Abstract
The course of Strongyloides stercoralis infection is usually asymptomatic with a low discharge of rhabditoid larva in feces. However, the deleterious effects of alcohol consumption seem to enhance the susceptibility to infection, as shown by a fivefold higher strongyloidiasis frequency in alcoholics than in nonalcoholics. Moreover, the association between S. stercoralis infection and alcoholism presents a risk for hyperinfection and severe strongyloidiasis. There are several possible mechanisms for the disruption of the host-parasite equilibrium in ethanol-addicted patients with chronic strongyloidiasis. One explanation is that chronic ethanol intake stimulates the hypothalamic-pituitary-adrenal (HPA) axis to produce excessive levels of endogenous cortisol, which in turn can lead to a deficiency in type 2 T helper cells (Th2) protective response, and also to mimic the parasite hormone ecdysone, which promotes the transformation of rhabditiform larvae to filariform larvae, leading to autoinfection. Therefore, when untreated, alcoholic patients are continuously infected by this autoinfection mechanism. Thus, the early diagnosis of strongyloidiasis and treatment can prevent serious forms of hyperinfection in ethanol abusers.
Highlights
Strongyloides stercoralis infection is prevalent in countries with tropical and subtropical climates and affects approximately 370 million people worldwide [1, 2]
Immunosuppressed patients with chronic strongyloidiasis are at high risk of developing serious complications, such as hyperinfection syndrome and the dissemination of the parasite to several organs, causing sepsis and even death
The main purpose of this article is to review the association between strongyloidiasis and chronic alcoholism, including describing the organic changes induced by both pathologies; the adverse effects of alcohol that predispose an individual to S. stercoralis infection and hyperinfection; and the current diagnostic tools and therapies for strongyloidiasis
Summary
Strongyloides stercoralis infection is prevalent in countries with tropical and subtropical climates and affects approximately 370 million people worldwide [1, 2]. In most hosts, the course of parasitism remains quiescent with no significant morbidity This parasite-host balance can be disrupted under conditions of impaired cellular immunity, resulting in the life-threatening strongyloidiasis condition [3]. Immunosuppressed patients with chronic strongyloidiasis are at high risk of developing serious complications, such as hyperinfection syndrome and the dissemination of the parasite to several organs, causing sepsis and even death. High risk groups for S. stercoralis infection and hyperinfection include patients under massive corticoid therapy, HTLV-1 coinfected individuals, and chronic alcoholics [4,5,6]. The main purpose of this article is to review the association between strongyloidiasis and chronic alcoholism, including describing the organic changes induced by both pathologies; the adverse effects of alcohol that predispose an individual to S. stercoralis infection and hyperinfection; and the current diagnostic tools and therapies for strongyloidiasis
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