1
|
Gordon CA, Utzinger J, Muhi S, Becker SL, Keiser J, Khieu V, Gray DJ. Strongyloidiasis. Nat Rev Dis Primers 2024; 10:6. [PMID: 38272922 DOI: 10.1038/s41572-023-00490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.
Collapse
Affiliation(s)
- Catherine A Gordon
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Department of Microbiology and Immunology, Parkville, Victoria, Australia
| | - Sören L Becker
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Darren J Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Breloer M, Linnemann L. Strongyloides ratti infection in mice: immune response and immune modulation. Philos Trans R Soc Lond B Biol Sci 2024; 379:20220440. [PMID: 38008111 PMCID: PMC10676808 DOI: 10.1098/rstb.2022.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/09/2023] [Indexed: 11/28/2023] Open
Abstract
Strongyloides ratti is a natural parasite of wild rats and most laboratory mouse strains are also fully permissive. The infection can be divided into three distinct phases: the tissue migration of the infective third stage larvae during the first two days, the early intestinal establishment of S. ratti parasites molting to adults on days three to six and the later intestinal parasitic phase until the end of infection. Immunocompetent mice terminate the S. ratti infection after one month and are semi-resistant to a second infection. Employing the powerful tools of mouse immunology has facilitated a detailed analysis of the initiation, execution and regulation of the immune response to S. ratti. Here we review the information collected to date on the protective immune response to migrating S. ratti larvae in tissues and to adult parasites in the intestine. We show that depending on the phase of infection, a site-specific portfolio of immune effector mechanisms is required for infection control. In addition, we summarize the strategies employed by S. ratti to evade the immune system and survive long enough in its host to replicate despite an effective immune response. Selected murine studies using the closely related Strongyloides venezuelensis will be discussed. This article is part of the Theo Murphy meeting issue 'Strongyloides: omics to worm-free populations'.
Collapse
Affiliation(s)
- Minka Breloer
- Section of Molecular Biology and Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg 20359, Germany
- Department of Biology, University of Hamburg, Hamburg 20156, Germany
| | - Lara Linnemann
- Section of Molecular Biology and Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg 20359, Germany
| |
Collapse
|
3
|
Rosca EC, Heneghan C, Spencer EA, Plüddemann A, Maltoni S, Gandini S, Onakpoya IJ, Evans D, Conly JM, Jefferson T. Coinfection with Strongyloides and SARS-CoV-2: A Systematic Review. Trop Med Infect Dis 2023; 8:tropicalmed8050248. [PMID: 37235296 DOI: 10.3390/tropicalmed8050248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Treatments for COVID-19, including steroids, might exacerbate Strongyloides disease in patients with coinfection. We aimed to systematically review clinical and laboratory features of SARS-CoV-2 and Strongyloides coinfection, investigate possible interventions, assess outcomes, and identify research gaps requiring further attention. METHODS We searched two electronic databases, LitCOVID and WHO, up to August 2022, including SARS-CoV-2 and Strongyloides coinfection studies. We adapted the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system for standardized case causality assessment to evaluate if using corticosteroids or other immunosuppressive drugs in COVID-19 patients determined acute manifestations of strongyloidiasis. RESULTS We included 16 studies reporting 25 cases of Strongyloides and SARS-CoV-2 coinfection: 4 with hyperinfection syndrome; 2 with disseminated strongyloidiasis; 3 with cutaneous reactivation of strongyloidiasis; 3 with isolated digestive symptoms; and 2 with solely eosinophilia, without clinical manifestations. Eleven patients were asymptomatic regarding strongyloidiasis. Eosinopenia or normal eosinophil count was reported in 58.3% of patients with Strongyloides reactivation. Steroids were given to 18/21 (85.7%) cases. A total of 4 patients (19.1%) received tocilizumab and/or Anakirna in addition to steroids. Moreover, 2 patients (9.5%) did not receive any COVID-19 treatment. The causal relationship between Strongyloides reactivation and COVID-19 treatments was considered certain (4% of cases), probable (20% of patients), and possible (20% of patients). For 8% of cases, it was considered unlikely that COVID-19 treatment was associated with strongyloidiasis reactivations; the relationship between the Strongyloides infection and administration of COVID-19 treatment was unassessable/unclassifiable in 48% of cases. Of 13 assessable cases, 11 (84.6%) were considered to be causally associated with Strongyloides, ranging from certain to possible. CONCLUSIONS Further research is needed to assess the frequency and risk of Strongyloides reactivation in SARS-CoV-2 infection. Our limited data using causality assessment supports recommendations that clinicians should screen and treat for Strongyloides infection in patients with coinfection who receive immunosuppressive COVID-19 therapies. In addition, the male gender and older age (over 50 years) may be predisposing factors for Strongyloides reactivation. Standardized guidelines should be developed for reporting future research.
Collapse
Affiliation(s)
- Elena C Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, 300041 Timisoara, Romania
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Elizabeth A Spencer
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Annette Plüddemann
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Susanna Maltoni
- Division of Research and Innovation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Igho J Onakpoya
- Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
| | - David Evans
- Li Ka Shing Institute of Virology and Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - John M Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, Synder Institute for Chronic Diseases and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 1N4, Canada
| | - Tom Jefferson
- Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
| |
Collapse
|
4
|
Oshima R, Matsuhisa T, Kondo T, Sato M, Sato J, Yamamura M. Strongyloidiasis presenting during treatment of low-dose glucocorticoid plus rituximab for anti-signal recognition particle antibody-positive polymyositis: A case report. Mod Rheumatol Case Rep 2023; 7:113-116. [PMID: 36264196 DOI: 10.1093/mrcr/rxac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
Strongyloidiasis, an intestinal parasitic infection caused by Strongyloides stercoralis, rarely occurs in Japan. When treated with immunosuppressive drugs, two potentially lethal conditions, hyperinfection and dissemination, may develop in asymptomatic carriers of this parasite. We report the development of strongyloidiasis during treatment of polymyositis with glucocorticoids plus rituximab (RTX). A 44-year-old woman had been diagnosed with anti-signal recognition particle antibody-positive polymyositis with interstitial pneumonia 6 years previously, for which she had recently been receiving prednisolone at 5 mg/day and RTX at 375 mg/m2 twice every 3 months. Her condition appeared to be well controlled. She was admitted to our hospital with a 1-month history of chronic diarrhoea and epigastric pain. Standard microscopic examination of a sample of faeces revealed the presence of S. stercoralis; however, serologic testing for parasites was negative. Treatment with ivermectin alleviated her inflammatory diarrhoea and eradicated the faecal parasites. We believe that our patient had an exacerbation of S. stercoralis infection (hyperinfection syndrome) that was exacerbated by low-dose glucocorticoids plus RTX. Strongyloidiasis should be considered in immunocompromised individuals with unexplained diarrhoea, even in non-endemic areas.
Collapse
Affiliation(s)
- Ryo Oshima
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takaharu Matsuhisa
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takeshi Kondo
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Motoki Sato
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Juichi Sato
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Yamamura
- Department of Rheumatology and Collagen Disease Centre, Okayama Saiseikai General Hospital, Okayama, Japan
| |
Collapse
|
5
|
Rovira-Diaz E, El-Naccache DW, Reyes J, Zhao Y, Nasuhidehnavi A, Chen F, Gause WC, Yap GS. The Impact of Helminth Coinfection on Innate and Adaptive Immune Resistance and Disease Tolerance during Toxoplasmosis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 209:2160-2171. [PMID: 36426972 PMCID: PMC10065986 DOI: 10.4049/jimmunol.2200504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/23/2022] [Indexed: 01/04/2023]
Abstract
More than 2 billion people worldwide are infected with helminths. Thus, it is possible for individuals to experience concomitant infection with helminth and intracellular microbes. Although the helminth-induced type 2 response can suppress type 1 proinflammatory responses required for the immunity against intracellular pathogens in the context of a coinfection, conflicting evidence suggest that helminth infection can enhance antimicrobial immunity. Using a coinfection model with the intestinal helminth Heligmosomoides polygyrus followed by infection with Toxoplasma gondii in Mus Musculus, we showed that the complex and dynamic effect of helminth infection is highly suppressive during the innate phase (days 0-3) of T. gondii infection and less stringent during the acute phase (d10). Helminth coinfection had a strong suppressive effect on the neutrophil, monocytic, and early IFN-γ/IL-12 responses. The IFN-γ response was later restored by compensatory production from T cells despite decreased effector differentiation of T. gondii-specific CD8 T cells. In accordance with the attenuated IFN-γ response, parasite loads were elevated during the acute phase (d10) of T. gondii infection but were transiently controlled by the compensatory T cell response. Unexpectedly, 40% of helminth-coinfected mice exhibited a sustained weight loss phenotype during the postacute phase (d14-18) that was not associated with T. gondii outgrowth, indicating that coinfection led to decreased disease tolerance during T. gondii infection. Our work uncovers the dynamic nature of the helminth immunomodulatory effects on concomitant infections or immune responses and unveils a loss of disease tolerance phenotype triggered by coinfection with intestinal helminth.
Collapse
Affiliation(s)
- Eliezer Rovira-Diaz
- Department of Medicine and Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ 07101
| | - Darine W. El-Naccache
- Department of Medicine and Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ 07101
| | - Jojo Reyes
- Department of Medicine and Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ 07101
| | - Yanlin Zhao
- Department of Medicine and Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ 07101
| | - Azadeh Nasuhidehnavi
- Department of Medicine and Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ 07101
| | - Fei Chen
- Department of Medicine and Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ 07101
| | - William C. Gause
- Department of Medicine and Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ 07101
| | - George S. Yap
- Department of Medicine and Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ 07101
| |
Collapse
|
6
|
Fatal Case of Autochthonous Strongyloides stercoralis Hyperinfection in an Immunosuppressed Calabrian Patient. REPORTS 2022. [DOI: 10.3390/reports5040047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Strongyloides stercoralis is an intestinal nematode that can induce disseminated infection in immunocompromised patients. It is most commonly acquired in tropical and subtropical countries; however, foci of the infection have also been reported in temperate geographic areas. In non-endemic areas, the diagnosis of an S. stercoralis infection is challenging due to the variety of clinical symptoms. Herein, we report the case of a patient, born and raised in the Calabria region of Southern Italy, who presented with melanoma and S. stercoralis hyperinfection, which is characterized by dyspnea, productive cough, inappetence, marked asthenia, weight loss, and Klebsiella pneumoniae bacteremia. He worked as a farmer and never traveled to another country known to be endemic for S. stercoralis. Despite the prompt identification of the parasite with sputum microscopy and the initiation of therapy with ivermectin and piperacillin–tazobactam, the patient later died. This case underscores the continued risk for S. stercoralis infection even in geographic areas that were previously considered non-endemic for the nematode and indicates that the geographic distribution of S. stercoralis may be expanding in Italy.
Collapse
|
7
|
Norman FF, Salvador F, Gullón B, Díaz-Menéndez M, Pérez-Ayala A, Rodriguez-Guardado A, García-Rodriguez M, Henriquez-Camacho C, Goikoetxea J, Bosch-Nicolau P, de la Calle F, Ramos-Rincon JM, Aznar ML, Peñaranda M, Calabuig E, Suarez-Garcia I, Pérez-Molina JA, López-Vélez R. Frequency and characteristics of HTLV in migrants: results from the +Redivi collaborative network in Spain. J Travel Med 2022; 29:6528728. [PMID: 35166822 DOI: 10.1093/jtm/taac019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The objective of this study was to describe the main characteristics of migrants diagnosed with human T-lymphotropic virus (HTLV) infection within the +Redivi Spanish network. METHODS Patients with a diagnosis of HTLV type 1 or 2 in +Redivi from October 2009 to December 2020 were included. Diagnosis was based on positive HTLV serology (enzyme-linked immunosorbent assay (ELISA)/chemiluminescent immunoassay (CLIA)) with line immunoassay (LIA)/Western blot with/without polymerase chain reaction (PCR). RESULTS A total of 107/17 007 cases (0.6%) had a final diagnosis of HTLV infection: 83 (77.67%) HTLV-1 infections, 6 (5.6%) HTLV-2 infections and 18 (16.8%) non-specified. The majority (76, 71%) were female, median age was 42 years and median time from arrival to Spain until consultation was 10 years. The group included 100 (93.5%) immigrants and 7 (6.6%) visiting friends and relatives (VFR)-immigrants. Most patients were from South America (71, 66.4%), followed by Sub-Saharan Africa (15, 14%) and Central America-Caribbean (13, 12.1%). Around 90% of patients were asymptomatic at presentation and diagnosed as part of screening programs. Median duration of follow-up was 5 years (IQR 2-7). Regarding HTLV-associated conditions, 90 patients (84.2%) had none, 7 (6.5%) had tropical spastic paraparesis , 5 (4.7%) had other associated conditions (dermatitis, uveitis, pulmonary disease), 3 (2.8%) had other neurological symptoms and 2 (1.9%) had adult T-cell leukaemia/lymphoma. No patients with HTLV-2 had HTLV-associated conditions. Four patients (3.7%) died. Concomitant diagnoses were found in 41 (38.3%) patients, including strongyloidiasis in 15 (14%) and HIV co-infection in 4 (3.7%). In 70% of patients, screening of potential contacts was not performed/recorded. CONCLUSIONS HTLV infections (the majority due to HTLV-1) were mainly diagnosed in asymptomatic migrants from Latin America (generally long-settled immigrants and the majority female with the consequent implications for screening/prevention). A high rate of association with strongyloidiasis was found. In the majority, screening of potential contacts was not performed, representing a missed opportunity for decreasing the under diagnosis of this infection.
Collapse
Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Fernando Salvador
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Beatriz Gullón
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Marta Díaz-Menéndez
- National Referral Centre for Imported Tropical diseases, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | | | | | | | | | | | - Pau Bosch-Nicolau
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Fernando de la Calle
- National Referral Centre for Imported Tropical diseases, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | | | - Maria-Luisa Aznar
- Unitat de Medicina Tropical y Salut Internacional Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | | | - Eva Calabuig
- Unidad de Enfermedades Infecciosas, La Fe University and Polytechnic Hospital, Medicine Department, University of Valencia, Valencia, Spain
| | | | - Jose A Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBER de Enfermedades Infecciosas, Madrid, Spain
| |
Collapse
|
8
|
Hashiba Y, Umekita K, Kimura M, Iwao C, Iwao K, Kariya Y, Kubo K, Miyauchi S, Kudou R, Rikitake Y, Kawaguchi T, Matsuda M, Takajo I, Inoue E, Hidaka T, Okayama A. High incidence of serious infections requiring hospitalisation in human T-cell leukaemia virus type 1-positive rheumatoid arthritis: A case-controlled observational study. Mod Rheumatol 2022; 32:866-874. [PMID: 34897491 DOI: 10.1093/mr/roab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We aimed to assess the clinical features of human T-cell leukaemia virus type 1 (HTLV-1)-positive rheumatoid arthritis (RA) patients. Furthermore, we investigated the impact of HTLV-1 infection on incidences of serious infections requiring hospitalisation (SIH) and malignancies. METHODS A total of 150 sex- and age-matched HTLV-1-negative and 50 HTLV-1-positive RA patients were enrolled from the HTLV-1 RA Miyazaki Cohort Study. Clinical and laboratory data were collected from this cohort database. The incidence rate (IR) for SIH and malignancies from 2015 to 2020 was analysed. RESULTS The median age and female ratio in the study population were 70 years old and 80%, respectively. Although no differences were found in inflammatory marker values between the two groups, the patient global assessment and Health Assessment Questionnaire scores were higher in HTLV-1-positive RA patients. In HTLV-1-negative RA patients, the IR for SIH was 6.37/100 person-years (PY) and 1.32/100 PY for malignancies. In HTLV-1-positive RA patients, SIH occurred in 11.1/100 PY and malignancies in 2.46/100 PY. The crude IR ratio comparing SIH between two groups was 1.74 (95% confidence interval, 1.04-2.84), which was a significant increase. CONCLUSIONS HTLV-1-positive RA patients may worsen RA symptoms. HTLV-1 may be a risk factor for SIH.
Collapse
Affiliation(s)
- Yayoi Hashiba
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Kunihiko Umekita
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masatoshi Kimura
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Chihiro Iwao
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kosho Iwao
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yumi Kariya
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazuyoshi Kubo
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Shunichi Miyauchi
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Risa Kudou
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuki Rikitake
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takeshi Kawaguchi
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Motohiro Matsuda
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Ichiro Takajo
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Toshihiko Hidaka
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Akihiko Okayama
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| |
Collapse
|
9
|
Buonfrate D, Rodari P, Barda B, Page W, Einsiedel L, Watts M. Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment. Expert Opin Pharmacother 2022; 23:1617-1628. [PMID: 35983698 DOI: 10.1080/14656566.2022.2114829] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Strongyloidiasis, an infection caused by the soil-transmitted helminth Strongyloides stercoralis, can lead immunocompromised people to a life-threatening syndrome. We highlight here current and emerging pharmacotherapeutic strategies for strongyloidiasis and discuss treatment protocols according to patient cohort. We searched PubMed and Embase for papers published on this topic between 1990 and May 2022. AREAS COVERED Ivermectin is the first-line drug, with an estimated efficacy of about 86% and excellent tolerability. Albendazole has a lower efficacy, with usage advised when ivermectin is not available or not recommended. Moxidectin might be a valid alternative to ivermectin, with the advantage of being a dose-independent formulation. EXPERT OPINION The standard dose of ivermectin is 200 µg/kg single dose orally, but multiple doses might be needed in immunosuppressed patients. In the case of hyperinfection, repeated doses are recommended up to 2 weeks after clearance of larvae from biological fluids, with close monitoring and further dosing based on review. Subcutaneous ivermectin is used where there is impaired intestinal absorption/paralytic ileus. In pregnant or lactating women, studies have not identified increased risk with ivermectin use. However, with limited available data, a risk-benefit assessment should be considered for each case.
Collapse
Affiliation(s)
- Dora Buonfrate
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria hospital, via Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Paola Rodari
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria hospital, via Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Beatrice Barda
- Ospedale La Carità, Ospedale regionale di Locarno, Locarno 6600, Switzerland
| | - Wendy Page
- Miwatj Health Aboriginal Corporation, 1424 Arnhem Rd, Nhulunbuy NT 0880, Australia
| | - Lloyd Einsiedel
- Peter Doherty Institute, University of Melbourne, 792 Elizabeth St, Melbourne VIC 3000, Australia
| | - Matthew Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research - New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Iwamoto N, Araki T, Umetsu A, Takatani A, Aramaki T, Ichinose K, Terada K, Hirakata N, Ueki Y, Kawakami A, Eguchi K. The Association of Increase of Human T-Cell Leukemia Virus Type-1 (HTLV-1) Proviral Load (PVL) With Infection in HTLV-1-Positive Patients With Rheumatoid Arthritis: A Longitudinal Analysis of Changes in HTLV-1 PVLs in a Single Center Cohort Study. Front Immunol 2022; 13:887783. [PMID: 35603142 PMCID: PMC9120818 DOI: 10.3389/fimmu.2022.887783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We evaluated changes of HTLV-1 proviral loads (PVLs) during treatment for rheumatoid arthritis (RA) and investigated whether these changes affect the clinical course in HTLV-1-positive RA patients. Methods A total of 41 HTLV-1-positive RA patients were analyzed. Their clinical picture including disease activity [Disease Activity Score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR), DAS28-CRP, simplified disease activity index (SDAI), and clinical disease activity index (CDAI)] and comorbidity were evaluated over a 2-year period. PVLs from peripheral blood mononuclear cells were investigated by real-time polymerase chain reaction (PCR). We investigated whether HTLV-1 PVLs is altered, or which clinical characteristics affect changes of HTLV1-PVLs during 2-year treatment. Results Clinical disease activity was not changed during the 2-year observational period. The mean HTLV-1 PVL value change from baseline to 2 years was -1.2 copies/1000 PBMCs, which was not statistically significant. No baseline clinical characteristics influenced changes in HTLV-1 PVL. However, a numerical change of HTLV-1 PVLs was increased in 4 patients initiating the new biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) at 2−10 months after starting the new b/ts DMARDs (numerical increase was 24.87 copies/1000 PBMCs). Infection occurred in 4 patients, and 3 of those patients showed an increased HTLV-1 PVL. Univariate analysis revealed an association between increase of HTLV-1 PVL and incidence of infection. Conclusions Over 2 years, HTLV-1 PVL did not significantly change in our HTLV-1-positive RA patients. Individual changes in HTLV-1 PVL were correlated with incidence of infection but not disease activity which indicate that we may take precaution toward infection at the uptick of HTLV-1 PVL in HTLV-1-positive RA patients.
Collapse
Affiliation(s)
- Naoki Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Takeshi Araki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Ayaka Umetsu
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Ayuko Takatani
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | | | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Kaoru Terada
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | | | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsumi Eguchi
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| |
Collapse
|
11
|
Oyesola OO, Souza COS, Loke P. The Influence of Genetic and Environmental Factors and Their Interactions on Immune Response to Helminth Infections. Front Immunol 2022; 13:869163. [PMID: 35572520 PMCID: PMC9103684 DOI: 10.3389/fimmu.2022.869163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/04/2022] [Indexed: 12/20/2022] Open
Abstract
Helminth infection currently affect over 2 billion people worldwide, with those with the most pathologies and morbidities, living in regions with unequal and disproportionate access to effective healthcare solutions. Host genetics and environmental factors play critical roles in modulating and regulating immune responses following exposure to various pathogens and insults. However, the interplay of environment and genetic factors in influencing who gets infected and the establishment, persistence, and clearance of helminth parasites remains unclear. Inbred strains of mice have long been used to investigate the role of host genetic factors on pathogenesis and resistance to helminth infection in a laboratory setting. This review will discuss the use of ecological and environmental mouse models to study helminth infections and how this could be used in combination with host genetic variation to explore the relative contribution of these factors in influencing immune response to helminth infections. Improved understanding of interactions between genetics and the environment to helminth immune responses would be important for efforts to identify and develop new prophylactic and therapeutic options for the management of helminth infections and their pathogenesis.
Collapse
|
12
|
Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection. Clin Microbiol Rev 2022; 35:e0007821. [PMID: 35195446 PMCID: PMC8941934 DOI: 10.1128/cmr.00078-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.
Collapse
|
13
|
Abstract
Strongyloidiasis has been estimated to affect over 600 million people worldwide. It is caused by Strongyloides stercoralis, a roundworm endemic to the tropics and subtropics, especially areas where sanitation is suboptimal Autochthonous transmission has been documented in rural areas of the USA and Europe. Humans are infected when larvae penetrate the skin or are ingested. Autoinfection, in which larvae generated in the host go on to re-infect the host, leads to a state of chronic asymptomatic infection often with eosinophilia. Hyperinfection syndrome may develop when patients develop immune suppression, due to medications such as corticosteroids or following solid-organ transplantation. Hyperinfection is characterized by exponential increase in parasitic burden, leading to tissue invasion and life-threatening disease and associated bloodstream infections due to enteric organisms. Cases following use of corticosteroids for COVID-19 pneumonia have been described. Strongyloidiasis can be diagnosed by direct visualization of larvae in stool or other body fluids, or by serology. Ivermectin is highly effective in treating the disease. Patients with exposure to endemic areas and those expected to become immune suppressed should be screened and treated before starting immune suppressive agents. Empiric treatment should be considered when timely testing is not readily available.
Collapse
|
14
|
Pereira Vieira Barreto NM, Brito Farias MM, Oliveira CDL, Almeida Costa Araujo W, Rios Grassi MF, Nascimento de Souza J, Soares Jacobina B, Aquino Teixeira MC, Galvão-Castro B, Matos Soares N. Evaluation of Strongyloides stercoralis infection in patients with HTLV-1. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:31-40. [PMID: 35471168 PMCID: PMC9041088 DOI: 10.7705/biomedica.5888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Individuals infected with the human T-lymphotropic virus type 1 (HTLV-1) may present severe and disseminated forms of Strongyloides stercoralis infection with low therapeutic response. OBJECTIVE To investigate the S. stercoralis infection and the seroprevalence of IgG anti-S. stercoralis antibodies in individuals infected with HTLV-1 attending the Reference Center for HTLV-1 (CHTLV) in Salvador, Bahia, Brazil. MATERIALS AND METHODS We conducted a cross-sectional study in 178 HTLV-1-infected individuals treated at the HTLV specialized center between January, 2014, and December, 2018. The parasitological diagnosis of S. stercoralis was performed using the Hoffman, Pons and Janer, agar plate culture, and Baermann-Morais methods. The IgG anti-S. stercoralis detection was performed using an in house enzyme-linked immunosorbent assay (ELISA). The HTLV-1 infection was diagnosed using a commercial ELISA and confirmed by Western blot. RESULTS The frequency of S. stercoralis infection was 3.4% (6/178). Individuals infected with S. stercoralis from rural areas (50.0%; 3/6) also showed S. stercoralis hyperinfection (>3,000 larvae/gram of feces). The frequency of circulating anti-S. stercoralis IgG antibodies was 20.8% (37/178). CONCLUSIONS HTLV-1-infected people living in precarious sanitary conditions are more prone to develop severe forms of S. stercoralis infection. Considering the high susceptibility and unfavorable outcome of the infection in these individuals, the serological diagnosis for S. stercoralis should be considered when providing treatment.
Collapse
Affiliation(s)
- Nilo Manoel Pereira Vieira Barreto
- Instituto de Ciências da Saúde, Programa de Pós-graduação em Processos Interativos dos Órgãos e Sistemas, Universidade Federal da Bahia, Bahia, Brasil.
| | - Marina Morena Brito Farias
- Instituto de Ciências da Saúde, Programa de Pós-graduação em Processos Interativos dos Órgãos e Sistemas, Universidade Federal da Bahia, Bahia, Brasil.
| | - Cíntia de Lima Oliveira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Bahia, Brasil.
| | - Weslei Almeida Costa Araujo
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Bahia, Brasil.
| | | | - Joelma Nascimento de Souza
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Bahia, Brasil.
| | | | | | | | - Neci Matos Soares
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Bahia, Brasil.
| |
Collapse
|
15
|
Ye L, Taylor GP, Rosadas C. Human T-Cell Lymphotropic Virus Type 1 and Strongyloides stercoralis Co-infection: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:832430. [PMID: 35237633 PMCID: PMC8882768 DOI: 10.3389/fmed.2022.832430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe distribution of human T cell lymphotropic virus type 1 (HTLV-1) overlaps with that of Strongyloides stercoralis. Strongyloides stercoralis infection has been reported to be impacted by co-infection with HTLV-1. Disseminated strongyloidiasis and hyperinfection syndrome, which are commonly fatal, are observed in HTLV-1 co-infected patients. Reduced efficacy of anti-strongyloidiasis treatment in HTLV-1 carriers has been reported. The aim of this meta-analysis and systematic review is to better understand the association between HTLV-1 and S. stercoralis infection.MethodsPubMed, Embase, MEDLINE, Global Health, Healthcare Management Information Consortium databases were searched. Studies regarding the prevalence of S. stercoralis, those evaluating the frequency of mild or severe strongyloidiasis, and treatment response in people living with and without HTLV-1 infection were included. Data were extracted and odds ratios were calculated. Random-effect meta-analysis was used to assess the pooled OR and 95% confidence intervals.ResultsFourteen studies were included after full-text reviewing of which seven described the prevalence of S. stercoralis and HTLV-1. The odds of S. stercoralis infection were higher in HTLV-1 carriers when compared with HTLV-1 seronegative subjects (OR 3.2 95%CI 1.7–6.2). A strong association was found between severe strongyloidiasis and HTLV-1 infection (OR 59.9, 95%CI 18.1–198). Co-infection with HTLV-1 was associated with a higher rate of strongyloidiasis treatment failure (OR 5.05, 95%CI 2.5–10.1).ConclusionStrongyloides stercoralis infection is more prevalent in people living with HTLV-1. Co-infected patients are more likely to develop severe presentation and to fail treatment. Screening for HTLV-1 and Strongyloides sp. should be routine when either is diagnosed.
Collapse
Affiliation(s)
- Lingqing Ye
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Graham P. Taylor
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
- National Centre for Human Retrovirology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- *Correspondence: Graham P. Taylor
| | - Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
| |
Collapse
|
16
|
Talukder MR, Pham H, Woodman R, Wilson K, Taylor K, Kaldor J, Einsiedel L. The Association between Diabetes and Human T-Cell Leukaemia Virus Type-1 (HTLV-1) with Strongyloides stercoralis: Results of a Community-Based, Cross-Sectional Survey in Central Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042084. [PMID: 35206272 PMCID: PMC8872355 DOI: 10.3390/ijerph19042084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
In central Australia, an area that is endemic for the human T-cell leukaemia virus type-1 (HTLV-1), the prevalence of Strongyloides stercoralis and its association with other health conditions are unknown. A cross-sectional community-based survey was conducted in seven remote Aboriginal communities in central Australia, from 2014 to 2018. All residents aged ≥10 years were invited to complete a health survey and to provide blood for Strongyloides serology, HTLV-1 serology and HTLV-1 proviral load (PVL). Risk factors for Strongyloides seropositivity and associations with specific health conditions including diabetes and HTLV-1 were determined using logistic regression. Overall Strongyloides seroprevalence was 27% (156/576) (children, 22% (9/40); adults (≥15 years), 27% (147/536), varied widely between communities (5–42%) and was not associated with an increased risk of gastrointestinal, respiratory or dermatological symptoms. Increasing age, lower HTLV-1 PVL (<1000 copies per 105 peripheral blood leucocytes) compared to the HTLV-1 uninfected group and community of residence were significant risk factors for Strongyloides seropositivity in an adjusted model. A modest reduction in the odds of diabetes among Strongyloides seropositive participants was found (aOR 0.58, 95% CI 0.35, 1.00; p = 0.049); however, this was lost when body mass index was included in the adjusted model (aOR 0.48, 95% CI 0.48, 1.47; p = 0.542). Strongyloides seropositivity had no relationship with anaemia. Exploring social and environmental practices in communities with low Strongyloides seroprevalence may provide useful lessons for similar settings.
Collapse
Affiliation(s)
- Mohammad Radwanur Talukder
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
| | - Hai Pham
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA 5001, Australia;
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, VIC 3065, Australia;
| | - Kerry Taylor
- Poche Centre for Indigenous Health and Wellbeing, Alice Springs, NT 0870, Australia;
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
- Alice Springs Hospital, Alice Springs, NT 0870, Australia
- Correspondence:
| |
Collapse
|
17
|
Aslam A, Barlas U, Yassan LJ, Lodhi M. An unusual case of gastric outlet obstruction and melena. Clin J Gastroenterol 2022; 15:374-380. [DOI: 10.1007/s12328-021-01584-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
|
18
|
The yin and yang of human soil-transmitted helminth infections. Int J Parasitol 2021; 51:1243-1253. [PMID: 34774540 PMCID: PMC9145206 DOI: 10.1016/j.ijpara.2021.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/22/2022]
Abstract
The major soil-transmitted helminths that infect humans are the roundworms, whipworms and hookworms. Soil-transmitted helminth infections rank among the most important neglected tropical diseases in terms of morbidity, and almost one billion people are still infected with at least one species. While anthelmintic drugs are available, they do not offer long term protection against reinfection, precipitating the need for vaccines that provide long-term immunologic defense. Vaccine discovery and development is in advanced clinical development for hookworm infection, with a bivalent human hookworm vaccine in clinical trials in Brazil and Africa, but is in its infancy for both roundworm (ascariasis) and whipworm (trichuriasis) infections. One of the greatest hurdles to developing soil-transmitted helminth vaccines is the potent immunoregulatory properties of these helminths, creating a barrier to the induction of meaningful long-term protective immunity. While challenging for vaccinologists, this phenomenon presents unique opportunities to develop an entirely new class of anti-inflammatory drugs that capitalise on these immunomodulatory strategies. Epidemiologic studies and clinical trials employing experimental soil-transmitted helminth challenge models, when coupled with findings from animal models, show that at least some soil-transmitted helminth-derived molecules can protect against the onset of autoimmune, allergic and metabolic disorders, and several natural products with the desired bioactivity have been isolated and tested in pre-clinical settings. The yin and yang of soil-transmitted helminth infections reflect both the urgency for effective vaccines and the potential for new immunoregulatory molecules from parasite products.
Collapse
|
19
|
Springer LE, Patton JB, Zhan T, Rabson AB, Lin HC, Manser T, Lok JB, Hess JA, Abraham D. Strongyloides stercoralis and HTLV-1 coinfection in CD34+ cord blood stem cell humanized mice: Alteration of cytokine responses and enhancement of larval growth. PLoS Negl Trop Dis 2021; 15:e0009559. [PMID: 34314415 PMCID: PMC8315519 DOI: 10.1371/journal.pntd.0009559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/11/2021] [Indexed: 12/20/2022] Open
Abstract
Viral and parasitic coinfections are known to lead to both enhanced disease progression and altered disease states. HTLV-1 and Strongyloides stercoralis are co-endemic throughout much of their worldwide ranges resulting in a significant incidence of coinfection. Independently, HTLV-1 induces a Th1 response and S. stercoralis infection induces a Th2 response. However, coinfection with the two pathogens has been associated with the development of S. stercoralis hyperinfection and an alteration of the Th1/Th2 balance. In this study, a model of HTLV-1 and S. stercoralis coinfection in CD34+ umbilical cord blood hematopoietic stem cell engrafted humanized mice was established. An increased level of mortality was observed in the HTLV-1 and coinfected animals when compared to the S. stercoralis infected group. The mortality was not correlated with proviral loads or total viral RNA. Analysis of cytokine profiles showed a distinct shift towards Th1 responses in HTLV-1 infected animals, a shift towards Th2 cytokines in S. stercoralis infected animals and elevated TNF-α responses in coinfected animals. HTLV-1 infected and coinfection groups showed a significant, yet non-clonal expansion of the CD4+CD25+ T-cell population. Numbers of worms in the coinfection group did not differ from those of the S. stercoralis infected group and no autoinfective larvae were found. However, infective larvae recovered from the coinfection group showed an enhancement in growth, as was seen in mice with S. stercoralis hyperinfection caused by treatment with steroids. Humanized mice coinfected with S. stercoralis and HTLV-1 demonstrate features associated with human infection with these pathogens and provide a unique opportunity to study the interaction between these two infections in vivo in the context of human immune cells.
Collapse
Affiliation(s)
- Lauren E Springer
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - John B Patton
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Arnold B Rabson
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Hsin-Ching Lin
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Tim Manser
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - James B Lok
- Department of Pathobiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jessica A Hess
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - David Abraham
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
20
|
Keikha M, Karbalaei M. Overview on coinfection of HTLV-1 and tuberculosis: Mini-review. J Clin Tuberc Other Mycobact Dis 2021; 23:100224. [PMID: 33681477 PMCID: PMC7918677 DOI: 10.1016/j.jctube.2021.100224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Human T-cell leukemia virus type 1 (HTLV-1) is one of the human retroviruses that causes various complications in humans, including lymphoma. Mycobacterium tuberculosis (Mtb), on the other hand, is a causative agent of tuberculosis (TB), a deadly infectious disease. According to the literature, patients infected with HTLV-1 are prone to TB due to lack of regulation in the immune system. In the present study, we discussed the association between previous HTLV-1 infection and TB susceptibility. We also reviewed the histopathological findings of respiratory involvement following HTLV-1 infection and the management of this infection.
Collapse
Affiliation(s)
- Masoud Keikha
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Karbalaei
- Department of Microbiology and Virology, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran
- Corresponding author.
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Human T-cell Leukemia Virus Type 1 and Strongyloides stercoralis: Partners in Pathogenesis. Pathogens 2020; 9:pathogens9110904. [PMID: 33137906 PMCID: PMC7692131 DOI: 10.3390/pathogens9110904] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
Infection with human T-cell leukemia/lymphoma virus type 1 (HTLV-1) has been associated with various clinical syndromes including co-infection with Strongyloides stercoralis, which is an intestinal parasitic nematode and the leading cause of strongyloidiasis in humans. Interestingly, HTLV-1 endemic areas coincide with regions citing high prevalence of S. stercoralis infection, making these communities optimal for elucidating the pathogenesis of co-infection and its clinical significance. HTLV-1 co-infection with S. stercoralis has been observed for decades in a number of published patient cases and case series; however, the implications of this co-infection remain elusive. Thus far, data suggest that S. stercoralis increases proviral load in patients co-infected with HTLV-1 compared to HTLV-1 infection alone. Furthermore, co-infection with HTLV-1 has been associated with shifting the immune response from Th2 to Th1, affecting the ability of the immune system to address the helminth infection. Thus, despite this well-known association, further research is required to fully elucidate the impact of each pathogen on disease manifestations in co-infected patients. This review provides an analytical view of studies that have evaluated the variation within HTLV-1 patients in susceptibility to S. stercoralis infection, as well as the effects of strongyloidiasis on HTLV-1 pathogenesis. Further, it provides a compilation of available clinical reports on the epidemiology and pathology of HTLV-1 with parasitic co-infection as well as data from mechanistic studies suggesting possible immunopathogenic mechanisms. Furthermore, specific areas of potential future research have been highlighted to facilitate advancing understanding of the complex interactions between these two pathogens.
Collapse
|
23
|
Tiberti N, Buonfrate D, Carbone C, Piro G, Bisoffi Z, Piubelli C. Systemic profile of immune factors in an elderly Italian population affected by chronic strongyloidiasis. Parasit Vectors 2020; 13:515. [PMID: 33059754 PMCID: PMC7559927 DOI: 10.1186/s13071-020-04391-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Strongyloidiasis caused by Strongyloides stercoralis is a soil-transmitted helminthiasis affecting an estimated 370 million people and considered one of the most neglected tropical diseases. Although mostly distributed in tropical and subtropical areas, autochthonous infections have also been documented in north-eastern Italy, even though the transmission presumably stopped decades ago. Because of its peculiar auto-infective cycle, strongyloidiasis can persist lifelong, but the pathophysiological mechanisms associated with the maintenance of such a chronic infection are yet to be fully deciphered. Methods Serum levels of 23 immune factors were retrospectively assessed in a subgroup of participants in a randomised clinical trial for the treatment of strongyloidiasis (Strong Treat). Here we included Italian subjects born between 1931 and 1964 and diagnosed with strongyloidiasis between 2013 and 2017 (Ss+, n = 32). Serum samples obtained before (BT) and 6 months (6M AT) after ivermectin treatment, as well as from age- and gender-matched uninfected controls (CTRL, n = 34) were analysed. Results The assessed immune factors showed a general reduced concertation in Ss+ patients and a lack of association with eosinophilia. In our cohort, we did not observe the classical shift towards a type 2 immune response, since Th1 and Th2 cytokines were mostly unaltered. Instead, we observed chemokines as particularly affected by the presence of the parasite, since IL-8, CCL3, CCL4 and CCL5 were significantly reduced in concentration in Ss+ subjects compared to CTRL, suggesting that immune cell recruitment to the infection site might be dampened in these patients. This observation was further sustained by a significant increase of CCL4, CCL5 and CCL11 concentrations 6M AT. A significant raised systemic concentration of three growth factors, bFGF, PDGF-BB and IL-7 (haematopoietic growth factor) was also observed post-treatment, indicating a potential involvement in restoring tissue integrity and homeostasis following parasite elimination. Conclusions These preliminary data suggest that, in order to survive for such a long period, S. stercoralis might suppress host responses that could otherwise result in its ejection. Our results offer novel insights in the potential mechanisms of disease tolerance that might take place during this chronic infection, including a potential T-cell hypo-responsiveness and a role for chemokines.![]()
Collapse
Affiliation(s)
- Natalia Tiberti
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Carmine Carbone
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Geny Piro
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Zeno Bisoffi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.,Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Chiara Piubelli
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| |
Collapse
|
24
|
Hashiba Y, Umekita K, Minami H, Kawano A, Nagayasu E, Maruyama H, Hidaka T, Okayama A. Strongyloides stercoralis colitis in a patient positive for human T-cell leukaemia virus with rheumatoid arthritis during an anti-rheumatic therapy: a case report. Mod Rheumatol Case Rep 2020; 5:16-21. [PMID: 32772699 DOI: 10.1080/24725625.2020.1808304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An elderly woman with rheumatoid arthritis (RA) presented with a chief complaint of abdominal pain and diarrhoea while undergoing treatment with low-dose corticosteroids and abatacept. Endoscopic and histopathological findings revealed manifestations of ulcerative colitis (UC). An intermediate dose of corticosteroids and 5-aminosalicylic acid were administered. Abatacept was discontinued; the anti-TNF biologic, golimumab, was administered for treatment of both RA and UC. However, colitis worsened in response to this therapeutic regimen. Colonoscopy revealed severe mucosal lesions; larvae were detected in samples taken from multiple shallow mucosal ulcers. The patient was diagnosed with Strongyloides stercoralis colitis based on the results of an anti-parasite antibody test and examination of the larval DNA. Furthermore, serology revealed a positive test for antibodies against human T-cell leukaemia virus type 1 (HTLV-1). Immunosuppressive treatment was terminated; ivermectin was administered, which resulted in improvements in colitis symptoms within a few weeks. There are several published reports describing S. stercoralis colitis as a lethal mimic of UC. Corticosteroid and anti-TNF therapies have been reported as among the major risk factors associated with strongyloidiasis in patients with HTLV-1 infection. Therefore, HTLV-1 and Strongyloides infections may be considered in cases of new-onset gastrointestinal symptoms during immunosuppressive therapy, particularly in HTLV-1-endemic regions.
Collapse
Affiliation(s)
- Yayoi Hashiba
- Institute of Rheumatology, Zenjin-kai Shimin-No-Mori Hospital, Miyazaki, Japan.,Department of Rheumatology, Infectious Diseases and Laboratory Medicine, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kunihiko Umekita
- Department of Rheumatology, Infectious Diseases and Laboratory Medicine, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroyuki Minami
- Institute of Rheumatology, Zenjin-kai Shimin-No-Mori Hospital, Miyazaki, Japan
| | - Atsuko Kawano
- Institute of Rheumatology, Zenjin-kai Shimin-No-Mori Hospital, Miyazaki, Japan
| | - Eiji Nagayasu
- Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Haruhiko Maruyama
- Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshihiko Hidaka
- Institute of Rheumatology, Zenjin-kai Shimin-No-Mori Hospital, Miyazaki, Japan
| | - Akihiko Okayama
- Department of Rheumatology, Infectious Diseases and Laboratory Medicine, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| |
Collapse
|
25
|
Hoces D, Barros N, Woll F, Bauer A, White AC, Montes M. Regulatory T cell expansion resolves after effective strongyloidiasis treatment in subjects with HTLV-1 co-infection. Parasitol Int 2020; 76:102092. [PMID: 32120049 DOI: 10.1016/j.parint.2020.102092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/10/2020] [Accepted: 02/23/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Regulatory T-cells (Tregs) are increased in patients with HTLV-1/Strongyloides stercoralis co-infection, and they may modify otherwise protective antigen-specific cytokine production. We hypothesized that effective anti-helminthic treatment would decrease Tregs and restore antigen-specific cytokine responses. METHODS/RESULTS We enrolled 19 patients with Strongyloides larvae in their stool by Baerman's test. Six were positive and 13 negative for antibody to HTLV-1 by ELISA, with positive tests confirmed by immunoblot. Before treatment, co-infected subjects had higher Tregs percentages and lower antigen-stimulated IL-5 levels compared to subjects with Strongyloides without HTLV-1. All patients were treated with ivermectin. After effective treatment, Tregs percentages decreased in patients with HTLV-1; however, antigen-specific IL-5 production remained blunted in co-infected subjects. CONCLUSION These results suggest that treating strongyloidiasis infection decreases circulating Tregs, but antigen-specific cytokine remains altered. This may reflect blunting of sensitization by Tregs.
Collapse
Affiliation(s)
- Daniel Hoces
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicolas Barros
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fernando Woll
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Allison Bauer
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A Clinton White
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0435, USA.
| | - Martin Montes
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0435, USA.
| |
Collapse
|
26
|
White MPJ, McManus CM, Maizels RM. Regulatory T-cells in helminth infection: induction, function and therapeutic potential. Immunology 2020; 160:248-260. [PMID: 32153025 PMCID: PMC7341546 DOI: 10.1111/imm.13190] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022] Open
Abstract
Helminth parasites infect an alarmingly large proportion of the world's population, primarily within tropical regions, and their ability to down‐modulate host immunity is key to their persistence. Helminths have developed multiple mechanisms that induce a state of hyporesponsiveness or immune suppression within the host; of particular interest are mechanisms that drive the induction of regulatory T‐cells (Tregs). Helminths actively induce Tregs either directly by secreting factors, such as the TGF‐β mimic Hp‐TGM, or indirectly by interacting with bystander cell types such as dendritic cells and macrophages that then induce Tregs. Expansion of Tregs not only enhances parasite survival but, in cases such as filarial infection, Tregs also play a role in preventing parasite‐associated pathologies. Furthermore, Tregs generated during helminth infection have been associated with suppression of bystander immunopathologies in a range of inflammatory conditions such as allergy and autoimmune disease. In this review, we discuss evidence from natural and experimental infections that point to the pathways and molecules involved in helminth Treg induction, and postulate how parasite‐derived molecules and/or Tregs might be applied as anti‐inflammatory therapies in the future.
Collapse
Affiliation(s)
- Madeleine P J White
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Caitlin M McManus
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Rick M Maizels
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| |
Collapse
|
27
|
Martyn E, Gration B, Somasundaram C, Chiodini PL. Strongyloides, HTLV-1 and small bowel obstruction. BMJ Case Rep 2019; 12:12/12/e232461. [PMID: 31822534 PMCID: PMC6904184 DOI: 10.1136/bcr-2019-232461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 81-year-old Jamaican man who has been resident in the UK for many years presented with one week history of generalised abdominal pain, postprandial vomiting, anorexia, weight loss and abdominal distension. He was managed conservatively for acute small bowel obstruction. Investigations revealed a duodenal stricture. Live Strongyloides stercoralis larvae were observed in stool samples and duodenal biopsy confirmed the presence of the parasite at multiple life cycle stages within the lamina propria. He was diagnosed with Strongyloides hyperinfection with underlying human T-cell lymphotropic virus type 1 and treated with a prolonged course of ivermectin with ongoing monitoring for relapse. This case demonstrates a rare but potentially fatal cause of small bowel obstruction.
Collapse
Affiliation(s)
- Emily Martyn
- Microbiology Department, North Middlesex University Hospital NHS Trust, London, UK
| | - Betty Gration
- Division of Infection, University College London Hospitals, London, UK
| | - Chitra Somasundaram
- Gastroenterology Department, North Middlesex University Hospital NHS Trust, London, UK
| | - Peter L Chiodini
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, UK
| |
Collapse
|
28
|
Abstract
Most of the 30 to 100 million people infected with Strongyloides stercoralis have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. The use of corticosteroids and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses that are like other nematodes. Definitive diagnosis of S stercoralis infection is based on stool examinations for larvae. S stercoralis remains largely neglected.
Collapse
Affiliation(s)
- Alejandro Krolewiecki
- Institute for Tropical Diseases Research, Universidad Nacional de Salta/CONICET, Alvarado 751, Oran 4530, Salta, Argentina
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 4 - Room B1-03, 4 Center Drive, Bethesda, MD 20892-0425, USA.
| |
Collapse
|
29
|
Rodrigues JP, Vasconcelos Azevedo FVP, Zoia MAP, Maia LP, Correia LIV, Costa-Cruz JM, de Melo Rodrigues V, Goulart LR. The Anthelmintic Effect on Strongyloides venezuelensis Induced by BnSP- 6, a Lys49-phospholipase A2 Homologue from Bothrops pauloensis Venom. Curr Top Med Chem 2019; 19:2032-2040. [DOI: 10.2174/1568026619666190723152520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/20/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
Background:
Phospholipases A2 (PLA2) from snake venoms have a broad potential as
pharmacological tools on medicine. In this context, strongyloidiasis is a neglected parasitic disease
caused by helminths of the genus Strongyloides. Currently, ivermectin is the drug of choice for treatment,
however, besides its notable toxicity, therapeutic failures and cases of drug resistance have been
reported. BnSP-6, from Bothorps pauloensis snake venom, is a PLA2 with depth biochemical characterization,
reporting effects against tumor cells and bacteria.
Objective:
The aim of this study is to demonstrate for the first time the action of the PLA2 on Strongyloides
venezuelensis.
Methods:
After 72 hours of treatment with BnSP-6 mortality of the infective larvae was assessed by motility
assay. Cell and parasite viability was evaluated by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl
tetrazolium bromide (MTT) assay. Furthermore, autophagic vacuoles were labeled with Monodansylcadaverine
(MDC) and nuclei of apoptotic cells were labeled with Propidium Iodide (PI). Tissue degeneration
of the parasite was highlighted by Transmission Electron Microscopy (TEM).
Results:
The mortality index demonstrated that BnSP-6 abolishes the motility of the parasite. In addition,
the MTT assay attested the cytotoxicity of BnSP-6 at lower concentrations when compared with
ivermectin, while autophagic and apoptosis processes were confirmed. Moreover, the anthelmintic effect
was demonstrated by tissue degeneration observed by TEM. Furthermore, we report that BnSP-6
showed low cytotoxicity on human intestinal cells (Caco-2).
Conclusion:
Altogether, our results shed light on the potential of BNSP-6 as an anthelmintic agent,
which can lead to further investigations as a tool for pharmaceutical discoveries.
Collapse
Affiliation(s)
- Jéssica Peixoto Rodrigues
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Fernanda Van Petten Vasconcelos Azevedo
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Mariana Alves Pereira Zoia
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Larissa Prado Maia
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Lucas Ian Veloso Correia
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Julia Maria Costa-Cruz
- Laboratory of Parasitological Diagnostics, Institute of Biomedical Sciences, Federal University of Uberlandia, Campus Umuarama BL-4C, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Veridiana de Melo Rodrigues
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Luiz Ricardo Goulart
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| |
Collapse
|
30
|
Tam J, Schwartz KL, Keystone J, Dimitrakoudis D, Downing M, Krajden S. Case Report: Central Nervous System Strongyloidiasis: Two Cases Diagnosed Antemortem. Am J Trop Med Hyg 2019; 100:130-134. [PMID: 30457095 DOI: 10.4269/ajtmh.18-0813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Central nervous system (CNS) strongyloidiasis is a known but rare form of disseminated infection. The diagnosis is often made postmortem, with only five published cases of an antemortem diagnosis. We report two fatal cases of CNS strongyloidiasis diagnosed antemortem, with Strongyloides stercoralis larvae visualized in the CNS sample in one case. Risk factors for disseminated strongyloidiasis common to both cases included origination from the Caribbean, underlying human T-lymphotropic virus-1 infection, and recent prednisone use. Both cases occurred in Canada, where the occurrence of Strongyloides is uncommon, and serve as a reminder to maintain a high index of suspicion in patients with epidemiologic or clinical risk factors for dissemination.
Collapse
Affiliation(s)
- Jennifer Tam
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Kevin L Schwartz
- Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jay Keystone
- Tropical Disease Unit, Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Dimitri Dimitrakoudis
- Division of Neurology, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada
| | - Mark Downing
- Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada
| | - Sigmund Krajden
- Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada
| |
Collapse
|
31
|
Poloni JAT, Zanotelli ML, Pedroso ADS, Trein MR, Tasca T. Strongyloides stercoralis larvae or egg: Which came first? Transpl Infect Dis 2019; 21:e13177. [PMID: 31541527 DOI: 10.1111/tid.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 11/28/2022]
Abstract
Strongyloides stercoralis (SS) hyperinfection is a well-documented condition. However, SS eggs in stool samples are not commonly observed during routine analysis. Here, we report a case on SS hyperinfection where both larvae and eggs were observed in the stool sample of an immunossupressed liver allograft transplanted patient.
Collapse
Affiliation(s)
- José Antonio Tesser Poloni
- Escola de Saúde, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.,Controllab, Rio de Janeiro, Brazil
| | - Maria Lucia Zanotelli
- Hepatology Transplant Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Márcia Rodrigues Trein
- Laboratório de Pesquisa em Parasitologia, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tiana Tasca
- Laboratório de Pesquisa em Parasitologia, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
32
|
Malpica L, White AC, Leguia C, Freundt N, Barros N, Chian C, Antunez EA, Montes M. Regulatory T cells and IgE expression in duodenal mucosa of Strongyloides stercoralis and human T lymphotropic virus type 1 co-infected patients. PLoS Negl Trop Dis 2019; 13:e0007415. [PMID: 31170141 PMCID: PMC6581271 DOI: 10.1371/journal.pntd.0007415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 06/18/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Strongyloides stercoralis is an intestinal nematode unique in its ability to replicate in the human host, allowing ongoing cycles of autoinfection, persisting for decades within the same host. Although usually asymptomatic, overwhelming infections can occur in Strongyloides and HTLV-1 co-infected individuals (SS/HTLV-1). Regulatory T cells (Tregs) are able to blunt specific Th2 responses necessary to control the parasite. We previously reported that peripheral blood Tregs are increased in SS/HTLV-1 and correlate with low Th2 responses. We hypothesized that Tregs are also increased at the site of infection in duodenal mucosa. Methods Paraffin embedded duodenal biopsies were obtained from 10 SS/HTLV-1 patients, 3 controls with non-parasitic chronic duodenitis, and 2 healthy controls. Immunohistochemistry was performed using monoclonal antibodies against human CD3, CD8, IgE and FoxP3. The number of cells were counted using a conventional light microscope. The number of CD3+, CD8+, FoxP3+ and IgE positive cells per 0.35 mm2 was measured using ImagePro Plus software comparing areas adjacent or distant from parasite material. Results In patients with SS/HTLV-1, T lymphocyte counts and CD8+ cells were lower in areas adjacent to the parasite compared to non-adjacent areas (CD3+: adjacent: 6.5 [Interquartile range (IQR: 2.8–12.3)]; non-adjacent: 24.5 [IQR: 20.9–34.4]; Mann-Whitney p = 0.0003; CD8+: adjacent: 4.5 [IQR: 2.3–11.8]; non-adjacent: 21 [IQR: 15.3–42.9]; Mann-Whitney p = 0.0011). Tregs cells in the intestines (FoxP3+ expressing cells) were increased in patients with SS/HTLV-1 compared with patients with chronic duodenitis (SS/HTLV-1: 1.5 [IQR: 0.7–2.3]; duodenitis controls: 0 [range 0–0.7]; healthy controls: 0; Mann-Whitney p = 0.034). There was also a trend towards fewer eosinophils adjacent to the parasites. Among SS/HTLV-1 patients the number of IgE expressing cells was increased for in areas not adjacent to the parasite compared to non-adjacent areas (ANOVA, p = 0.001). Conclusions Our data shows increased Treg cell numbers localized adjacent to the parasites in the duodenum SS/HTLV-1 patients. In addition, other T lymphocytes and IgE expressing cells were decreased adjacent to the parasites, suggesting an important role for Tregs in down-regulating local parasite effector responses. Strongyloidiasis is a parasitic infection found worldwide in warm, moist climates. In most people, Strongyloides causes a mild and chronic infection with few symptoms. However, some patients, including those infected with the Human T Lymphotrophic Virus 1 (HTLV-1), can get uncontrolled disease called hyperinfection, which can be fatal. To help determine why this infection is so serious in co-infected patients, we studied biopsies obtained from the small intestine from patients with both infections and compared them to control biopsies. The biopsies from patients with both Strongyloides and HTLV-1 had increased numbers of white blood cells in their biopsies. In particular they displayed a type of lymphocyte that downregulates immune responses. Some of them had increased numbers of cells called eosinophils in the intestines. These cells can help eliminate Strongyloides. However, they were not found near the parasite, suggesting that something near the parasite was suppressing the host response that would control infection. These studies provide more evidence that HTLV-1 suppresses the host response that controls Strongyloides and that the suppression occurs at the site of infection in the small intestines.
Collapse
Affiliation(s)
- Luis Malpica
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A. Clinton White
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch at Galveston, Texas, United States of America
| | - Cristina Leguia
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Natalia Freundt
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicolas Barros
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Chian
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Patología, Hospital Nacional Arzobispo Loayza in Lima, Peru
| | - E. Antonio Antunez
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Patología, Hospital Nacional Arzobispo Loayza in Lima, Peru
| | - Martin Montes
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch at Galveston, Texas, United States of America
- * E-mail:
| |
Collapse
|
33
|
Kathamuthu GR, Munisankar S, Sridhar R, Baskaran D, Babu S. Helminth mediated modulation of the systemic and mycobacterial antigen - stimulated cytokine profiles in extra-pulmonary tuberculosis. PLoS Negl Trop Dis 2019; 13:e0007265. [PMID: 30897083 PMCID: PMC6445485 DOI: 10.1371/journal.pntd.0007265] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/02/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background Helminth infections are known to regulate cytokine responses in both pulmonary and latent tuberculosis infection. Whether helminth infections also modulate cytokine responses in extra-pulmonary tuberculosis, specifically tuberculous lymphadenitis (TBL), has not been examined thus far. Methodology Hence, to determine the cytokine profile in helminth-TBL coinfection, we measured the systemic and mycobacterial (TB)–antigen stimulated levels of Type 1, Type 2, Type 17, regulatory and pro-inflammatory cytokines in TBL individuals coinfected with or without Strongyloides stercoralis (Ss) infection. Significant findings TBL-Ss+ individuals have significantly higher bacterial burdens in the affected lymph nodes in comparison to TBL-Ss- individuals. TBL-Ss+ individuals exhibit significantly enhanced plasma levels of Type 2 (IL-5 and IL-13), Type 17 (IL-17 and IL-22) and regulatory (IL-10) cytokines in comparison to TBL-Ss- individuals. In contrast, TBL-Ss+ individuals exhibit significantly diminished plasma levels of pro-inflammatory cytokines (IL-1α and GM-CSF) in comparison to TBL-Ss- individuals. TBL-Ss+ individuals also exhibit significantly diminished unstimulated or mycobacterial—antigen stimulated levels of Type 1, Type 17 or IL-1 family cytokines in comparison to TBL-Ss- individuals but no differences in mitogen stimulated cytokine levels. Conclusion Therefore, our data reveal a profound influence of Ss infection on the bacteriological profile of TBL and suggesting that the underlying modulation of cytokine responses might be a mechanism by which this helminth infection could impart a detrimental effect on the pathogenesis of TBL disease. Strongyloides stercoralis (Ss) infects about 30–100 million people worldwide and it is the main causative agent of strongyloidiasis, a chronic parasitic infection. Similarly, tuberculosis (TB) affects nearly 2 billion people and both Ss and TB are co-endemic as well as share a major global disease burden. Earlier studies have revealed that helminth co-infection can modify the effect produced by the host immunity against Mycobacterium tuberculosis. However, no studies have examined the association of helminth co-infection with extra-pulmonary TB, especially in tuberculous lymphadenitis (TBL). In the present study, we have addressed this gap by measuring the cytokine profile in co-infected helminth-TBL individuals. Our study first shows that TBL-Ss+ co-infection is associated with “higher bacterial burden” in the affected lymph nodes. Our study also shows that co-infection is associated with alterations in plasma cytokines, specifically Type 2, regulatory and Type 17 cytokines were elevated and pro-inflammatory cytokines were reduced. Our study demonstrates significantly diminished unstimulated or TB—antigen stimulated levels of Type 1, Type 17 or IL-1 family of cytokines in TBL-Ss+ coinfected individuals. Hence, we conclude that helminth coinfection can possibly skew the protective immunity in TBL disease or infection.
Collapse
Affiliation(s)
- Gokul Raj Kathamuthu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
- * E-mail:
| | - Saravanan Munisankar
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | | | - Dhanaraj Baskaran
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| |
Collapse
|
34
|
Vasquez-Rios G, Pineda-Reyes R, Pineda-Reyes J, Marin R, Ruiz EF, Terashima A. Strongyloides stercoralis hyperinfection syndrome: a deeper understanding of a neglected disease. J Parasit Dis 2019; 43:167-175. [PMID: 31263320 DOI: 10.1007/s12639-019-01090-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022] Open
Abstract
Strongyloides stercoralis hyperinfection syndrome (SHS) is a life-threatening condition that warrants early detection and management. We describe the pathogenesis, organ-specific clinical manifestations, and risk factors associated to this condition. A comprehensive review of the literature was conducted in PubMed, LILACS, EBSCO and SciELO by using the keywords: "hyperinfection syndrome"; "Strongyloides stercoralis"; "disseminated strongyloidiasis"; "systemic strongyloidiasis", "pathogenesis" and "pathophysiology". Relevant articles on this topic were evaluated and included by consensus. Also, a secondary search of the literature was performed. Articles in English and Spanish language were included. SHS has been described in tropical and sub-tropical regions. However, there is growing evidence of cases detected in developed countries favored by increasing migration and the advance in immunosuppressive therapies for oncologic and inflammatory diseases. SHS is characterized by massive multiplication of larvae, typically in immunocompromised hosts. Clinical manifestations vary according to the organ involved and include diarrhea, intestinal bleeding, alveolar hemorrhages, heart failure, jaundice, bacteremia among others. Despite advances in the understanding of this condition, fatality rates are near 90%. Clinicians should consider SHS in the differential diagnosis of acutely ill patients with multiple organ damage and epidemiological risk factors. Adverse outcomes are common, especially with delayed anti-parasitic treatment.
Collapse
Affiliation(s)
- George Vasquez-Rios
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Roberto Pineda-Reyes
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Pineda-Reyes
- 2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Marin
- 2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eloy F Ruiz
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angélica Terashima
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
35
|
Akinboyo IC, Crane GM, Chen L, Arav-Boger R. A 17-Year-Old Boy With Right Face Palsy, Left Leg Weakness, and Lytic Skull-Bone Lesions. J Pediatric Infect Dis Soc 2018; 7:350-354. [PMID: 29373673 PMCID: PMC6276027 DOI: 10.1093/jpids/pix101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/18/2017] [Indexed: 11/13/2022]
Abstract
Human T-cell lymphotropic virus (HTLV), an infection that is endemic in certain parts of Asia, Africa, and South America, has been associated with malignancy and neurological deficits. Here, we describe a pediatric patient with chronic HTLV-I infection who developed complications associated with HTLV-I (ie, adult T-cell leukemia/lymphoma and HTLV-I-associated myelopathy/tropical spastic paraparesis). To our knowledge, this presentation in a child has never been described. The patient underwent a bone marrow transplant and, at the time of this writing, was in remission. This case report highlights the fact that HTLV-related complications, previously expected to occur after decades of infection, also can occur in pediatric patients, particularly those who acquired HTLV-I perinatally.
Collapse
Affiliation(s)
- Ibukunoluwa C Akinboyo
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland,Correspondence: I. C. Akinboyo, 200 N Wolfe St., Room 3155, Baltimore, MD 21287 ()
| | - Genevieve M Crane
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lingling Chen
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravit Arav-Boger
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
36
|
Mabbott NA. The Influence of Parasite Infections on Host Immunity to Co-infection With Other Pathogens. Front Immunol 2018; 9:2579. [PMID: 30467504 PMCID: PMC6237250 DOI: 10.3389/fimmu.2018.02579] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022] Open
Abstract
Parasites have evolved a wide range of mechanisms that they use to evade or manipulate the host's immune response and establish infection. The majority of the in vivo studies that have investigated these host-parasite interactions have been undertaken in experimental animals, especially rodents, which were housed and maintained to a high microbiological status. However, in the field situation it is increasingly apparent that pathogen co-infections within the same host are a common occurrence. For example, chronic infection with pathogens including malarial parasites, soil-transmitted helminths, Mycobacterium tuberculosis and viruses such as HIV may affect a third of the human population of some developing countries. Increasing evidence shows that co-infection with these pathogens may alter susceptibility to other important pathogens, and/or influence vaccine efficacy through their effects on host immune responsiveness. Co-infection with certain pathogens may also hinder accurate disease diagnosis. This review summarizes our current understanding of how the host's immune response to infection with different types of parasites can influence susceptibility to infection with other pathogenic microorganisms. A greater understanding of how infectious disease susceptibility and pathogenesis can be influenced by parasite co-infections will enhance disease diagnosis and the design of novel vaccines or therapeutics to more effectively control the spread of infectious diseases.
Collapse
Affiliation(s)
- Neil A Mabbott
- The Roslin Institute & Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
37
|
Quintero O, Berini CA, Waldbaum C, Avagnina A, Juarez M, Repetto S, Sorda J, Biglione M. Importance of a Rapid and Accurate Diagnosis in Strongyloides Stercoralis and Human T-Lymphotropic Virus 1 Co-infection: A Case Report and Review of the Literature. Front Microbiol 2017; 8:2346. [PMID: 29270152 PMCID: PMC5724150 DOI: 10.3389/fmicb.2017.02346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/15/2017] [Indexed: 12/14/2022] Open
Abstract
Strongyloides (S.) stercoralis and Human T-Lymphotropic Virus 1 (HTLV-1) share some endemic regions such as Japan, Jamaica, and South America and are mostly diagnosed elsewhere in immigrants from endemic areas. This co-infection has not been documented in Argentina although both pathogens are endemic in the Northwest. We present a case of S. stercoralis and HTLV-1 co-infection with an initial presentation due to gastrointestinal symptoms which presented neither eosinophilia nor the presence of larvae in stool samples in a non-endemic area for these infections. A young Peruvian woman living in Buenos Aires attended several emergency rooms and finally ended up admitted in a gastroenterology ward due to incoercible vomiting, diarrhea, abdominal pain, fever, and weight loss. Gastrointestinal symptoms started 3 months before she returned to Argentina from a trip to Peru. She presented malnutrition and abdominal distension parameters. HIV-1 and other immunodeficiencies were discarded. The serial coproparasitological test was negative. Computed tomography showed diffuse thickening of duodenal and jejunal walls. At the beginning, vasculitis was suspected and corticosteroid therapy was initiated. The patient worsened rapidly. Skin, new enteral biopsies, and a new set of coproparasitological samples revealed S. stercoralis. Then, HTLV-1 was suspected and infection was confirmed. Ivermectin and albendazole were administrated, until the stool sample remained negative for 2 weeks. Larvae were not observed in fresh stool, Ritchie method, and agar culture 1 week post-treatment. Although she required initial support with parenteral nutrition due to oral intolerance she slowly progressed favorably. It has been highly recommended to include a rapid and sensitive PCR strategy in the algorithm to confirm Strongyloides infection, which has demonstrated to improve early diagnosis in patients at-risk of disseminated strongyloidiasis.
Collapse
Affiliation(s)
- Olga Quintero
- Servicio de Gastroenterología del Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Carolina A Berini
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carlos Waldbaum
- Servicio de Gastroenterología del Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Alejandra Avagnina
- División Anatomía Patológica Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - María Juarez
- División Anatomía Patológica Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Silvia Repetto
- Instituto de Investigaciones en Microbiología y Parasitología Médica, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan Sorda
- Servicio de Gastroenterología del Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Mirna Biglione
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
38
|
Tariq H, Kamal MU, Reddy P, Bajantri B, Niazi M, Matela A, Zeana C, Ihimoyan A, Dev A, Chilimuri S. Anemia, intractable vomiting, chronic diarrhea, and syndrome of inappropriate antidiuretic secretion: a diagnostic dilemma: Disseminated strongyloidosis in a patient with newly diagnosed HTLV infection-case report and review of literature. Medicine (Baltimore) 2017; 96:e9229. [PMID: 29384908 PMCID: PMC6392699 DOI: 10.1097/md.0000000000009229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Strongyloidiasis hyperinfection and disseminated disease have high mortality rates due to several complications and early detection of Strongyloides infection is therefore prudent. PATIENT CONCERNS A 37-year-old male patient came with chronic diarrhea, intractable vomiting and was found to have hyponatremia, and anemia on the initial laboratory tests. DIAGNOSES Further work up revealed syndrome of inappropriate antidiuretic secretion to be the cause of the hyponatremia in addition to gastrointestinal loses. His hospital course was complicated by persistent hyponatremia and later development of partial small bowel obstruction. INTERVENTIONS Considering his symptoms we had a suspicion of small bowel pathology for which he underwent an esophagogastroduodenoscopywith biopsies that revealed strongyloidosis as the cause of his symptoms. He was also found to have human T-cell lymphotropic virus infection, likely contributing to the disseminated disease. OUTCOMES He was started on ivermectin with complete resolution of symptoms and improvement of hyponatremia. LESSONS It is very important to suspect Strongyloides infection in a patient presenting with syndrome ofinappropriate antidiuretic secretion as hyperinfection and disseminated disease can be life threatening without antihelmintic therapy.
Collapse
Affiliation(s)
| | | | | | | | - Masooma Niazi
- Department of Pathology, Bronx Lebanon Hospital Center, Bronx, NY
| | | | | | | | | | | |
Collapse
|
39
|
Salvador F, Sulleiro E, Piron M, Sánchez-Montalvá A, Sauleda S, Molina I. Seroprevalence of Strongyloides stercoralis infection among HTLV-I infected blood donors in Barcelona, Spain: A cross-sectional study. Acta Trop 2017; 176:412-414. [PMID: 28939495 DOI: 10.1016/j.actatropica.2017.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
Strongyloides stercoralis infection in patients with HTLV-I infection may lead to severe clinical manifestations. The aim of the present study is to determine the seroprevalence of S. stercoralis infection among blood donors who tested positive for HTLV-I infection. A cross-sectional study was performed at the Vall d'Hebron University Hospital (Barcelona, Spain) in 2016. Serum samples from HTLV-I positive patients diagnosed from 2008 to 2015 were retrieved from the Blood Bank, and S. stercoralis serology was performed. Thirty six serum samples from HTLV-I positive patients were retrieved from the Blood Bank. The blood samples came from 36 blood donors, and most of them were born in Latin America (75%), being Peru the most frequent country (11 participants). S. stercoralis serology was positive in one patient, corresponding to a prevalence of 2.8% (3.4% if we exclude donors coming from European countries, where the risk of S. stercoralis infection is highly unlikely).
Collapse
Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain.
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital,PROSICS Barcelona, Barcelona, Spain
| | - Maria Piron
- Catalan Blood and Tissue Bank (Banc de Sang i Teixits de Catalunya), Transfusion Safety Laboratory, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREhd), Instituto de Salud Carlos III, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Silvia Sauleda
- Catalan Blood and Tissue Bank (Banc de Sang i Teixits de Catalunya), Transfusion Safety Laboratory, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREhd), Instituto de Salud Carlos III, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| |
Collapse
|
40
|
Reyes F, Singh N, Anjuman-Khurram N, Lee J, Chow L. Strongyloides Hyperinfection Syndrome causing fatal meningitis and septicemia by Citrobacter koseri. IDCases 2017; 10:102-104. [PMID: 29062711 PMCID: PMC5647512 DOI: 10.1016/j.idcr.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/15/2022] Open
Abstract
Citrobacter koseri is a gram-negative bacillius that belongs to the Enterobacteriaceae family. It is an uncommon pathogen that typically causes meningitis and brain abscesses in children, however central nervous system (CNS) infections are rarely found in adults. We present a case of C. koseri meningitis in an immunocompetent adult secondary to intestinal micro-perforation caused by Strongyloides A 76-year-old man admitted for asthma exacerbation developed septic shock. A lumbar puncture revealed bacterial meningitis. Blood and CSF cultures grew Citrobacter koseri with identical susceptibilities, suggesting infection by one strain. Despite broad-spectrum antibiotics, the patient expired of multi-organ failure. Autopsy identified diffuse alveolar hemorrhage as the immedi ate cause of death with a heavy burden of Strongyloides stercoralis in his gastrointestinal system, lungs, and meninges. Citrobacter koseri is a gram-negative bacillus of the Enterobacteriaceae family. It is an uncommon pathogen that typically causes meningitis and brain abscesses in children. Infections in adults occur in immunocompromised hosts or instances where an insult creates a port of entry. This is the first documented case of C.koseri sepsis in an immunocompetent host associated with Strongyloides Hyperinfection Syndrome (SHS), where massive parasitic intestinal invasion reaches pulmonary circulation and perforates the alveolar membrane. This case highlights that presence of rare enterobacterial infections should prompt consideration of differentials including SHS.
Collapse
Affiliation(s)
- Felix Reyes
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
- Department of Pulmonary and Critical Care Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Navneet Singh
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
- Corresponding author at: 450 Clarkson Ave, Box 1262, Brooklyn, NY, 11203, USA.
| | | | - Jihae Lee
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Lillian Chow
- Department of Pulmonary and Critical Care Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
41
|
Nabeya D, Haranaga S, Parrott GL, Kinjo T, Nahar S, Tanaka T, Hirata T, Hokama A, Tateyama M, Fujita J. Pulmonary strongyloidiasis: assessment between manifestation and radiological findings in 16 severe strongyloidiasis cases. BMC Infect Dis 2017; 17:320. [PMID: 28464844 PMCID: PMC5414214 DOI: 10.1186/s12879-017-2430-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 04/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background Strongyloidiasis is a chronic parasitic infection caused by Strongyloides stercoralis. Severe cases such as, hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), can involve pulmonary manifestations. These manifestations frequently aid the diagnosis of strongyloidiasis. Here, we present the pulmonary manifestations and radiological findings of severe strongyloidiasis. Methods From January 2004 to December 2014, all patients diagnosed with severe strongyloidiasis at the University of the Ryukyus Hospital or affiliated hospitals in Okinawa, Japan, were included in this retrospective study. All diagnoses were confirmed by the microscopic or histopathological identification of larvae. Severe strongyloidiasis was defined by the presence of any of the following: 1) the identification of S. stercoralis from extra gastrointestinal specimens, 2) sepsis, 3) meningitis, 4) acute respiratory failure, or 5) respiratory tract hemorrhage. Patients were assigned to either HS or DS. Medical records were further reviewed to extract related clinical features and radiological findings. Results Sixteen severe strongyloidiasis cases were included. Of those, fifteen cases had pulmonary manifestations, eight had acute respiratory distress syndrome (ARDS) (53%), seven had enteric bacterial pneumonia (46%) and five had pulmonary hemorrhage (33%). Acute respiratory failure was a common indicator for pulmonary manifestation (87%). Chest X-ray findings frequently showed diffuse shadows (71%). Additionally, ileum gas was detected for ten of the sixteen cases in the upper abdomen during assessment with chest X-ray. While, chest CT findings frequently showed ground-glass opacity (GGO) in 89% of patients. Interlobular septal thickening was also frequently shown (67%), always accompanying GGO in upper lobes. Conclusions In summary, our study described HS/DS cases with pulmonary manifestations including, ARDS, bacterial pneumonia and pulmonary hemorrhage. Chest X-ray findings in HS/DS cases frequently showed diffuse shadows, and the combination of GGO and interlobular septal thickening in chest CT was common in HS/DS, regardless of accompanying pulmonary manifestations. This CT finding suggests alveolar hemorrhage could be used as a potential marker indicating the transition from latent to symptomatic state. Respiratory specimens are especially useful for detecting larvae in cases of HS/DS.
Collapse
Affiliation(s)
- Daijiro Nabeya
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Shusaku Haranaga
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Gretchen Lynn Parrott
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Takeshi Kinjo
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Saifun Nahar
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Teruhisa Tanaka
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Tetsuo Hirata
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Akira Hokama
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Masao Tateyama
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| |
Collapse
|
42
|
Ichikawa A, Miyoshi H, Arakawa F, Kiyasu J, Sato K, Niino D, Kimura Y, Yoshida M, Kawano R, Muta H, Sugita Y, Ohshima K. Detection of Tax-specific CTLs in lymph nodes of adult T-cell leukemia/lymphoma patients and its association with Foxp3 positivity of regulatory T-cell function. Oncol Lett 2017; 13:4611-4618. [PMID: 28599462 PMCID: PMC5453040 DOI: 10.3892/ol.2017.6067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/27/2016] [Indexed: 12/22/2022] Open
Abstract
Human T-cell lymphotropic virus type (HTLV)-1 Tax is a viral protein that has been reported to be important in the proliferation of adult T-cell leukemia/lymphoma (ATLL) cells and to be a target of HTLV-1-specific cytotoxic T lymphocytes (CTLs). However, it is not clear how Tax-specific CTLs behave in lymph nodes of ATLL patients. The present study analyzed the immunostaining of Tax-specific CTLs. Furthermore, ATLL tumor cells are known to be positive for forkhead box P3 (Foxp3)and to have a regulatory T (Treg)-cell-like function. The association between T-reg function and number and activity of Tax-specific CTLs was also investigated. A total of 15 ATLL lymphoma cases with human leukocyte antigen (HLA)-A24, for which Tax has a high affinity, were selected from the files of the Department of Pathology, School of Medicine, Kurume University (Kurume, Japan) using a polymerase chain reaction (PCR) method. Immunostaining was performed for cluster of differentiation (CD) 20, CD3, CD4, CD8, T-cell intracellular antigen-1 and Foxp3 in paraffin sections, and for Tax, interferon γ and HLA-A24 in frozen sections. In addition, the staining of Tax-specific CTLs (HLA-A24-restricted) was analyzed by MHC Dextramer® assay in frozen sections. In addition, the messenger RNA expression of Tax and HTLV-1 basic leucine zipper factor were also evaluated by reverse transcription-PCR. Immunohistochemical staining of Tax protein in lymphoma tissue revealed the presence of positive lymphoma cells ranging from 5 to 80%, and immunohistochemical staining of HLA-A24 revealed the presence of positive lymphoma cells ranging from 1 to 95%. The expression of Tax and HLA-A24 was downregulated by viral function. Foxp3, a marker for Treg cells, was expressed in 0-90% of cells. Several cases exhibited Tax-specific CTL (HLA-A24-restricted)-positive cells, and there was an inverse correlation between Tax-specific CTLs and Foxp3. However, neither Tax nor HLA-A24 expression was associated with CTL or Foxp3. Our study indicated the possibility that ATLL cells, which expressed Tax, target of CTL, evade the CTL-mediated immune control by expression of Foxp3 as a Treg function.
Collapse
Affiliation(s)
- Ayako Ichikawa
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Fumiko Arakawa
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Junichi Kiyasu
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Kensaku Sato
- Biostatistics Center, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Daisuke Niino
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Yoshizo Kimura
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Maki Yoshida
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Riko Kawano
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Hiroko Muta
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Yasuo Sugita
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| | - Koichi Ohshima
- Department of Pathology, School of Medicine, Kurume University, Kurume, Fukuoka 830 0011, Japan
| |
Collapse
|
43
|
Strongyloidiasis Current Status with Emphasis in Diagnosis and Drug Research. J Parasitol Res 2017; 2017:5056314. [PMID: 28210503 PMCID: PMC5292188 DOI: 10.1155/2017/5056314] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/08/2016] [Indexed: 12/27/2022] Open
Abstract
Strongyloidiasis is a parasitic neglected disease caused by the nematode Strongyloides stercoralis affecting 30 to 100 million people worldwide. Complications, strongly associated with alcoholism, organ transplants, and HTLV-1 virus, often arise due to late diagnosis, frequently leading to patient death. Lack of preemptive diagnosis is not the only difficulty when dealing with this parasite, since there are no gold standard diagnostic techniques, and the ones used have problems associated with sensitivity, resulting in false negatives. Treatment is also an issue as ivermectin and benzimidazoles administration leads to inconsistent cure rates and several side effects. Researching new anti-Strongyloides drugs is a difficult task since S. stercoralis does not develop until the adult stages in Mus musculus (with the exception of SCID mice), the main experimental host model. Fortunately, alternative parasite models can be used, namely, Strongyloides ratti and S. venezuelensis. However, even with these models, there are other complications in finding new drugs, which are associated with specific in vitro assay protocol steps, such as larvae decontamination. In this review, we highlight the challenges associated with new drug search, the compounds tested, and a list of published in vitro assay methodologies. We also point out advances being made in strongyloidiasis diagnosis so far.
Collapse
|
44
|
Ribeiro SR, Covre LP, Stringari LL, da Penha Zago-Gomes M, Gomes DCO, Pereira FEL. Peripheral blood CD4 +/CD25 + regulatory T cells in alcoholic patients with Strongyloides stercoralis infection. Parasitol Res 2017; 116:1071-1074. [PMID: 28083657 DOI: 10.1007/s00436-016-5355-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/15/2016] [Indexed: 01/21/2023]
Abstract
An increased number of regulatory T (Treg) cells has been reported in patients with HTLV-1 and Strongyloides stercoralis co-infection, suggesting the contribution of these cells to worm survival. As Strongyloides infections have been found to be highly prevalent in chronic alcoholics, we investigated the effect of abusive ethanol ingestion on the induction of Treg cells in alcoholic patients with Strongyloides infection. Treg cells were assessed by flow cytometry in the peripheral blood of 12 healthy non-alcoholic (control) and 14 alcoholic patients (alcoholic) without Strongyloides infection and five non-alcoholics (controlSs) and five chronic alcoholics (alcoholSs) with Strongyloides infection. The results showed significantly higher frequencies of Treg cells in the alcoholic, controlSs and alcoholSs group patients than in the control group patients. However, the frequencies of Treg cells did not differ between the alcoholSs and controlSs groups. In conclusion, our results demonstrate that ethanol consumption induced an increase in the number of circulating Treg cells in chronic alcoholics in this study but was unable to potentiate the induction of these cells in alcoholics with Strongyloides infection.
Collapse
Affiliation(s)
- Steveen Rios Ribeiro
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, CEP: 29043-900, Brazil
| | - Luciana Polaco Covre
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, CEP: 29043-900, Brazil
| | - Lorenzzo Lyrio Stringari
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, CEP: 29043-900, Brazil
| | - Maria da Penha Zago-Gomes
- Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Daniel Cláudio Oliveira Gomes
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, CEP: 29043-900, Brazil.,Núcleo de Biotecnologia, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Fausto Edmundo Lima Pereira
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, CEP: 29043-900, Brazil.
| |
Collapse
|
45
|
Current progress toward vaccine and passive immunization approaches for Strongyloides spp. Immunol Lett 2016; 180:17-23. [DOI: 10.1016/j.imlet.2016.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/11/2016] [Accepted: 10/14/2016] [Indexed: 02/02/2023]
|
46
|
Souza A, Santos S, Carvalho LP, Grassi MFR, Carvalho EM. Impairment of the humoral and CD4(+) T cell responses in HTLV-1-infected individuals immunized with tetanus toxoid. Hum Immunol 2016; 77:674-681. [PMID: 27282836 DOI: 10.1016/j.humimm.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 05/11/2016] [Accepted: 06/05/2016] [Indexed: 12/17/2022]
Abstract
T cells from HTLV-1-infected individuals have a decreased ability to proliferate after stimulation with recall antigens. This abnormality may be due to the production of regulatory cytokine or a dysfunctional antigen presentation. The aims of this study were to evaluate the antibody production and cytokine expression by lymphocytes before and after immunization with tetanus toxoid (TT) and to evaluate the immune response of monocytes after stimulation with TT and frequency of dendritic cells (DC) subsets. HTLV-1 carriers (HC) and uninfected controls (UC) with negative serology for TT were immunized with TT, and the antibody titers were determined by ELISA as well as the cell activation markers expression by monocytes. The frequencies of DC subsets were determined by flow cytometry. Following immunization, the IgG anti-TT titers and the frequency of CD4(+) T cells expressing IFN-γ, TNF-α and IL-10 in response to TT were lower in the HC than in the UC. Additionally, monocytes from HC did not exhibit increased HLA-DR expression after stimulation with TT, and presented low numbers of DC subsets, therefore, it's necessary to perform functional studies with antigen-presenting cells. Collectively, our finding suggests that HC present an impairment of the humoral and CD4(+) T cell immune responses after vaccination.
Collapse
Affiliation(s)
- Anselmo Souza
- Immunology Service, Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil; National Institute of Science and Technology - Tropical Diseases (INCT-DT), CNPq, Brazil
| | - Silvane Santos
- Immunology Service, Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil; Biological Science Department, State University of Feira de Santana, Feira de Santana, Bahia, Brazil; National Institute of Science and Technology - Tropical Diseases (INCT-DT), CNPq, Brazil
| | - Lucas P Carvalho
- Immunology Service, Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maria Fernanda R Grassi
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (Fiocruz), Salvador, Bahia, Brazil
| | - Edgar M Carvalho
- Immunology Service, Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil; National Institute of Science and Technology - Tropical Diseases (INCT-DT), CNPq, Brazil; Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (Fiocruz), Salvador, Bahia, Brazil.
| |
Collapse
|
47
|
Abstract
The majority of the 30-100 million people infected with Strongyloides stercoralis, a soil transmitted intestinal nematode, have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding because of the autoinfective process associated with its unique life cycle. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses both local and systemic that remain poorly characterized. Definitive diagnosis of S. stercoralis infection is based on stool examinations for larvae, but newer diagnostics - including new immunoassays and molecular tests - will assume primacy in the next few years. Although good treatment options exist for infection and control of this infection might be possible, S. stercoralis remains largely neglected.
Collapse
|
48
|
Higher HTLV-1c proviral loads are associated with blood stream infections in an Indigenous Australian population. J Clin Virol 2016; 78:93-8. [DOI: 10.1016/j.jcv.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 01/08/2023]
|
49
|
Cabral AC, Iñiguez AM, Moreno T, Bóia MN, Carvalho-Costa FA. Clinical conditions associated with intestinal strongyloidiasis in Rio de Janeiro, Brazil. Rev Soc Bras Med Trop 2016; 48:321-5. [PMID: 26108011 DOI: 10.1590/0037-8682-0019-2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/24/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Strongyloides stercoralis is a soil-transmitted helminth that produces an infection that can persist for decades. The relationships between certain clinical conditions and strongyloidiasis remains controversial. This study aims to identify the clinical conditions associated with intestinal strongyloidiasis at a reference center for infectious diseases in Rio de Janeiro, Brazil. METHODS The clinical conditions that were assessed included HIV/AIDS, HTLV infection, cardiovascular diseases, diabetes, obstructive respiratory diseases, viral hepatitis, tuberculosis, cancer, chronic renal disease, nutritional/metabolic disorders, psychiatric conditions, rheumatic diseases and dermatologic diseases. We compared 167 S. stercoralis-positive and 133 S. stercoralis-negative patients. RESULTS After controlling for sex (male/female OR = 2.29; 95% (CI): (1.42 - 3.70), rheumatic diseases remained significantly associated with intestinal strongyloidiasis (OR: 4.96; 95% CI: 1.34-18.37) in a multiple logistic regression model. With respect to leukocyte counts, patients with strongyloidiasis presented with significantly higher relative eosinophil (10.32% ± 7.2 vs. 4.23% ± 2.92) and monocyte (8.49% ± 7.25 vs. 5.39% ± 4.31) counts and lower segmented neutrophil (52.85% ± 15.31 vs. 61.32% ± 11.4) and lymphocyte counts (28.11% ± 9.72 vs. 30.90% ± 9.51) than S. stercoralis-negative patients. CONCLUSIONS Strongyloidiasis should be routinely investigated in hospitalized patients with complex conditions facilitate the treatment of patients who will undergo immunosuppressive therapy. Diagnoses should be determined through the use of appropriate parasitological methods, such as the Baermann-Moraes technique.
Collapse
Affiliation(s)
- Anna Caryna Cabral
- Disciplina de Doenças Infecciosas e Parasitárias, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alena Mayo Iñiguez
- Laboratório de Biologia de Tripanosomatídeos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Taiza Moreno
- Disciplina de Doenças Infecciosas e Parasitárias, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcio Neves Bóia
- Disciplina de Doenças Infecciosas e Parasitárias, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipe Anibal Carvalho-Costa
- Laboratório de Epidemiologia e Sistemática Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
50
|
Toulza F, Tsang L, Ottenhoff THM, Brown M, Dockrell HM. Mycobacterium tuberculosis-specific CD4+ T-cell response is increased, and Treg cells decreased, in anthelmintic-treated patients with latent TB. Eur J Immunol 2016; 46:752-61. [PMID: 26638865 DOI: 10.1002/eji.201545843] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 11/09/2015] [Accepted: 11/30/2015] [Indexed: 11/07/2022]
Abstract
In many settings, adults with active or latent tuberculosis will also be coinfected with helminths. Our study aimed to investigate how anthelmintic treatment modulates antimycobacterial immunity, in a setting where helminth reinfection should not occur. We investigated the potential impact of helminth infection on immune responses to Mycobacterium tuberculosis (Mtb) in patients with latent Mtb infection with or without helminth infection (Strongyloides or Schistosoma), and tested T-cell responses before and after anthelmintic treatment. The study was performed in migrants resident in the United Kingdom, where reexposure and reinfection following anthelmintic treatment would not occur. The frequency of CD4(+) IFN-γ(+) T cells was measured following stimulation with Mtb Purified Protein Derivative or ESAT-6/CFP-10 antigen, and concentrations of IFN-γ in culture supernatants measured by ELISA and multiplex bead array. Helminth infection was associated with a lower frequency of CD4(+) IFN-γ(+) T cells, which increased following treatment. Patients with helminth infection showed a significant increase in CD4(+) FoxP3(+) T cells (Treg) compared to those without helminth infection. There was a decrease in the frequency of Treg cells, and an associated increase in CD4(+) IFN-γ(+) T cells after the anthelmintic treatment. Here, we show a potential role of Treg cells in reducing the frequency and function of antimycobacterial CD4(+) IFN-γ(+) T cells, and that these effects are reversed after anthelmintic treatment.
Collapse
Affiliation(s)
- Frederic Toulza
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Lillian Tsang
- Hospital for Tropical Diseases, University College Hospital, and Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Brown
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Hospital for Tropical Diseases, University College Hospital, and Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Hazel M Dockrell
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|