Case Report: Disseminated Paracoccidioidomycosis and Strongyloides Hyperinfection in a Patient with Human T-Lymphotropic Virus Type 1/2 Infection

Juan Montenegro-Idrogo Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú;

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Alfredo Chiappe-Gonzalez Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú;
Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú;

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Esperanza Vicente-Lozano Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú;

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Gonzalo Cornejo-Venegas Universidad Peruana de Ciencias Aplicadas, Chorrillos, Perú

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Cristhian Resurrección-Delgado Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú;
Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú;

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ABSTRACT.

Co-occurrence of paracoccidioidomycosis and strongyloidiasis in immunosuppressed patients, particularly those infected with human T-lymphotropic virus type 1/2, is infrequent. We describe the case of a Peruvian farmer from the central jungle with human T-lymphotropic virus type 1/2 infection, with 2 months of illness characterized by respiratory and gastrointestinal symptoms associated with fever, weight loss, and enlarged lymph nodes. Strongyloides stercoralis and Paracoccidioides brasiliensis were isolated in sputum and bronchoalveolar lavage samples, respectively. The clinical evolution was favorable after the patient received ivermectin and amphotericin B. We hypothesize that autoinfestation by S. stercoralis in human T-lymphotropic virus type 1/2–infected patients may contribute to the disseminated presentation of Paracoccidioides spp. Understanding epidemiological context is crucial for suspecting opportunistic regional infections, particularly those that may coexist in immunosuppressed patients.

Author Notes

Authors’ contributions: J. Montenegro-Idrogo and A. Chiappe-Gonzalez conceived and designed the report. J. Montenegro-Idrogo, A. Chiappe-Gonzalez, E. Vicente-Lozano, G. Cornejo-Venegas, and C. Resurrección-Delgado developed, interpreted the main outputs of, and drafted the manuscript. All authors reviewed and edited the manuscript. All authors read and approved the final version of the manuscript.

Authors’ addresses: Juan Montenegro-Idrogo, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú, E-mail: montenegroidrogo@gmail.com. Alfredo Chiappe-Gonzalez and Cristhian Resurrección-Delgado, Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú, and Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú, E-mails: alfredochiappe911@hotmail.com and cristhianprd27@hotmail.com. Esperanza Vicente-Lozano, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú, E-mail: yurikovicente@gmail.com. Gonzalo Cornejo-Venegas, Universidad Peruana de Ciencias Aplicadas, Chorrillos, Lima, Perú, E-mail: gonza_cornejo@icloud.com.

Address correspondence to Alfredo Chiappe-Gonzalez, Calle Dr. Carlos E. Ferreyros, U. 776 Dpto. 401, San Isidro, Lima 15036, Perú. E-mail: alfredochiappe911@hotmail.com
  • 1.

    Hahn RC , Hagen F , Mendes RP , Burger E , Nery AF , Siqueira NP , Guevara A , Rodrigues AM , de Camargo ZP , 2022. Paracoccidioidomycosis: Current status and future trends. Clin Microbiol Rev 35: e0023321.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Peçanha PM , Peçanha-Pietrobom PM , Grão-Velloso TR , Rosa Júnior M , Falqueto A , Gonçalves SS , 2022. Paracoccidioidomycosis: What we know and what is new in epidemiology, diagnosis, and treatment. J Fungi (Basel) 8: 1098.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Zurita S , 2014. Sporotrichosis and paracoccidioidomycosis in Peru: Experiences in prevention and control. Rev Peru Med Exp Salud Publica 31: 352357.

  • 4.

    Almeida FA , Neves FF , Mora DJ , Reis TA , Sotini DM , Ribeiro BM , Andrade-Silva LE , Nascentes GN , Ferreira-Paim K , Silva-Vergara ML , 2017. Paracoccidioidomycosis in Brazilian patients with and without human immunodeficiency virus infection. Am J Trop Med Hyg 96: 368372.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Vázquez C , Orlova M , Zarba M , Catanzariti MJ , Christiansen SB , Dalurzo MCL , Freixas AA , Vallone MG , 2018. Timely diagnosis of disseminated paracoccidioidomycosis in an immunocompetent adult. Medicina (B Aires) 78: 199202.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Falcão EM , de Macedo PM , Freitas DFS , Freitas AD , Grinsztejn B , Veloso VG , Almeida-Paes R , Francesconi do Valle AC , 2022. Paracoccidioidomycosis in people living with HIV/AIDS: A historical retrospective cohort study in a national reference center for infectious diseases, Rio de Janeiro, Brazil. PLoS Negl Trop Dis 16: e0010529.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Dall Bello AG , Severo CB , Oliveira Fde M , Severo LC , 2011. Disseminated paracoccidioidomycosis (simulating metastatic lung cancer) and Strongyloides stercoralis hyperinfestation in a steroid-treated patient. J Clin Microbiol 49: 20542055.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Shikanai-Yasuda MA et al., 2017. Brazilian guidelines for the clinical management of paracoccidioidomycosis. Rev Soc Bras Med Trop 50: 715740.

  • 9.

    León M , Alave J , Bustamante B , Cok J , Gotuzzo E , Seas C , 2010. Human T lymphotropic virus 1 and paracoccidioidomycosis: A probable association in Latin America. Clin Infect Dis 51: 250251.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Meira Dias O , Belousova N , Sharif N , Brasg I , Singer LG , Tikkanen J , Chaparro C , Rotstein C , 2022. Strongyloides hyper-infection in a lung transplant recipient: Case report and review of the literature. J Assoc Med Microbiol Infect Dis Can 7: 150156.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Singh K , Ganorkar S , Bhalekar S , Rao R , 2021. Hyperinfection with Strongyloides stercoralis presenting as acute abdomen in a patient on corticosteroid therapy: A case report. Indian J Pathol Microbiol 64: 831833.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Dykie A , Wijesinghe T , Rabson AB , Madugula K , Farinas C , Wilson S , Abraham D , Jain P , 2020. Human T-cell leukemia virus type 1 and Strongyloides stercoralis: Partners in pathogenesis. Pathogens 9: 904.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Porto AF , Santos SB , Muniz AL , Basilio V , Rodrigues W Jr. , Neva FA , Dutra WO , Gollob KJ , Jacobson S , Carvalho EM , 2005. Helminthic infection down-regulates type 1 immune responses in human T cell lymphotropic virus type 1 (HTLV-1) carriers and is more prevalent in HTLV-1 carriers than in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. J Infect Dis 191: 612618.

    • PubMed
    • Search Google Scholar
    • Export Citation
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