A high incidence of Strongyloides stercoralis infection is present in areas of the world with favorable environmental and social conditions. The unique ability of this nematode to have 2 distinct life cycles allows for its persistence and infectivity Similarly, infection with the retrovirus human T-cell leukemia/lymphoma virus-1 (HTLV-1) is quite prevalent in many of the same geographic areas where patients with chronic strongyloidiasis are located. Individuals who are coinfected are at a substantially increased risk of severe infestation, or hyperinfection, with Strongyloides organisms, owing to the often subtle alterations in the host's immune defenses brought about by HTLV-1. In addition, clinical manifestations, diagnostic tests, and response to routine therapy may not mimic the expected patterns generally seen in the patient that is HTLV-1 naive infected with Strongyloides.
From the *Department of Medicine, University of Miami-Miller School of Medicine, Miami; †Division of Infectious Diseases, JFK Medical Center, Palm Beach County; and ‡Department of Pathology and Laboratory Medicine, University of Miami-Miller School of Medicine, Jackson Memorial Hospital, Miami, FL.
Reprints: Larry M. Bush, MD, FACP, Atlantis Medical Center, 5503 South Congress Ave, Suite 104, Atlantis, FL 33462; E-mail: firstname.lastname@example.org.