Strongyloidiasis in patients at a comprehensive cancer center in the 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.
Safdar
Amar
A
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M D Anderson Cancer Center, Houston, Texas 77030, USA. asafdar@mdanderson.org
Malathum
Kumthorn
K
Rodriguez
Saul J
SJ
Husni
Rola
R
Rolston
Kenneth V I
KV
D000293:Adolescent; D000328:Adult; D000368:Aged; D000969:Antinematodal Agents / Q000627:therapeutic use; D018893:Bronchoalveolar Lavage; D002648:Child; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000469:parasitology; D012189:Retrospective Studies; D013322:Strongyloidiasis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D013827:Thiabendazole / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
D000969:Antinematodal Agents; D013827:Thiabendazole