in immunocompromised hosts

“…Parasitic infections that can pose specific significant risks in immunocom-promised patients include Toxoplasmosis, Cryptosporidiosis, Strongyloidiasis, Leishmaniasis, Trypanosomiasis (i.e., African sleeping sickness and Chagas disease), and Paragonimiasis among others. Amidst these, Strongyloidiasis has been more extensively described and present peculiar features such as an auto-infective cycle [11,12]. Broadly, global climate change and demographic changes are modifying the natural eco-system, and travel across continents have resulted in an increase in the transmission of parasites to human beings.…”