Case Report: Strongyloides stercoralis Hyperinfection in a Patient with HTLV-1: An Infection with Filariform and Rhabditiform Larvae, Eggs, and Free-Living Adult Females Output

Am J Trop Med Hyg. 2018 Dec;99(6):1583-1586. doi: 10.4269/ajtmh.18-0402. Epub 2018 Sep 27.

Abstract

Strongyloides stercoralis is the main etiological agent of human strongyloidiasis. Severe strongyloidiasis is commonly associated to alcoholism, corticostereoid use, and human T cell lymphotropic virus type 1 (HTLV-1) coinfection. Herein, we report a case of a 13-year-old boy coinfected with S. stercoralis and HTLV-1, excreting several parasitic forms in the stool. The parasitological examination of his feces showed a large amount of filariform (about 3,000 larvae per gram of feces) and rhabditiform larvae (about 2,000 larvae per gram of feces). In addition, free-living adult females (about 50 parasites per gram of feces) and eggs (about 60 eggs per gram of feces) were detected. The main laboratory findings pointed to high immunoglobulin E (IgE) levels (228 UI/mL) and eosinophila (11.6%). The patient was treated with three courses of ivermectin (200 µg/kg twice, 2 weeks apart), achieving the parasitological cure. An increase of about 19 times in interleucin (IL)-17 level was observed following the parasitological cure, in addition to a decrease in the white blood cell, eosinophil counts, and IgE levels. This is the first case report, to our knowledge, in which an S. stercoralis adult free-living female was described in human feces and where an increase in IL-17 levels after Strongyloides treatment in a HTLV-1 coinfected individual was observed. This finding raises the need for further studies about IL-17 immunomodulation in S. stercoralis and HTLV-1 coinfected patients.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Animals
  • Anthelmintics / therapeutic use
  • Brazil
  • Coinfection
  • Feces / parasitology*
  • Female
  • HTLV-I Infections / diagnosis*
  • HTLV-I Infections / immunology
  • HTLV-I Infections / pathology
  • Human T-lymphotropic virus 1 / immunology*
  • Human T-lymphotropic virus 1 / isolation & purification
  • Humans
  • Immunoglobulin E / biosynthesis
  • Interleukin-17 / biosynthesis
  • Ivermectin / therapeutic use
  • Larva / immunology
  • Male
  • Parasite Egg Count
  • Strongyloides stercoralis / immunology*
  • Strongyloides stercoralis / isolation & purification
  • Strongyloidiasis / diagnosis*
  • Strongyloidiasis / drug therapy
  • Strongyloidiasis / immunology
  • Strongyloidiasis / pathology
  • Zygote / immunology

Substances

  • Anthelmintics
  • Interleukin-17
  • Immunoglobulin E
  • Ivermectin