Theunissen Caroline, Bottieau Emmanuel, Van Esbroeck Marjan, Tsoumanis Achilleas, Florence Eric
Institute of Tropical Medicine, Department of Clinical Sciences, 2000 Antwerp, Belgium.
Pathogens. 2020 May 18;9(5):388. doi: 10.3390/pathogens9050388.
a nematode endemic in all (sub)tropical regions, can cause life-threatening disease, especially in immunosuppressed patients. Many countries with high HIV-prevalence rates are also highly endemic, and co-infection may occur.
Retrospective study based on serological testing for in all HIV-infected migrants followed at the Institute of Tropical Medicine, Antwerp, Belgium. If untested, serologic testing was performed on stored samples, dating from the first HIV viral load determination. The epidemiological, clinical and laboratory features of patients with and without strongyloidiasis were retrieved from the electronic medical files.
Of the 2846 HIV patients in active follow-up, 723 (25.4%) had a migration background. Thirty-six patients (5.1%) were diagnosed with co-infection, including 29 during their medical evaluation and seven retrospectively. Patients had a median age of 35.3 years (IQR 30.3-44.4), 28 patients (78%) originated from Sub-Saharan Africa and median time in Belgium was 3.5 years (IQR 0.8-5.7). Symptoms compatible with strongyloidiasis were present in 17 (47%) patients, of whom two were diagnosed retrospectively. Eosinophilia (eosinophil cell count > 450/µL) was observed in 19 (53%) participants. Median CD4 level was 386 /µL (IQR 299-518) at diagnosis of co-infection. Of note, 8 (22%) patients with strongyloidiasis had no reported symptoms nor eosinophilia. None of the patients developed hyperinfection syndrome. There were no differences in age, gender, geographic origin, clinical presentation, CD4 level or viral load between patients with and without strongyloidiasis. Only eosinophilia was strongly correlated with the presence of in multivariate analysis (OR 10.74 (95% CI 5.19-22.25), < 0.001); the positive likelihood ratio (LR+) of eosinophilia for strongyloidiasis was 5.38 (95% CI 3.66-7.91).
Strongyloidiasis was diagnosed in 5.1% of HIV-infected migrants. Eosinophilia had good confirming power for the presence of the disease. However, a sizeable proportion (22%) of co-infected individuals were asymptomatic and had normal eosinophil count, supporting universal screening of all HIV-positive patients native to tropical countries.
一种在所有（亚）热带地区流行的线虫，可导致危及生命的疾病，尤其是在免疫抑制患者中。许多艾滋病毒高流行率的国家也是高度流行区，可能会发生合并感染。
基于比利时安特卫普热带医学研究所对所有接受随访的艾滋病毒感染移民进行血清学检测的回顾性研究。如果未进行检测，则对自首次测定艾滋病毒病毒载量起保存的样本进行血清学检测。从电子病历中检索有或没有类圆线虫病患者的流行病学、临床和实验室特征。
在2846名接受积极随访的艾滋病毒患者中，723名（25.4%）有移民背景。36名患者（5.1%）被诊断为合并感染，其中29名在医学评估期间诊断，7名回顾性诊断。患者的中位年龄为35.3岁（四分位间距30.3 - 44.4），28名患者（78%）来自撒哈拉以南非洲，在比利时的中位时间为3.5年（四分位间距0.8 - 5.7）。17名（47%）患者有与类圆线虫病相符的症状，其中2名是回顾性诊断。19名（53%）参与者观察到嗜酸性粒细胞增多（嗜酸性粒细胞计数>450/µL）。合并感染诊断时的中位CD4水平为386 /µL（四分位间距299 - 518）。值得注意的是，8名（22%）类圆线虫病患者既无报告症状也无嗜酸性粒细胞增多。所有患者均未发生高度感染综合征。有或没有类圆线虫病的患者在年龄、性别、地理来源、临床表现、CD4水平或病毒载量方面无差异。在多变量分析中，只有嗜酸性粒细胞增多与类圆线虫病的存在密切相关（比值比10.74（95%置信区间5.19 - 22.25），P<0.001）；嗜酸性粒细胞增多对类圆线虫病的阳性似然比（LR +）为5.38（95%置信区间3.66 - 7.91）。
在5.1%的艾滋病毒感染移民中诊断出类圆线虫病。嗜酸性粒细胞增多对该病的存在有很好的确诊能力。然而，相当一部分（22%）合并感染个体无症状且嗜酸性粒细胞计数正常，支持对所有来自热带国家的艾滋病毒阳性患者进行普遍筛查。
