Strongyloidiasis in patients at a comprehensive cancer center in the United States

TitleStrongyloidiasis in patients at a comprehensive cancer center in the United States
Publication TypeJournal Article
Year of Publication2004
AuthorsSafdar A, Malathum K, Rodriguez SJ, Husni R, Rolston KV
Pagination1531 - 1536
Date Published36982
ISSN0008-543X; 0008-543X
Accession NumberPMID: 15042689
KeywordsAdolescent, Adult, Aged, Antinematodal Agents / therapeutic use, Bronchoalveolar Lavage, Child, Feces / parasitology, Female, Humans, Male, Middle Aged, Neoplasms / complications / parasitology, Retrospective Studies, Strongyloidiasis / complications / drug therapy / epidemiology, Thiabendazole / therapeutic use, Treatment Outcome, United States

BACKGROUND: The frequency of Strongyloides stercoralis infestation and complication in patients with cancer in the United States is unknown. METHODS: The authors performed a retrospective analysis of S. stercoralis infection in patients who were undergoing cancer treatment at The University of Texas M. D. Anderson Cancer Center (Houston, TX). RESULTS: The overall S. stercoralis infection frequency was approximately 1.0 per 10,000 new cancer cases between 1971 and 2003. Twenty-two of 25 patients (88%) were U.S. residents (19 from Texas; 1 each from Mississippi, Tennessee, and Puerto Rico), and the remaining 3 (13%) were from Latin America. Thirteen (52%) had solid-organ malignancies, whereas 12 (48%) had hematologic malignancies (lymphoma or multiple myeloma, n=8; leukemia, n=3; aplastic anemia, n=1). Twelve patients (48%) received systemic corticosteroids, 9 (36%) received antineoplastic therapy, and 2 underwent hematopoietic stem cell transplantation (HSCT). Diarrhea was reported in 13 patients (57%), and eosinophilia was observed in 11 patients (48%); 4 patients (16%) had probable hyperinfection syndrome (in 3 cases of polymicrobial gram-negative bacteremia, 1 patient had Klebsiella pneumoniae pneumonia, whereas 1 patient presented with K. pneumoniae lung infection alone). Evidence of definite pulmonary hyperinfection syndrome was observed in 2 HSCT recipients (8%). Fourteen (74%) of 19 patients responded to thiabendazole therapy. Two patients with definite pulmonary hyperinfection syndrome developed fatal S. stercoralis hemorrhagic alveolitis despite receiving high-dose thiabendazole plus ivermectin therapy. CONCLUSIONS: In the current study, strongyloidiasis was uncommon in patients with cancer and remained localized in individuals with solid-organ malignancies. Definite pulmonary accelerated autoinfections were observed only in HSCT recipients. Therefore, pre-HSCT S. stercoralis screening in individuals from endemic regions of the United States warrants further study.

Alternate JournalCancer
Notify Library Reference ID1733

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