Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis and delay in starting antiretroviral therapy for AIDS patients

OBJECTIVE: To compare the clinical characteristics and outcomes of HIV-1-HTLV-1 coinfected patients, in Bahia, Brazil. METHODS: Retrospective, comparative study. RESULTS: Among a total of 123 consecutive HIV infected patients, 20 men (20.6 percent) and 6 women (23.1 percent) had detectable antibodies against HTLV-I/II. The major risk factor associated with coinfection by HTLV was intravenous drug use (57.7 percent of coinfected patient versus 9.2 percent of HTLV seronegative patients, p < 0.0001). Coinfected patients had higher absolute lymphocyte counts (1,921 + 762 versus 1,587 + 951, p = 0.03). Both groups of patients had similar means of CD4+ and CD8+ cell counts. However, among patients with AIDS CD4+ cell counts were significantly higher among those coinfected with HTLV-I/II (292 ± 92 cells/mm³, versus 140 ± 177cells/mm³, p = 0.36). The frequency and type of opportunistic infections were similar for both groups, but strongyloidiasis and encephalopathy were more frequently diagnosed in coinfected patients (p < 0.05). On the other hand, patients coinfected with HTLV-I/II received significantly less antiretroviral therapy than singly infected by HIV-1. CONCLUSION: Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis for HIV patients. Higher CD4 count may lead to underestimation of immunodeficiency, and delay to initiate antiretroviral therapy.

A case of fatal hyperinfective strongyloidiasis with discovery of autoinfective filariform larvae in sputum

The autoinfective filariform larva of Strongyloides stercoralis causes hyperinfection in immunosuppressed hosts. Here we report on the case of a male patient who was admitted to the emergency room at Gwangju Veterans Hospital with a complaint of dyspnea, and who was receiving corticosteroid therapy for asthma. Many slender larvae of S. stercoralis with a notched tail were detected in Papanicolaou stained sputum. They measured 269 +/- 21.2 micrometer in length and 11 +/- 0.6 micrometer in width. The esophagus extended nearly half of the body length. The larvae were identified putatively as autoinfective third-stage filariform larvae, and their presence was fatal. The autoinfective filariform larva of S. stercoralis has not been previously reported in Korea.

Hyperinfection with strongyloides stercoralis

A case of Strongyloides hyperinfection syndrome, associated with corticosteroid therapy is described here. A 69-year-old male patient was admitted with a minor stroke. A history of headache arid a markedly elevated ESR prompted a temporal artery biopsy, which was consistent with temporal arteritis. Treatment was started with prednisolone 60 mg per day and the patient was discharged for follow-up. He was readmitted with a dense hemiplegia arid high fever. Blood culture grew E.co/i. He rapidly deteriorated arid died with evidence of disseminated intravascular coagulation and acute respiratory distress syndrome. Wet smears of sputum were positive for larvae of Strongyloides sterco ru/is, suggesting generalised infection. The importance of early diagnosis arid therapy, and screening methods for detection of parasites in stool are discussed

Manifestação intestinal rara em paciente com imunodeficiencia comum variavel e estrongiloidiase: relato de caso / Uncommom gastrointestinal manifestation in immunodeficient patient's report case

Relato de paciente com imunodeficiencia rara e manifestacao gastrointestinal incomum. Paciente...

Estrongiloidíase disseminada / Disseminated strongyloidiasis

Apresenta-se caso de criança com estrongiloidíase disseminada com evolução fatal. Enfatizam-se os fatores de risco, as manifestações clínicas, os meios diagnósticos e o tratamento. Recomenda-se a investigação de Strongyloides stercoralis em crianças severamente mal nutridas, doenças neoplásicas, AIDS ou em uso de corticoterapia prolongada

Esporotricose verrucosa / Verrucous sporotrichosis

Os autores apresentam um caso de esporotricose verrucosa em paciente do sexo feminino, branca, 23 anos de idade e história de três anos de evoluçäo; havia concomitância de quadro clínico e laboratorial de doença de Cushing