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

Am J Trop Med Hyg. 2024 Mar 26;110(5):961-964. doi: 10.4269/ajtmh.23-0171. Print 2024 May 1.

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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amphotericin B / therapeutic use
  • Animals
  • Antifungal Agents / therapeutic use
  • Coinfection
  • HTLV-I Infections* / complications
  • HTLV-II Infections / complications
  • Human T-lymphotropic virus 1 / isolation & purification
  • Humans
  • Immunocompromised Host
  • Ivermectin* / therapeutic use
  • Male
  • Paracoccidioides / isolation & purification
  • Paracoccidioidomycosis* / complications
  • Paracoccidioidomycosis* / diagnosis
  • Paracoccidioidomycosis* / drug therapy
  • Strongyloides stercoralis* / isolation & purification
  • Strongyloidiasis* / complications
  • Strongyloidiasis* / diagnosis
  • Strongyloidiasis* / drug therapy

Substances

  • Ivermectin
  • Amphotericin B
  • Antifungal Agents