Association between Strongyloides stercoralis infection and cortisol secretion in alcoholic patients

Abstract

A higher prevalence of Strongyloides stercoralis infections has been reported in alcoholic patients compared to nonalcoholic patients living in the same area. Excessive alcohol consumption increases the levels of endogenous corticosteroids that subsequently enhance the fecundity of S. stercoralis parthenogenetic females. These corticosteroids also enhance the transformation of rhabditiform larvae into infective filariform larvae by mimicking the effect of the ecdysteroid hormones produced by the parasite, thus leading to autoinfection. In addition, alterations in the intestinal barrier and host immune response contribute to the development of hyperinfection and severe strongyloidiasis in alcoholic patients. The aim of this study was to evaluate the frequency of S. stercoralis infections in alcoholic patients and to determine the association between S. stercoralis infection and endogenous cortisol levels. The frequency of infection was evaluated in 332 alcoholic and 92 nonalcoholic patients. The parasitological diagnosis was carried out by agar plate culture, the modified Baermann-Moraes method and spontaneous sedimentation. The immunological diagnosis was performed using an ELISA with anti-S. stercoralis IgG. The cortisol levels were measured in serum samples by ELISA. The frequency of S. stercoralis infection in alcoholic patients was 23.5% (78/332), while in nonalcoholic patients, it was 5.4% (5/92) (p<0.05). The cortisol levels were higher in alcoholic than in nonalcoholic patients (p<0.05). However, among the alcoholic patients, the cortisol levels did not differ between S. stercoralis-infected and uninfected patients (p>0.05). As demonstrated in this work, 81.3% (26/32) of patients with a high parasite load, considered as more than 11 larvae per gram of feces, presented serum cortisol levels above the normal reference value (24 mg/dL). High endogenous cortisol levels in alcoholic patients were not associated to susceptibility to S. stercoralis infection, however once infected, this may lead to a high parasite load.

Strongyloides stercoralisInfection in Alcoholic Patients

“…This action leads to the invasion of the intestinal mucosa, resembling the autoinfection mechanism observed in patients under massive corticosteroid therapy [73, 74]. In fact, we have recently observed that high endogenous cortisol levels in alcoholic patients may not be associated with susceptibility to S. stercoralis infection; however, once infected, this may lead to a high parasite load [37]. …”

“…However, the rate of infection in the entire Costa Rica population was 0.1%, indicating that alcoholics were four to five times more susceptible to S. stercoralis infection [36], as observed in Brazilian studies. In fact, our group reported an occurrence of 23.5% of S. stercoralis infection in alcoholics from the Brazilian Northeast [37]. …”

Características clínico-epidemiológicas de la estrongiloidiasis en pacientes portadores de co-morbilidades

“…Marques y cols., evaluaron 263 pacientes consumidores crónicos de alcohol, identificando una tasa de infección de 20,5% mientras en 590 individuos no alcohólicos, tan sólo 4,4% resultaron positivos 32 . En 2016, Silva y cols., identificaron resultados semejantes a los presentados en la literatura médica, observando una frecuencia de estrongiloidiasis entre individuos alcohólicos de 23,5% y entre no consumidores de alcohol de 5,4% 33 .…”

Effect of a high-fat diet and alcohol on cutaneous repair: A systematic review of murine experimental models

“…Alcoholism is considered a risk factor that compromises tissue repair by increasing susceptibility to infections and reducing the number of cells of the innate and adaptive immune systems [26,27]. Its consumption is also related to the formation of ROS, which induces cell morphological and functional destruction [28].…”