Strongyloidiasis co-occurrence with tuberculosis and aspergillosis in immunocompromised patients: a global scoping review

Abstract

Reports on cases of strongyloidiasis and tuberculosis or aspergillosis coinfection are fragmented in the literature and no large-scale reviews are describing its occurrence across the globe. We identified a total of 230 cases of strongyloidiasis and tuberculosis coinfection amongst 2376 participants with tuberculosis disease from eight epidemiological surveys conducted in Ethiopia (n = 4, 50%); Tanzania (n = 3, 37.5%) and Malaysia (n = 1, 12.5%). Clinical outcomes in these studies were not stated as they were largely descriptive. In addition, there were ten individual case reports of strongyloidiasis and tuberculosis coinfection. Of the ten, four were from the USA (40%), two each from India (20%) and Japan (20%), and one each from the UK (10%) and Argentina (10%). Of the ten, six had favourable outcomes, two were fatal and outcomes were unclear in the remainder. Ten cases of strongyloidiasis and aspergillosis coinfection were identified, five were reported from the USA (50%), and one each from the Netherlands (10%), China (10%), Iran (10%), Colombia (10%) and Italy (10%). Five each had favourable and fatal outcomes. Fatal outcomes in strongyloidiasis and tuberculosis or aspergillosis coinfection were associated with steroid therapy (n = 3), decline for treatment (n = 1), delayed diagnosis (n = 2) and delayed presentation (n = 1). Our findings suggest a significant proportion of individuals living with tuberculosis are also affected with strongyloidiasis, especially in sub-Saharan Africa. However, more studies are required to ascertain the burden of strongyloidiasis and tuberculosis coinfection as few cases were reported from other highly burdened tuberculosis regions. In addition, the role of the attending clinician is critical to reduce morbidities from the coexistence of these clinical entities as a significant number of cases with documented outcomes were fatal.