[Recurrent strongyloidiasis as an indicator of HTLV-1 infection].
METHODS
A 53-year-old West African man presented two years after a travel to Guinea because of severe headache, neck stiffnes, fever and pruritus. The patient had been in orthopedical treatment for the last five months.


METHODS
Stool microscopy revealed a high number of Strongyloides stercoralis larvae. Hematology, biochemistry and all other parasitology results were normal. HIV-1/2 testing was negative and CD4+-lymphocyte count was normal. Concomitant infection by Human T Cell lymphotropic virus type 1 (HTLV-1) was confirmed by serology and PCR. The phylogenetic analysis confirmed African origin of the virus.


METHODS
The infection responded to a five-day course of albendazol at 400 mg/d but during the following five years repeat recrudescences were observed inspite of high-dosage and prolonged antiparasitic treatments. Eventually, eradication of the infection was achieved by a four day course of ivermectin 0.2 mg/kg/d.


CONCLUSIONS
Although both strongyloidiasis and HTLV-1 infections occur most frequently in tropical areas, these may also be observed in temperate regions. Suppression of the immune system by HTLV-1 differs from that by HIV. CD4+-lymphocytes were rarely decreased. Prolonged treatment with ivermectin in a dosage exceeding the current recommendations may be required in HTLV-1 infected patients and was well tolerated. The unusual presentation of the infection with muscular symptoms contributed to the delay of the diagnosis. HTLV-1 positive patients must be monitored for years. They and their partners must be instructed how to prevent transmission of the virus.
Richter
J
J
Tropenmedizinische Ambulanz, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich-Heine-Universität, Düsseldorf. Joachim.Richter@med.uni-duesseldorf.de
Schwarz
U
U
Duwe
S
S
Ellerbrok
H
H
Poggensee
G
G
Pauli
G
G
D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D005243:Feces / Q000469:parasitology; D005334:Fever; D005858:Germany; D016701:Guinea / Q000208:ethnology; D015490:HTLV-I Infections / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D006261:Headache; D015368:Human T-lymphotropic virus 1 / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019547:Neck Pain; D010270:Parasite Egg Count; D010802:Phylogeny; D011537:Pruritus; D017171:Strongyloides stercoralis / Q000145:classification / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014195:Travel
D000871:Anthelmintics; D007559:Ivermectin; D015766:Albendazole