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

Area of Science:

• Medical Parasitology
• Infectious Diseases
• Immunology

Background:

• Human T-cell lymphotropic virus type 1 (HTLV-1) infection is endemic in many tropical and subtropical regions.
• Strongyloidiasis, caused by the nematode Strongyloides stercoralis, is also prevalent in these areas.
• HTLV-1 infection can impair cell-mediated immunity, potentially increasing susceptibility to opportunistic infections like strongyloidiasis.

Observation:

• A case report details a 45-year-old West Indian man with a history of HTLV-1 infection presenting with severe gastrointestinal symptoms.
• Clinical signs included intense diarrhea, vomiting, and significant weight loss.
• Microscopic examination of stool samples confirmed the presence of Strongyloides stercoralis larvae.

Findings:

• Despite treatment with thiabendazole, a standard antihelmintic, the patient experienced a fatal outcome.
• Autopsy revealed extensive ileocolitis caused by Strongyloides larvae, a subdiaphragmatic abscess, and severe pleuritis.
• This indicates a hyperinfective state of Strongyloides stercoralis, leading to disseminated disease.

Implications:

• Mortality remains high in patients with Strongyloides hyperinfection syndrome, even with appropriate antihelmintic therapy.
• For individuals in or from areas endemic for both HTLV-1 and strongyloidiasis, particularly those positive for HTLV-1, repeated stool microscopy is essential for early diagnosis.
• This case underscores the importance of considering co-infections and their synergistic impact on disease severity and outcomes.