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Henry RK, Bagg A, Wu C, Eagle RC, Milman T. Orbital and Ocular Adnexal Manifestations of Adult T-Cell Leukemia/Lymphoma: a Case Report and Systematic Review. Ophthalmic Plast Reconstr Surg 2021; 37:201-211. [PMID: 32427727 DOI: 10.1097/iop.0000000000001695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe a patient with orbital adult T-cell leukemia/lymphoma (ATLL) and to review the literature on presentation, diagnostics, management, and clinical course of this rare disease. METHODS A systematic literature review. PubMed/MEDLINE and Google Scholar databases were searched for all well-documented cases of orbital/ocular adnexal ATLL. RESULTS Sixteen patients were included in the final analysis. The median age at diagnosis was 47 years (range, 20-85), 9/16 patients (56%) were male, and patients were of Japanese (10/16, 63%), Caribbean (5/16, 31%), or African (1/16, 6%) origin. Proptosis (6/15, 40%) and visual loss (5/15, 33%) were the most common presenting signs. Involvement of adjacent structures was documented in 8 of 16 (50%) patients. All patients had evidence of systemic ATLL, which was identified concurrently with orbital/ocular adnexal disease in 9 of 15 (60%) patients. Management included multi-agent chemotherapy with steroids (9/13, 69%), antivirals (2/13, 15%), biologic agents (4/13, 31%), and umbilical cord blood transplantation (1/13, 8%). Most patients (8/12, 67%) experienced at least partial remission with disease relapse occurring in 6 of 8 patients (75%). The median survival time was 28 months (95% CI, 5.5-50.5 months). CONCLUSIONS Adult T-cell leukemia/lymphoma should be considered in the differential diagnosis of orbital and ocular adnexal space-occupying lesions, particularly in male patients from endemic regions. Orbital disease is frequently locally aggressive and presents concurrently with systemic ATLL, highlighting the importance of comprehensive multimodal work-up and multidisciplinary management. Emerging targeted therapies and hematopoietic stem cell transplant may prolong survival.
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Affiliation(s)
- Roger K Henry
- Pathology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Connie Wu
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- Pathology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Pathology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Pathology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Gordon CA, Shield JM, Bradbury RS, Muhi S, Page W, Judd JA, Lee R, Biggs BA, Ross K, Kurscheid J, Gray DJ, McManus DP. HTLV-I and Strongyloides in Australia: The worm lurking beneath. ADVANCES IN PARASITOLOGY 2021; 111:119-201. [PMID: 33482974 DOI: 10.1016/bs.apar.2020.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Strongyloidiasis and HTLV-I (human T-lymphotropic virus-1) are important infections that are endemic in many countries around the world with an estimated 370 million infected with Strongyloides stercoralis alone, and 5-10 million with HTVL-I. Co-infections with these pathogens are associated with significant morbidity and can be fatal. HTLV-I infects T-cells thus causing dysregulation of the immune system which has been linked to dissemination and hyperinfection of S. stercoralis leading to bacterial sepsis which can result in death. Both of these pathogens are endemic in Australia primarily in remote communities in Queensland, the Northern Territory, and Western Australia. Other cases in Australia have occurred in immigrants and refugees, returned travellers, and Australian Defence Force personnel. HTLV-I infection is lifelong with no known cure. Strongyloidiasis is a long-term chronic disease that can remain latent for decades, as shown by infections diagnosed in prisoners of war from World War II and the Vietnam War testing positive decades after they returned from these conflicts. This review aims to shed light on concomitant infections of HTLV-I with S. stercoralis primarily in Australia but in the global context as well.
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Affiliation(s)
- Catherine A Gordon
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Jennifer M Shield
- Department of Pharmacy and Biomedical Sciences, La Trobe University, Bendigo, VIC, Australia; Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University, Berwick, VIC, Australia
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Page
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Jenni A Judd
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia; Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, QLD, Australia
| | - Rogan Lee
- Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia
| | - Beverley-Ann Biggs
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kirstin Ross
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Donald P McManus
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Gillet NA, Cook L, Laydon DJ, Hlela C, Verdonck K, Alvarez C, Gotuzzo E, Clark D, Farré L, Bittencourt A, Asquith B, Taylor GP, Bangham CRM. Strongyloidiasis and infective dermatitis alter human T lymphotropic virus-1 clonality in vivo. PLoS Pathog 2013; 9:e1003263. [PMID: 23592987 PMCID: PMC3617147 DOI: 10.1371/journal.ppat.1003263] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 02/05/2013] [Indexed: 01/03/2023] Open
Abstract
Human T-lymphotropic Virus-1 (HTLV-1) is a retrovirus that persists lifelong by driving clonal proliferation of infected T-cells. HTLV-1 causes a neuroinflammatory disease and adult T-cell leukemia/lymphoma. Strongyloidiasis, a gastrointestinal infection by the helminth Strongyloides stercoralis, and Infective Dermatitis associated with HTLV-1 (IDH), appear to be risk factors for the development of HTLV-1 related diseases. We used high-throughput sequencing to map and quantify the insertion sites of the provirus in order to monitor the clonality of the HTLV-1-infected T-cell population (i.e. the number of distinct clones and abundance of each clone). A newly developed biodiversity estimator called “DivE” was used to estimate the total number of clones in the blood. We found that the major determinant of proviral load in all subjects without leukemia/lymphoma was the total number of HTLV-1-infected clones. Nevertheless, the significantly higher proviral load in patients with strongyloidiasis or IDH was due to an increase in the mean clone abundance, not to an increase in the number of infected clones. These patients appear to be less capable of restricting clone abundance than those with HTLV-1 alone. In patients co-infected with Strongyloides there was an increased degree of oligoclonal expansion and a higher rate of turnover (i.e. appearance and disappearance) of HTLV-1-infected clones. In Strongyloides co-infected patients and those with IDH, proliferation of the most abundant HTLV-1+ T-cell clones is independent of the genomic environment of the provirus, in sharp contrast to patients with HTLV-1 infection alone. This implies that new selection forces are driving oligoclonal proliferation in Strongyloides co-infection and IDH. We conclude that strongyloidiasis and IDH increase the risk of development of HTLV-1-associated diseases by increasing the rate of infection of new clones and the abundance of existing HTLV-1+ clones. HTLV-1 is a human retrovirus estimated to infect 20 million people world-wide and is causing in a small proportion of the infected individuals an inflammatory disease or a leukemia/lymphoma. HTLV-1 persists lifelong by driving clonal proliferation of infected T-cells. Strongyloidiasis, a gastrointestinal infection by an helminth (Strongyloides stercoralis) and Infective Dermatitis associated with HTLV-1 (IDH), a skin inflammation with bacterial infection, appear to increase the risk of developing HTLV-1-related diseases. It is well known that the chance of developing HTLV-1-related diseases increases with the number of cells infected by the virus (also called proviral load). It is also known that HTLV-1-infected individuals co-infected by Strongyloides or affected by IDH have a higher proviral load, but the mechanism is still unclear. Consequently, the aim of this study was to test if co-infection increases the total number and/or the abundance (or size) of HTLV-1-infected T-cell clones. We have shown that the significantly increased proviral load in HTLV-1-infected individuals with IDH or strongyloidiasis is due to an increase in the mean clone abundance (bigger clones), not to an increase in the number of infected clones. These patients appear to be less capable of restricting clone abundance than those with HTLV-1 alone.
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Affiliation(s)
- Nicolas A. Gillet
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
- Molecular and Cellular Epigenetics, Interdisciplinary Cluster for Applied Genoproteomics (GIGA) of University of Liège (ULg), Liège, Belgium
- * E-mail: (NAG); (CRMB)
| | - Lucy Cook
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Daniel J. Laydon
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Carol Hlela
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Kristien Verdonck
- Instituto de Medicina Tropical Alexander von Humboldt and Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Carolina Alvarez
- Instituto de Medicina Tropical Alexander von Humboldt and Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt and Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Clark
- Instituto de Medicina Tropical Alexander von Humboldt and Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lourdes Farré
- Laboratory of Experimental Pathology, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Achiléa Bittencourt
- Complexo Hospitalar Universitário Prof. Edgard Santos, Department of Pathology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Becca Asquith
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Graham P. Taylor
- Section of Infectious Diseases, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Charles R. M. Bangham
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
- * E-mail: (NAG); (CRMB)
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Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, Van Den Ende J, Bisoffi Z. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 2013; 13:78. [PMID: 23394259 PMCID: PMC3598958 DOI: 10.1186/1471-2334-13-78] [Citation(s) in RCA: 229] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 01/19/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Strongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis. METHODS We conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011. We restricted search to papers in English, Spanish, Italian and French. Case reports were classified as HS/DS according to given definitions. RESULTS Records screened were 821, and 311 were excluded through titles and abstract evaluation. Of 510 full-text articles assessed for eligibility, 213 were included in qualitative analysis. As some of them were short case series, eventually the number of cases analyzed was 244.Steroids represented the main trigger predisposing to HS and DS (67% cases): they were mostly administered to treat underlying conditions (e.g. lymphomas, rheumatic diseases). However, sometimes steroids were empirically prescribed to treat signs and symptoms caused by unsuspected/unrecognized strongyloidiasis. Diagnosis was obtained by microscopy examination in 100% cases, while serology was done in a few cases (6.5%). Only in 3/29 cases of solid organ/bone marrow transplantation there is mention of pre-transplant serological screening. Therapeutic regimens were different in terms of drugs selection and combination, administration route and duration. Similar fatality rate was observed between patients with DS (68.5%) and HS (60%). CONCLUSIONS Proper screening (which must include serology) is mandatory in high - risk patients, for instance candidates to immunosuppressive medications, currently or previously living in endemic countries. In some cases, presumptive treatment might be justified. Ivermectin is the gold standard for treatment, although the optimal dosage is not clearly defined in case of HS/DS.
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Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ana Requena-Mendez
- Barcelona Centre for International Health Research (CRESIB) Hospital Clinic, Barcelona, Spain
| | - Andrea Angheben
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Jose Muñoz
- Barcelona Centre for International Health Research (CRESIB) Hospital Clinic, Barcelona, Spain
| | - Federico Gobbi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Jef Van Den Ende
- Department of Clinical sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Zeno Bisoffi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
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Choksi M, Joseph AJ, Simon E, Shah A, Ramachandran J, Ramakrishna BS. The association of HTLV-1 infection, persistent intestinal infection with Strongyloides stercoralis and gastrointestinal lymphoma. BMJ Case Rep 2009; 2009:bcr07.2008.0373. [PMID: 21686837 DOI: 10.1136/bcr.07.2008.0373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Human T cell lymphotropic virus type 1 (HTLV-1) infection is a risk factor for Strongyloides stercoralis infection. HTLV-1 also predisposes to the development of T cell malignancies. We report a case of a patient with severe, treatment resistant Strongyloides infection and HTLV-1 infection who progressed to develop an advanced high grade T cell lymphoma of the intestine.
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Affiliation(s)
- Mehul Choksi
- Christian Medical College, Ida Scudder Road, Vellore, 632004, India
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6
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Porto AF, Santos SB, Alcantara L, Guerreiro JB, Passos J, Gonzalez T, Neva F, Gonzalez D, Ho JL, Carvalho EM. HTLV-1 modifies the clinical and immunological response to schistosomiasis. Clin Exp Immunol 2004; 137:424-9. [PMID: 15270862 PMCID: PMC1809103 DOI: 10.1111/j.1365-2249.2004.02508.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The immunological response in HTLV-1 infected individuals is characterized by a prominent Type-1 cytokine response with high production of IFN-gamma and TNF-alpha. In contrast, helminthic infections and in particular chronic schistosomiasis are associated with a predominant production of IL-4, IL-5, IL-10 and IL-13. Liver fibrosis is the main pathological finding in schistosomiasis that occurs after many years of infection. This pathology is T cell dependent but the immune response mechanisms are not completely understood. The North-east region of Brazil is endemic for both HTLV-1 and schistosomiasis. In the present study the immune response, clinical severity, and therapeutic response to praziquantel of patients with schistosomiasis coinfected with HTLV-1 were compared with patients infected only with S. mansoni. Patients with HTLV-1 and S. mansoni had lower levels of IL-5 (P < 0.05) and higher levels of IFN-gamma (P < 0.05) in cultures stimulated with S. mansoni antigen and decreased S. mansoni antigen specific IgE levels when compared with patients with schistosomiasis without HTLV-1 coinfection. Liver fibrosis was mild in all HTLV-1 coinfected patients and efficacy of praziquantel was lower in patients dually infected than in patients infected only with S. mansoni.
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Affiliation(s)
- A F Porto
- Serviço de Imunologia do Hospital Unversitário Prof Edgard Santos, Salvador, Bahia, Brazil
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7
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Santos SB, Porto AF, Muniz AL, Jesus ARD, Carvalho EM. Clinical and immunological consequences of human T cell leukemia virus type-I and Schistosoma mansoni co-infection. Mem Inst Oswaldo Cruz 2004; 99:121-6. [PMID: 15486648 DOI: 10.1590/s0074-02762004000900022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Human T cell leukemia virus type-I (HTLV-I) infection is associated with spontaneous T cell activation and uncontrolled lymphocyte proliferation. An exacerbated type-1 immune response with production of pro-inflammatory cytokines (interferon-gamma and tumor necrosis factor-alpha) is significantly higher in patients with myelopathy associated to HTLV-I than in HTLV-I asymptomatic carriers. In contrast with HTLV-I, a chronic Schistosoma mansoni infection is associated with a type-2 immune response with high levels of interleukin (IL-4, IL-5, and IL-10) and low levels of IFN-gamma. In this study, clinical and immunological consequences of the HTLV-I and S. mansoni infection were evaluated. The immune response in patients with schistosomiasis co-infected with HTLV-I showed low levels of IL-5 (p < 0.05) in peripheral blood mononuclear cells cultures stimulated with S. mansoni antigen (SWAP) and decreased SWAP-specific IgE levels when compared with patients with only schistosomiasis (p < 0.05). Liver fibrosis was mild in all HTLV-I co-infected patients. Immunological response was also compared in individuals who had only HTLV-I infection with those who were co-infected with HTLV-I and helminths (S. mansoni and Strongyloides stercoralis). In patients HTLV-I positive co-infected with helminths the IFN-gamma levels were lower than in individuals who had only HTLV-I. Moreover, there were fewer cells expressing IFN-gamma and more cells expressing IL-10 in individuals co-infected with HTLV-I and helminths. These dates indicate that HTLV-I infection decrease type 2-response and IgE synthesis and are inversely associated with the development of liver fibrosis. Moreover, helminths may protect HTLV-I infected patients to produce large quantities of pro-inflammatory cytokines such as IFN-gamma.
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Affiliation(s)
- Silvane Braga Santos
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Rua João das Botas, s/n, 40110-160 Salvador, BA, Brazil
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8
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Clyti E, Reynier C, Couppie P, Kazanji M, Sainte-Marie D, Prevost G, Aznar C, Pradinaud R. [Infective dermatitis and recurrent strongyloidiasis in a child]. Ann Dermatol Venereol 2004; 131:191-3. [PMID: 15026748 DOI: 10.1016/s0151-9638(04)93569-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Infective dermatitis is a chronic childhood dermatosis, associated with HTLV-1 infection. We report the observation of a young Haitian girl in French Guyana. OBSERVATION An 8 year-old girl presented recurring dermatosis on the scalp and armpits since she was 2 years old. The initial clinical examination showed the presence of centro-facial micro-papules, associated with a nasal pyodermatitis. A bacteriological culture isolated a Staphylococcus aureus. Phenotypic analysis did not indicate any production of exfoliatin or leucocidin. Serologic tests for HTLV1 were positive. In addition, the child presented recurring symptomatic anguillulosis, despite numerous antihelmintic treatments. A clinical and parasitological cure was obtained with a monthly treatment of ivermectin. COMMENTS This is the first case of infective dermatitis reported in french Guyana. The clinical analysis that led to this diagnosis showed a minor form of this dermatosis. The phenotypic analysis of the Staphylococcus aureus isolated from the cutaneous lesions did not indicate any factors of virulence habitually associated with pyodermatitis in Guyana. This is the first case of chronic digestive anguillulosis (a parasitic complaint usually associated with an adult HTLV-1 infection) associated with an infective dermatitis.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon, BP 6006, 97306 Cayenne Cedex.
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Cebular S, Lee S, Tolaney P, Lutwick L. Community-acquired pneumonia in immunocompromised patients. Opportunistic infections to consider in differential diagnosis. Postgrad Med 2003; 113:65-6, 69-70, 73-4 passim. [PMID: 12545593 DOI: 10.3810/pgm.2003.01.1351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Immunocompromised persons are at increased risk for a large group of infections that are either uncommon or much less severe in the immunocompetent host. These opportunistic infections broaden the diagnostic considerations in differential diagnosis of community-acquired pneumonia in patients with immunodeficiencies. This article highlighted epidemiologic factors, clinical presentations, and treatment options for four selected opportunistic infections that represent varied classes of pathogens: nematodes (S stercoralis), mycoses (C neoformans), bacteria (P aeruginosa in patients with HIV infection), and viruses (measles virus).
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Affiliation(s)
- Sanda Cebular
- State University of New York-Downstate Medical Center, Brooklyn, USA
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10
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Porto MAF, Muniz A, Oliveira Júnior J, Carvalho EM. [Clinical and immunological consequences of the association between HTLV-1 and strongyloidiasis]. Rev Soc Bras Med Trop 2002; 35:641-9. [PMID: 12612748 DOI: 10.1590/s0037-86822002000600016] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Strongyloidiasis is one of most important forms of helminthiasis in tropical countries and epidemiologic studies have shown the association of this parasitic disease with HTLV. It has been observed in regions where both these agents are endemic and coinfection may result in an increase in the disseminated forms of strongyloidiasis as well as recurrent strongyloidiasis. While HTLV-1 is related to a high production of IFN-gamma; and deviation of the immune response towards a Th1 response, the protection against helminths is associated with Th2 like immune response. Individuals infected with HTLV and S. stercoralis have a reduction in the production of IL-4, IL-5, IL-13 and parasitic IgE response, all of which are factors participating in the defense mechanism against S. stercoralis. These abnormalities are the basis for the occurrence of an increase in the severe forms of strongyloidiasis among patients infected with HTLV-1.
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Affiliation(s)
- Maria Aurélia F Porto
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil
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11
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Porto AF, Neva FA, Bittencourt H, Lisboa W, Thompson R, Alcântara L, Carvalho EM. HTLV-1 decreases Th2 type of immune response in patients with strongyloidiasis. Parasite Immunol 2001; 23:503-7. [PMID: 11589779 DOI: 10.1046/j.1365-3024.2001.00407.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Eosinophils, immunoglobulin (Ig)E and cytokines have important roles in defence mechanisms against helminths. In this study, the influence of HTLV-1 infection, characterized by a Th1 type of immune response, was evaluated on the cytokine pattern and parasitic specific IgE response in patients with strongyloidiasis. Patients were divided into four groups: strongyloidiasis without HTLV-1 infection, strongyloidiasis with HTLV-1, HTLV-1 without strongyloidiasis and controls without either helminth infection or HTLV-1. The cytokine profile was determined in supernatants of mononuclear cells stimulated with Strongyloides stercoralis crude antigen and the parasite specific IgE was measured by ELISA. Patients coinfected with HTLV-1 had higher levels of interferon (IFN)-gamma and interleukin (IL)-10 (P < 0.05) and lower levels of IL-5 and IgE (P < 0.05) than patients with strongyloidiasis without HTLV-1. There was an inverse relationship between IFN-gamma and IL-5 (P = 0.01; rs = - 0.37) and between IFN-gamma and parasite specific IgE (P = 0.01; rs = - 0.39), and a direct relationship between IFN-gamma and IL-10 (P = 0.04; rs = 0.35). These data show that coinfection with HTLV-1 decreases IL-5 and IgE responses in patients with strongyloidiasis consistent with a relative switch from Th2 to Th1 response. Immunological responses such as these are important in the control of this helminthic infection.
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Affiliation(s)
- A F Porto
- Serviço de Imunologia do Hospital Unversitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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12
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Gabet AS, Mortreux F, Talarmin A, Plumelle Y, Leclercq I, Leroy A, Gessain A, Clity E, Joubert M, Wattel E. High circulating proviral load with oligoclonal expansion of HTLV-1 bearing T cells in HTLV-1 carriers with strongyloidiasis. Oncogene 2000; 19:4954-60. [PMID: 11042682 DOI: 10.1038/sj.onc.1203870] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adult T cell leukemia (ATLL) develops in 3 - 5% of HTLV-1 carriers after a long period of latency during which a persistent polyclonal expansion of HTLV-1 infected lymphocytes is observed in all individuals. This incubation period is significantly shortened in HTLV-1 carrier with Strongyloides stercoralis (Ss) infection, suggesting that Ss could be a cofactor of ATLL. As an increased T cell proliferation at the asymptomatic stage of HTLV-1 infection could increase the risk of malignant transformation, the effect of Ss infection on infected T lymphocytes was assessed in vivo in HTLV-1 asymptomatic carriers. After real-time quantitative PCR, the mean circulating HTLV-1 proviral load was more than five times higher in HTLV-1 carriers with strongyloidiasis than in HTLV-1+ individuals without Ss infection (P<0.009). This increased proviral load was found to result from the extensive proliferation of a restricted number of infected clones, i.e. from oligoclonal expansion, as evidenced by the semiquantitative amplification of HTLV-1 flanking sequences. The positive effect of Ss on clonal expansion was reversible under effective treatment of strongyloidiasis in one patient with parasitological cure whereas no significant modification of the HTLV-1 replication pattern was observed in an additional case with strongyloidiasis treatment failure. Therefore, Ss stimulates the oligoclonal proliferation of HTLV-1 infected cells in HTLV-1 asymptomatic carriers in vivo. This is thought to account for the shortened period of latency observed in ATLL patients with strongyloidiasis. Oncogene (2000) 19, 4954 - 4960
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Affiliation(s)
- A S Gabet
- Unité d'Oncogenèse Virale, UMR5537 CNRS-Université Claude Bernard, Centre Léon Bérard, 28 rue Laënnec 69373, Lyon Cedex 08, France
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Patil P, Jayshree RS, Acharya RS, Sridhar H, Babu G, Suresh TM. Fulminant fatal Strongyloides stercoralis infection in a postchemotherapy immunosuppressed cancer patient. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 33:504-5. [PMID: 10531578 DOI: 10.1002/(sici)1096-911x(199911)33:5<504::aid-mpo13>3.0.co;2-q] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P Patil
- Kidwai Memorial Institute Of Oncology, Bangalore, India.
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Atkins NS, Lindo JF, Lee MG, Hanchard B, Robinson RD, Bundy DA. Immunomodulatory effects of concurrent HTLV-I infection in strongyloidiasis. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1998; 18:188-90. [PMID: 9637586 DOI: 10.1097/00042560-199806010-00013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Heyworth MF. Parasitic diseases in immunocompromised hosts. Cryptosporidiosis, isosporiasis, and strongyloidiasis. Gastroenterol Clin North Am 1996; 25:691-707. [PMID: 8863046 DOI: 10.1016/s0889-8553(05)70269-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cryptosporidiosis and isosporiasis are intestinal infections caused by the protozoan parasites Cryptosporidium parvum and Isospora belli, respectively. HIV infection and other immunodeficiency diseases predispose human subjects to severe and prolonged cryptosporidiosis. There is also evidence that HIV infection predisposes to chronic isosporiasis. Strongyloidiasis is caused by a nematode worm, Strongyloides stercoralis. Administration of corticosteroids to patients with chronic low-grade S. stercoralis infection can trigger a fulminant, life-threatening form of strongyloidiasis.
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Affiliation(s)
- M F Heyworth
- Medical Service, Department of Veterans Affairs Medical, Fargo, North Dakota, USA
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Plumelle Y, Edouard A. [Strongyloides stercoralis in T-cell leukemia/lymphoma in adults and acquired immunodeficiency syndrome]. Rev Med Interne 1996; 17:125-9. [PMID: 8787083 DOI: 10.1016/0248-8663(96)82961-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The mechanisms of chronic infestation by Strongyloides stercoralis (Ss) are unknown. Immunodepression is classically evoked to explain the proliferation of the parasite that is sometimes massive and overwhelming. We present here two retrospective studies of 13 cases of strongyloidiasis (three disseminated strongyloidiasis) out of 26 patients with adult T-cell leukemia/lymphoma (ATL) and of ten cases of strongyloidiasis out of 98 patients with AIDS. Ten patients out of 98 were dually infected with both HIV and HTLV-1: 2/10 also infected by Ss. The frequency of Ss infection appears higher in ATL patients when compared with AIDS patients (P < 0.001). Ss-infected ATL patients were younger than those uninfected (P < 0.01). Ss-infected AIDS patients were older than the ones uninfected (p < 0.03). No significative difference was found between ATL and AIDS patients who were over 40 years-old. These data suggest that 1) the particular type of immunodepression produced early by HTLV-1 is more favorable to the development of Ss infection than the one associated with HIV, 2) the latency of expression of HTLV-1, prior to the development of leukemia, is reduced in Ss-infected patients, 3) Ss infection may slow down VIH pathogenic activity.
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Affiliation(s)
- Y Plumelle
- Service d'hématologie biologique, CHU, Martinique, France
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Affiliation(s)
- D I Grove
- Department of Clinical Microbiology and Infectious Diseases, Queen Elizabeth Hospital, Adelaide, South Australia
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Aydin H, Doppl W, Battmann A, Bohle RM, Klör HU. Opportunistic strongyloides stercoralis hyperinfection in lymphoma patients undergoing chemotherapy and/or radiotherapy--report of a case and review of the literature. Acta Oncol 1994; 33:78-80. [PMID: 8142133 DOI: 10.3109/02841869409098386] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- H Aydin
- Dept. of Radiation Oncology, University of Giessen, Germany
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