Impact of Strongyloides stercoralis Coinfection on Disease Severity and Treatment Outcomes in Pulmonary Tuberculosis.

Abstract

Background: This study investigates how Strongyloides stercoralis (Ss) infection impacts pulmonary tuberculosis (PTB) treatment outcomes, disease severity, and bacterial burdens in PTB patients with Ss coinfection.

Methods: We used chest x-rays and sputum smear grades to assess lung conditions and bacterial loads in 483 PTB patients. Ss infection was confirmed by seropositivity, and cytokine and profibrotic factor levels were analyzed using multiplex enzyme-linked immunosorbent assay. Treatment outcomes were categorized as favorable (cure without recurrence) or unfavorable (treatment failure or TB recurrence) during treatment or within 12 months postcure.

Results: PTB patients coinfected with Ss had significantly higher bacterial loads, increased risk of bilateral lung lesions, and greater likelihood of cavitary disease compared with those without Ss infection. The coinfected individuals exhibit significantly increased levels of cytokines (interleukin [IL]-4, IL-5, IL-13, interferon [IFN]-α, and IFN-β) and profibrotic factors (vascular endothelial growth factor, epidermal growth factor [EGF], fibroblast growth factor 2 [FGF-2], and PDGF-AB/BB [platelet-derived growth factor]) and significantly diminished levels of cytokines (IFN-γ and IL-2).

Conclusions: This study underscores the exacerbating impact of Ss coinfection on PTB severity and treatment outcomes, emphasizing the need for integrated management strategies for affected patients.