Severe Strongyloidiasis Associated With Subclinical Human T-cell Leukemia/Lymphoma Virus-1 Infection

A high incidence of Strongyloides stercoralis infection is present in areas of the world with favorable environmental and social conditions. The unique ability of this nematode to have 2 distinct life cycles allows for its persistence and infectivity Similarly, infection with the retrovirus human T-cell leukemia/lymphoma virus-1 (HTLV-1) is quite prevalent in many of the same geographic areas where patients with chronic strongyloidiasis are located. Individuals who are coinfected are at a substantially increased risk of severe infestation, or hyperinfection, with Strongyloides organisms, owing to the often subtle alterations in the host's immune defenses brought about by HTLV-1. In addition, clinical manifestations, diagnostic tests, and response to routine therapy may not mimic the expected patterns generally seen in the patient that is HTLV-1 naive infected with Strongyloides.