Predictive markers for development of strongyloidiasis in patients infected with both <i>Strongyloides stercoralis</i> and HTLV-1

Satoh, Masao; Kiyuna, S.; Shiroma, Yoshiyuki; Toma, Hiromu; Kokaze, Akatsuki; Sato, Yoshiya

doi:10.1046/j.1365-2249.2003.02224.x

Cited by 33 publications

(26 citation statements)

References 35 publications

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“…There is an increasing body of evidence regarding the strong association between S. stercoralis and HTLV-1 co-infection and hyperinfection syndrome [21][22][23][24][25][26] , which has been further strengthened by our striking result that a majority (72%) of the patients with hyperinfection were co-infected with HTLV-1. We also confirmed the well-described role of corticosteroids in triggering hyperinfection regardless of the presence of HTLV-1 co-infection.…”

Section: Discussionsupporting

confidence: 49%

“…This study was conducted in the Okinawa islands, a subtropical region of Japan, where both S. stercoralis and HTLV-1 are endemic and epidemiological studies have been thoroughly conducted [21][22][23][24] . There is an increasing body of evidence regarding the strong association between S. stercoralis and HTLV-1 co-infection and hyperinfection syndrome [21][22][23][24][25][26] , which has been further strengthened by our striking result that a majority (72%) of the patients with hyperinfection were co-infected with HTLV-1.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Kishimoto

Hokama²,

Hirata³

et al. 2008

WJG

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AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis (S. stercoralis ) hyperinfection. METHODS:Over a period of 23 years , we investigated 25 patients with S. stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis. The clinical and endoscopic findings were analyzed retrospectively. R E S U LT S :Tw e n t y -f o u r ( 9 6 % ) o f t h e p a t i e n t s investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1 (HTLV-1) infection. The abnormal endoscopic findings, mainly edematous mucosa, white villi and erythematous mucosa, were observed in 23 (92%) patients. The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy. The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative (Endoscopic severity score: 4.86 ± 2.47 vs 2.71 ± 1.38, P < 0.05). CONCLUSION:Our study clearly demonstrates that, in addition to stool analysis, endoscopic observation and biopsies are very important. We also emphasize that S. stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Kishimoto

Hokama²,

Hirata³

et al. 2008

WJG

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“…A high viral DNA burden in peripheral blood mononuclear cells (PBMCs) is a risk factor for HAM/TSP (13) and ATL development (14-16), and patients with HAM/TSP have a higher virus level in the cerebrospinal fluid (CSF) than in the peripheral blood (12). The virus level alone is not sufficient to differentiate symptomatic patients from healthy carriers, suggesting the importance of other factors, including the host immune response (16)(17)(18)(19)(20). HAM/TSP patients present diverse immunological alterations, such as increased levels of spontaneous lymphocyte proliferation (21, 22), tax-specific cytotoxic CD8 ϩ T cell expansion, and the production of high levels of inflammatory cytokines (23)(24)(25).…”

mentioning

confidence: 99%

Human T Cell Leukemia Virus Type 1 Infection of the Three Monocyte Subsets Contributes to Viral Burden in Humans

Castro-Amarante

Pise-Masison

McKinnon

et al. 2016

J Virol

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A pproximately 2 to 3% of human T cell leukemia virus type 1 (HTLV-1)-infected individuals develop adult T-cell leukemia/lymphoma (ATL) and another 2 to 3% develop HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) in their lifetimes (1-4). In addition to HAM/TSP (5, 6), HTLV-1 is also associated with other inflammatory conditions, such as uveitis (6) Sjögren's syndrome (7), bronchoalveolitis and arthritis (8), and polymyositis (9). It is noteworthy that some patients present with more than one of these inflammatory conditions (10). HTLV-1 primarily infects CD4 ϩ and CD8 ϩ effector and memory T cells and regulatory CD4 ϩ CD25 ϩ T cells (11,12). A high viral DNA burden in peripheral blood mononuclear cells (PBMCs) is a risk factor for HAM/TSP (13) and ATL development (14-16), and patients with HAM/TSP have a higher virus level in the cerebrospinal fluid (CSF) than in the peripheral blood (12). The virus level alone is not sufficient to differentiate symptomatic patients from healthy carriers, suggesting the importance of other factors, including the host immune response (16)(17)(18)(19)(20). HAM/TSP patients present diverse immunological alterations, such as increased levels of spontaneous lymphocyte proliferation (21, 22), tax-specific cytotoxic CD8 ϩ T cell expansion, and the production of high levels of inflammatory cytokines (23)(24)(25). Several studies have also suggested that monocytes are involved in immune reg-

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“…The patient was found to be human immunodeficiency virus (HIV) negative, and human T-cell leukemia virus type 1 (HTLV-1) positive, a risk factor for disseminated Strongyloides infection. 2 She was well during clinic appointments at 1, 2, and 3 months after discharge. Her family members were counseled and screened for HTLV-1 infection.…”

Section: Casementioning

confidence: 99%

Failure of Ivermectin per Rectum to Achieve Clinically Meaningful Serum Levels in Two Cases of Strongyloides Hyperinfection

Bogoch¹,

Khan²,

Abrams³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Two cases of Strongyloides hyperinfection are presented. Ivermectin was initially administered orally and per rectum pending the availability of subcutaneous (SC) preparations. In neither case did rectal suppositories of ivermectin achieve clinically meaningful serum values. Clinicians should use SC preparations of ivermectin as early as possible in Strongyloides hyperinfection and dissemination. CASE 1A 38-year-old Nigerian-born female with no prior medical history presented with worsening nausea and vomiting over a 6-week period. One year prior admission she had traveled to Nigeria for 1 month. Two months before admission she was referred to a gastroenterologist for dyspepsia and underwent upper endoscopy with a small bowel biopsy. At the time of her presentation to hospital, endoscopic biopsy results showed filariform larvae of Strongyloides stercoralis. On admission she was ill appearing, afebrile, with a blood pressure of 90/ 50 mmHg, heart rate of 115 beats/min, and normal oxygen saturations. Her examination was unremarkable apart from a tender epigastrium and diminished bowel sounds.Blood examination revealed a normal complete blood count, creatinine, and liver function tests. Computed tomography (CT) of her abdomen with contrast demonstrated a thickened proximal small bowel wall and evidence of ileus. Strongyloides hyperinfection syndrome was suspected, and she was empirically treated with crystalloid resuscitation and albendazole (400 mg PO BID) while an urgent request for ivermectin was made to Health Canada (ivermectin is a special access drug in Canada available only with the authorization of the Health Protection Branch). In addition, intravenous ceftriaxone and metronidazole were administered for presumed gram-negative sepsis. The patient was unable to tolerate oral albendazole because of intractable nausea and vomiting, so albendazole was administered via nasogastric (NG) tube although there was concern regarding poor absorption given her ileus and persistent vomiting. Pending the availability of subcutaneous (SC) ivermectin, we had a compounding pharmacy prepare oral ivermectin into rectal suppositories; we administered these in the evening on her first and second hospital day (200 μg/kg, totaling 15 mg per rectum (PR). Her persistent ileus prompted the General Surgery service to perform an urgent laparotomy on her second hospital day. She was found to have a dilated proximal small bowel, what appeared to be a fecal bezoar as a result of the ileus that was milked distally. She required norepinephrine for blood pressure control during the operation and for 6 hours immediately after. She was extubated shortly after her laparotomy and was able to tolerate oral medications the following day at which point she was given oral ivermectin. Table 1 shows her medication schedule and microbiology results during and after her hospital stay. Serum ivermectin levels were measured on hospital day 2, 3, and 8 as per the protocol described previously in a study. 1 PR ivermectin did not achieve clinicall...

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Predictive markers for development of strongyloidiasis in patients infected with both Strongyloides stercoralis and HTLV-1

Cited by 33 publications

References 35 publications

Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Human T Cell Leukemia Virus Type 1 Infection of the Three Monocyte Subsets Contributes to Viral Burden in Humans

Failure of Ivermectin per Rectum to Achieve Clinically Meaningful Serum Levels in Two Cases of Strongyloides Hyperinfection

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