Immune reconstitution syndrome to Strongyloides stercoralis infection

Taylor, Clare L; Ustianowski, Andrew

doi:10.1097/qad.0b013e3282ffdeba

Cited by 13 publications

(4 citation statements)

References 5 publications

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“…Lower prevalence rates were found in the general population from Laos [6], [7], [8], [9], [10], [11] as well as in HIV-infected patients from neighboring countries [22], [24], [25], [27], [28], [29], [49]. With the increasing use of antiretroviral drugs in developing countries, the problem of possible immune reconstitution inflammatory syndrome (IRIS) to S. stercoralis infection has recently emerged [50], [51]. Considering the high prevalence of strongyloidiasis and the frequent advanced stage of immunosuppression at HIV infection diagnosis in Laos, the risk of developing Strongyloides IRIS should be carefully assessed and prevented when initiating ART.…”

Section: Discussionmentioning

confidence: 99%

Intestinal Parasitic Infections in HIV-Infected Patients, Lao People’s Democratic Republic

et al. 2014

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BackgroundHIV infection is an emerging problem in Laos. We conducted the first prospective study on intestinal parasites, including opportunistic protozoa, in newly diagnosed HIV infected patients, with or without diarrhea. The aims were to describe the spectrum of infections, to determine their prevalence and to assess their associations with diarrhea, CD4 cell count, place of residence and living conditions.MethodologyOne to three stool samples over consecutive days were obtained from 137 patients. The Kato thick smear method, formalin-ethyl concentration and specific stains for coccidia and microsporidia diagnosis were performed on 260 stool samples. Baseline characteristics regarding relevant demographics, place of residence and living conditions, clinical features including diarrhea, were collected using a standardized questionnaire.Principal FindingsThe 137 patients were young (median age: 36 years) and severely immunocompromised (83.9% at WHO stage 3 or 4, median CD4 cell count: 41/mm3). Diarrhea was present in 43.0% of patients. Parasite infection was found in 78.8% of patients, infection with at least two species in 49.6%. Prevalence rates of protozoan and helminth infections were similar (54.7% and 58.4% respectively). Blastocystis sp. was the most frequent protozoa (26.3%). Cryptosporidium sp., Cytoisospora belli and microsporidia, found at low prevalence rates (6.6%, 4.4%, 2.9%, respectively), were described for the first time in Laos. Cryptosporidium sp. was associated with persistent diarrhea. Strongyloides stercoralis was the most prevalent helminth following Opisthorchis viverrini (20.4% and 47.5% respectively). The most immunocompromised patients, as assessed by a CD4 count ≤ 50 cells/mm3, were more likely to be infected with intestinal parasites.Conclusions/SignificanceHIV infection was mainly diagnosed at an advanced stage of immunosuppression in Lao patients. Intestinal parasite infections were highly prevalent regardless of their diarrheal status. Opportunistic infections were reported. Improving the laboratory diagnosis of intestinal parasite infections and the knowledge on their local risk factors is warranted.

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Section: Discussionmentioning

confidence: 99%

Intestinal Parasitic Infections in HIV-Infected Patients, Lao People’s Democratic Republic

et al. 2014

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“…The IRIS after initiation of ART in patients with chronic strongyloidiasis (the so-called “unmasking IRIS”) was reported in 4 cases so far. 10 -13 The IRIS in these patients might increase replication of larvae and promote typical symptoms of chronic strongyloidiasis (diarrhea, vomiting, constipation, etc) On the other hand, documented IRIS development after resolution of SHS (“paradoxical IRIS”) has not been reported in the literature so far. This case report describes one of the many forms IRIS can present with and highlights the need for comprehensive follow-up in HIV-positive patients after the initiation of ART.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 94%

Strongyloidiasis-Related IRIS

Bar-Yoseph

Zohar

Lorber

2016

J Int Assoc Provid AIDS Care

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Helminthic infection and HIV have been reported to coexist, particularly in sub-Saharan African patients living with HIV. Strongyloidiasis is one of the most common helminths, usually leading to cutaneous and gastrointestinal (GI) symptoms. In the immunocompromised host, this infection can lead to strongyloidiasis hyperinfection syndrome (SHS), not common in HIV-infected patients. Immune reconstitution inflammatory syndrome (IRIS) can follow the initiation of antiretroviral therapy (ART), with a variety of presentations. The authors present here a 32-year-old HIV-infected female who was recently diagnosed with AIDS, started ART, and recovered from SHS. Her upper endoscopy revealed severe duodenitis but no causal agent per biopsy or stool examination. After receiving symptomatic therapy, she showed improvement, a course of events that fit the diagnosis of GI-related IRIS.

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“…The incidence rate of TB-IRIS in patients co-infected with HIV, and TB ranges from 11% to 68.8%. 6,7 The co-infection rate of HIV and TB is increasing steadily in China, which makes TB-IRIS the most important and commonly early complication for patients who received HAART treatment, and coinfected with HIV and TB. However, only several studies have reported the incidence of TB-IRIS and the clinical features.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in HIV/TB Co-infected Patients During HAART

Zhou¹,

Wang²,

Li³

et al. 2014

Infection International

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Objectives To investigate the clinical features of tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (TB-IRIS) in patients co-infected with HIV/TB or latent infection during highly active antiretroviral therapy (HAART). Methods HIV-infected patients treated in the Third People’s Hospital of Shenzhen, China between March 2012 and March 2013 were recruited, and divided into 3 groups: 1) HIV/TB co-infection group (n = 50), 2) HIV/ MTB latent infection group (n = 50), and 3) HIV infection group (n = 50), with 12-month follow-up. Patients in the HIV/TB co-infection group were treated with HAART 2 weeks after TB therapy. Patients were assessed at different time-points. Results The incidence and mortality rates of TB-IRIS were 40% and 10% in the HIV/TB co-infected patients, and 2% (and no mortality) in the HIV/MTB group. The HIV infected group did not display TB-IRIS or death. About 95% HIV/TB co-infected patients were 20-39 years old when TB-IRIS occurred, and 65% of the patients developed TB-IRIS 2 weeks after HAART. For the co-infection group, those with TB-IRIS (20/20, 100%) had fever, with a significantly higher incidence than those who did not develop TB-IRIS (6.7%, 2/30, P < 0.05). The patients with TB-IRIS in co-infection group displayed markedly higher clinical biochemical markers, acute phase reactants, increased CD4+ cell counts, and 2 log10-decreases of HIV RNA loads, compared with the patients not presenting with TB-IRIS (P < 0.05). Conclusion HIV/TB co-infected patients presented with a high-risk of developing TB-IRIS during HAART treatment. Early diagnosis and treatment could decrease mortality rates in TB-IRIS.

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Immune reconstitution syndrome to Strongyloides stercoralis infection

Cited by 13 publications

References 5 publications

Intestinal Parasitic Infections in HIV-Infected Patients, Lao People’s Democratic Republic

Intestinal Parasitic Infections in HIV-Infected Patients, Lao People’s Democratic Republic

Strongyloidiasis-Related IRIS

Analysis of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in HIV/TB Co-infected Patients During HAART

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