Overlapping Infection by <i>Strongyloides</i> spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature.

Abstract

<i>Strongyloides</i> and cytomegalovirus co-infections are rarely reported, even though they are distinguished by high morbidity and mortality, especially in immunocompromised hosts. We narratively reviewed the literature on reported cases of <i>Strongyloides</i> and CMV co-infections in immunosuppressed patients. Most cases occurred in males with a median age of 47 (IQR, 37-59). <i>Strongyloides</i>/CMV co-infections occurred among immunocompromised hosts, especially in solid organ transplants and hematological or rheumatological diseases. Most of the patients underwent a course of steroid treatment before the diagnosis of co-infections. Other common immunomodulatory agents were tacrolimus and mycophenolate. The first clinical manifestations of co-infections were mainly gastrointestinal, followed by respiratory symptoms. CMV was, in most patients, co-infected with an isolated reactivation, although <i>Strongyloides</i> manifested especially as hyperinfection syndrome. Ganciclovir and ivermectin are the mainstays of CMV and <i>Strongyloides</i> treatment. However, the treatment mortality reported in this narrative review is around 52.4%. Interestingly secondary bacterial infections are common in CMV/<i>Strongyloides</i>-infected patients.