Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru.

Abstract

Abstract.A study was conducted in Lima, Peru to determine if patients with Strongyloides hyperinfection had human T cell lymphotropic virus type-1 (HTLV-I) infection. The study included patients with Strongyloides hyperinfection and a control group consisted of sex-and age-matched asymptomatic healthy individuals whose stools were negative for Strongyloides. A third group included patients with intestinal strongyloidiasis. Sera from each study subject were tested for HTLV-1/2I by an ELISA and Western blot. The HLTV-1 infection rates (85.7%, 18 of 21) were significantly (P Ͻ 0.001) associated with Strongyloides hyperinfection compared with the control group (4.7%, 1 of 21). The HTLV-1 rate (10%, 6 of 62) for patients with intestinal strongyloidiasis was significantly (P Ͻ 0.001) lower than patients with Strongyloides hyperinfection, but did not differ significantly (P Ͼ 0.05) from the control group. The association of HTLV-1 infection was observed among 17 of 19 patients more than 20 years of age and one of two younger patients. None had HTLV-2 infection. In conclusion, Strongyloides hyperinfection among Peruvian patients was highly associated with HTLV-1 infection.Strongyloides stercoralis is a soil-transmitted intestinal nematode that has been estimated to infect at least 60 million people, especially in tropical and subtropical regions.1 The parasite is unique among the parasitic nematodes because of its ability to multiply within the human host for many decades, with the potential to cause life-threatening disease in immunocompromised patients. The usual route of transmission is by penetration of the skin by filariform larvae (infectious form), following contact with contaminated soil. After migration through the lung, the larvae crawl over the glottis, and are then swallowed and develop to adults in the small bowel mucosa. The uncomplicated intestinal form of disease produces nonspecific abdominal symptoms with or without mild sporadic diarrhea. Many infected patients are completely asymptomatic. 2 However, an autoinfective cycle may develop in a proportion of untreated cases. In these cases, infectious filariform larvae develop in the intestines from rhabditiform larvae. Penetration of the colon or the anal skin by filariform larvae, and migration through lung allow reinfection of the same host. The autoinfective cycle, which usually results in a low-grade, chronic infection in immunocompetent hosts, is poorly understood 3 . A large number of cases of chronic, asymptomatic Strongyloides infections were reported among World War II in Southeast Asian prisoners of war and in refugees up to 40 years after leaving endemic regions. [4][5][6] In contrast to autoinfection, Strongyloides may produce a disseminated infection in immunocompromised hosts incapable of mounting an immune response against the parasite. Massive dissemination of invasive filariform larvae from the colon to the lung, liver, central nervous system, or kidney frequently results in a fatal outcome. Carriage by Strongyloides larvae of enterobacte...

Case study: Fatal strongyloidiasis associated with human T-cell lymphotropic virus type 1 infection.

“…This case supports other documented cases in literature of fatal strongyloidiasis in HTLV-1-infected patients. 12,16,17 This patient died as a result of sepsis after subdiaphragmatic pyogenic abscess. Sepsis is reported to be a major contributor to mortality in most case reports of hyperinfective strongyloidiasis.…”

Hyperinfection by Strongyloides stercoralis probably associated with Rituximab in a patient with mantle cell lymphoma and hyper eosinophilia

“…Steroids are known to suppress eosinophilia and lymphocyte activation 4,14 . Other important causes include coinfection with the human T cell lymphotropic virus type-1 (HTLV-1) 9,26 , hypogammaglobulinemia and malnutrition 14 . Coinfection with HIV has also been implicated, although the views are somewhat conflicting and the accepted view is that there are no solid criteria to establish a relationship between HIV infection and HS 14,16 .…”

Asociación entre infección por el virus linfotrópico humano de células T tipo I (HTLV-I) y mortalidad en pacientes hospitalizados con tuberculosis.

“…La infección por HTLV-I se asocia con desórdenes linfoproliferativos como la leucemia/linfoma de células T del adulto (ATL) (4), y con desórdenes autoinmunes, como la mielopatía asociada a HTLV-I/paraparesia espástica tropical (PET) (5). La infección por HTLV-I parece conferir también un riesgo incrementado para el desarrollo de algunas infecciones específicas, como lepra (6), sarna noruega (7), dermatitis infectiva (8), y formas severas de estrongiloidiasis (9). Otros reportes han sugerido que la infección por HTLV-I tiene un efecto agravante sobre el curso de la infección por el virus de inmunodeficiencia humana (VIH): los pacientes con infección dual VIH/HTLV-I tienen un mayor riesgo de desarrollar SIDA y un menor tiempo de sobrevida que los pacientes infectados únicamente por el VIH (10,11).…”