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Strongyloidiasis in patients at a comprehensive cancer center in the United States
Author(s) -
Safdar Amar,
Malathum Kumthorn,
Rodriguez Saul J.,
Husni Rola,
Rolston Kenneth V. I.
Publication year - 2004
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.20120
Subject(s) - medicine , strongyloides stercoralis , cancer , strongyloidiasis , hematopoietic stem cell transplantation , gastroenterology , multiple myeloma , pneumonia , surgery , transplantation , immunology , helminths
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. Cancer 2004;100:1531–6. © 2004 American Cancer Society.