Influence of Strongyloides stercoralis Coinfection on the Presentation, Pathogenesis, and Outcome of Tuberculous Meningitis

Abstract Background Helminth infections may modulate the inflammatory response to Mycobacterium tuberculosis and influence disease presentation and outcome. Strongyloides stercoralis is common among populations with high tuberculosis prevalence. Our aim was to determine whether S. stercoralis coinfection influenced clinical presentation, cerebrospinal fluid (CSF) inflammation, and outcome from tuberculous meningitis (TBM). Methods From June 2017 to December 2019, 668 Vietnamese adults with TBM, enrolled in the ACT HIV or LAST ACT trials (NCT03092817 and NCT03100786), underwent pretreatment S. stercoralis testing by serology, stool microscopy, and/or stool polymerase chain reaction. Comparisons of pretreatment TBM severity, CSF inflammation (including cytokines), and 3-month clinical end points were performed in groups with or without active S. stercoralis infection. Results Overall, 9.4% participants (63 of 668) tested positive for S. stercoralis. Active S. stercoralis infection was significantly associated with reduced pretreatment CSF neutrophil counts (median [interquartile range], 3/μL [0–25/μL] vs 14 /μL [1–83/μL]; P = .04), and with reduced CSF interferon ɣ, interleukin 2, and tumor necrosis factor α concentrations (11.4 vs 56.0 pg/mL [P = .01], 33.1 vs 54.5 pg/mL [P = .03], and 4.5 vs 11.9 pg/mL [P = .02], respectively), compared with uninfected participants. Neurological complications by 3 months were significantly reduced in participants with active S. stercoralis infection compared with uninfected participants (3.8% [1 of 26] vs 30.0% [33 of 110], respectively; P = .01). Conclusions S. stercoralis coinfection may modulate the intracerebral inflammatory response to M. tuberculosis and improve TBM clinical outcomes.

• Publication year

  2020

• Venue

  Journal of Infectious Diseases

• Publication date

  2020-10-26

• Fields of study

  Medicine

• Identifiers
  DOI 10.1093/infdis/jiaa672PMID 33104201PMCID 9071290
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Neutrophils express pro- and anti-inflammatory cytokines in granulomas from Mycobacterium tuberculosis-infected cynomolgus macaques

  2019cited by this paper
• Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection—A systematic review and meta-analysis

  2018cited by this paper
• Pretreatment Cerebrospinal Fluid Bacterial Load Correlates With Inflammatory Response and Predicts Neurological Events During Tuberculous Meningitis Treatment

  2018cited by this paper
• Adjunctive dexamethasone for the treatment of HIV-infected adults with tuberculous meningitis (ACT HIV): Study protocol for a randomised controlled trial

  2018cited by this paper
• Adjunctive dexamethasone for the treatment of HIV-uninfected adults with tuberculous meningitis stratified by Leukotriene A4 hydrolase genotype (LAST ACT): Study protocol for a randomised double blind placebo controlled non-inferiority trial

  2018cited by this paper
• Leukotriene A4 Hydrolase Genotype and HIV Infection Influence Intracerebral Inflammation and Survival From Tuberculous Meningitis

  2017cited by this paper
• Prognostic Models for 9-Month Mortality in Tuberculous Meningitis

  2017cited by this paper
• Tuberculous meningitis

  2017cited by this paper
• Clinical Parameters, Routine Inflammatory Markers, and LTA4H Genotype as Predictors of Mortality Among 608 Patients With Tuberculous Meningitis in Indonesia

  2017cited by this paper
• Long-term Mortality of Patients With Tuberculous Meningitis in New York City: A Cohort Study

  2016cited by this paper
• Modulation of pro- and anti-inflammatory cytokines in active and latent tuberculosis by coexistent Strongyloides stercoralis infection.

  2015cited by this paper
• Neutrophil-Associated Central Nervous System Inflammation in Tuberculous Meningitis Immune Reconstitution Inflammatory Syndrome

  2014cited by this paper
• Evaluation of GeneXpert MTB/RIF for Diagnosis of Tuberculous Meningitis

  2013cited by this paper
• Intensified regimen containing rifampicin and moxifloxacin for tuberculous meningitis: an open-label, randomised controlled phase 2 trial.

  2013cited by this paper
• Effect of helminth-induced immunity on infections with microbial pathogens

  2013influential reference
• Host genotype-specific therapies can optimize the inflammatory response to mycobacterial infections.

  2012cited by this paper
• Prevalence of Strongyloides stercoralis infection among HIV-positive immigrants attending two Italian hospitals, from 2000 to 2009

  2011cited by this paper
• Long-Term Mortality in Patients with Tuberculous Meningitis: A Danish Nationwide Cohort Study

  2011cited by this paper
• A study of cytokines in tuberculous meningitis: clinical and MRI correlation.

  2010cited by this paper
• Tuberculous meningitis: a uniform case definition for use in clinical research.

  2010cited by this paper
• Intestinal helminth co‐infection has a negative impact on both anti‐Mycobacterium tuberculosis immunity and clinical response to tuberculosis therapy

  2006cited by this paper
• Pretreatment Intracerebral and Peripheral Blood Immune Responses in Vietnamese Adults with Tuberculous Meningitis: Diagnostic Value and Relationship to Disease Severity and Outcome

  2006cited by this paper
• Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults.

  2004cited by this paper
• Type 1/Type 2 immunity in infectious diseases.

  2001cited by this paper
• Diagnosis of Strongyloides stercoralis infection.

  2001cited by this paper
• The value of an immunoenzymatic test (enzyme-linked immunosorbent assay) for the diagnosis of strongyloidiasis in patients immunosuppressed by hematologic malignancies.

  2001cited by this paper
• Cerebrospinal fluid cytokines in patients with tuberculous meningitis.

  1997cited by this paper
• Concentrations of interferon gamma, tumor necrosis factor alpha, and interleukin-1 beta in the cerebrospinal fluid of children treated for tuberculous meningitis.

  1995cited by this paper
• Concentrations of Interferon γ, Tumor Necrosis Factor α, and Interleukin-1β in the Cerebrospinal Fluid of Children Treated for Tuberculous Meningitis

  1995cited by this paper
• Immunological modulation and evasion by helminth parasites in human populations

  1993cited by this paper
• TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties.

  1989cited by this paper
• TUBERCULOUS MENINGITIS.

  1964cited by this paper
• Streptomycin in the Treatment of Tuberculous Meningitis

  1950cited by this paper
• STREPTOMYCIN treatment of tuberculous meningitis.

  1948cited by this paper

• CSF Hypo-Inflammation Drives Mortality in HIV-Associated Tuberculous Meningitis

  2025cites this paper
• Interactions between CNS and immune cells in tuberculous meningitis

  2024cites this paper
• Recent advances in understanding the human host immune response in tuberculous meningitis

  2024cites this paper
• Human Strongyloides stercoralis infection.

  2024cites this paper
• Humans seropositive for Trypanosoma cruzi co-infected with intestinal helminths have higher infectiousness, parasitaemia and Th2-type response in the Argentine Chaco

  2024cites this paper
• Human strongyloidiasis: complexities and pathways forward

  2023cites this paper
• Strongyloidiasis-related lung involvement: too much of a bad thing

  2023cites this paper
• Neurologic Complications of Tuberculosis

  2021cites this paper