Strongyloides stercoralis hyperinfection in a patient with the acquired immune deficiency syndrome

Maayan, Shlomo; Wormser, Gary P.; Widerhorn, Josef; Sy, Ernsto R.; Kim, Ye H.; Ernst, J. A.

doi:10.1016/0002-9343(87)90656-5

Cited by 91 publications

(43 citation statements)

References 17 publications

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“…3 The cellular immune response may be of less importance since there is no increased incidence of disseminated strongyloidiasis in patients with acquired immunodeficiency syndrome with low CD4 counts. 25 A role for parasite-specific antibody, in particular IgE, has been strongly implicated in Strongyloides immunity, 3 but definitive evidence is lacking. In disseminated strongyloidiasis, low serum IgE levels and few or no eosinophils in the peripheral blood have been described.…”

Section: Discussionmentioning

confidence: 99%

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

Gotuzzo¹,

Terashima²,

Alvarez³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

159

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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...

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Section: Discussionmentioning

confidence: 99%

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

Gotuzzo¹,

Terashima²,

Alvarez³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

159

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“…In all, there are fewer than 30 cases of hyperinfection occurring in human immunodeficiency virus (HIV)-infected patients in the literature. A number of these patients had previously received steroids, either as adjunctive treatment for Pneumocystis carinii pneumonia (15,65,100) or as part of a chemotherapeutic regimen for nonHodgkin's lymphoma (28). HTLV-1 infection is generally not commented on in these case reports.…”

Section: Hiv Infectionmentioning

confidence: 99%

“…The number of cases of hyperinfection in AIDS patients that have occurred within a few weeks of treating chronic intestinal infection (38,44,59,65,123) is interesting. Whether anthelmintic therapy actually induces parasite migration, as occurs in filarial infections (30,117), and is thereby the initiating event in hyperinfection is a matter for speculation.…”

Section: Hiv Infectionmentioning

confidence: 99%

“…This "posttreatment hyperinfection" has also been observed in renal transplant recipients (108) in whom S. stercoralis infection was treated both before and after transplant. While these cases undoubtedly represent a tiny fraction of AIDS patients who have received anthelmintic treatment for positive stool exams, it does challenge the notion that screening HIV-positive individuals for S. stercoralis and treating coinfected individuals with conventional doses of anthelmintics will prevent hyperinfection (65).…”

Section: Hiv Infectionmentioning

confidence: 99%

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Strongyloides stercoralisin the Immunocompromised Population

2004

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Strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. S. stercoralis is unique among intestinal nematodes in its ability to complete its life cycle within the host through an asexual autoinfective cycle, allowing the infection to persist in the host indefinitely. Under some conditions associated with immunocompromise, this autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome, characterized by increased numbers of infective filariform larvae in stool and sputum and clinical manifestations of the increased parasite burden and migration, such as gastrointestinal bleeding and respiratory distress. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid treatment and human T-lymphotropic virus type 1 infection are the two conditions most specifically associated with triggering hyperinfection, but cases have been reported in association with hematologic malignancy, malnutrition, and AIDS. Anthelmintic agents such as ivermectin have been used successfully in treating the hyperinfection syndrome as well as for primary and secondary prevention of hyperinfection in patients whose exposure history and underlying condition put them at increased risk

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“…In some of the reports, the patients did in fact have strongyloidiasis, but there was no evidence of extraintestinal dissemination (7). Other patients had concurrent conditions, for example, lymphomas, that had been treated with chemotherapeutic drug regimens that included corticosteroids (29,77,110). A recent brief report from southern Brazil (84) suggested that in an area of that country where S. stercoralis is endemic, HIV-infected patients have a higher prevalence of S. stercoralis infection than the HIV-negative population, but the authors readily admitted that the incidence of overwhelming strongyloidiasis does not seem to be higher in the HIV-positive patients.…”

Section: Regulation Of Autoinfectionmentioning

confidence: 99%

Dysregulation of strongyloidiasis: a new hypothesis

Genta

1992

Clin Microbiol Rev

152

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Few other human parasites are associated with such a diverse spectrum of clinical manifestations as Strongyloides stercoralis, yet the basic biological behavior of this unusually versatile worm, particularly with respect to its ability to cause severe disseminated disease in certain hosts, is poorly understood. The current uncritical acceptance of the theory that cell-mediated immunity controls autoinfection has stifled research in other directions. After reviewing what is and is not known about the parasite's behavior in its host, this article explores some of the mechanisms that could be involved in the regulation of the parasite population. Taking the provocative viewpoint that the parasite, not the host, is mainly responsible for the maintenance of a balanced relationship between the two, I propose a new theory that corticosteroids may act on the intraintestinal larvae as molting hormones and directly promote the development of disseminated disease.

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Strongyloides stercoralis hyperinfection in a patient with the acquired immune deficiency syndrome

Cited by 91 publications

References 17 publications

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

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

Strongyloides stercoralisin the Immunocompromised Population

Dysregulation of strongyloidiasis: a new hypothesis

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