Disseminated strongyloidiasis with central nervous system involvement diagnosed antemortem in a patient with acquired immunodeficiency syndrome and Burkitts lymphoma

Dutcher, Janice P.; Marcus, Stuart L.; Tanowitz, Herbert B.; Wittner, Murray; Fuks, Joachim Z.; Wiernik, Peter H.

doi:10.1002/1097-0142(19901201)66:11<2417::aid-cncr2820661129>3.0.co;2-g

Cited by 55 publications

(31 citation statements)

References 24 publications

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“…In one case (Case 2) there was Strongyloides stercoralis larvae in the feces. Although there are reports of Strongyloides larvae entering the central nervous system, this occurrence is extremely rare and is associated with the disseminated form of the infection 9 . The other paratenic nematodes that can cause eosinophilic meningitis or encephalitis have not yet been described in Brazil.…”

Section: Discussionmentioning

confidence: 99%

Toxocariasis of the central nervous system: with report of two cases

Moreira-Silva

Rodrigues

Pimenta

et al. 2004

Rev. Soc. Bras. Med. Trop.

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Section: Discussionmentioning

confidence: 99%

Toxocariasis of the central nervous system: with report of two cases

Moreira-Silva

Rodrigues

Pimenta

et al. 2004

Rev. Soc. Bras. Med. Trop.

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“…Sputum may demonstrate filariform or rhabditiform larvae (15,28,37,110) and even, occasionally, eggs (55). These findings suggest that filariform larvae develop into adults in the lungs and a new generation of rhabditiform larvae are produced locally (15).…”

Section: Cardiopulmonary Manifestationsmentioning

confidence: 99%

“…In all, there are fewer than 30 cases of hyperinfection occurring in human immunodeficiency virus (HIV)-infected patients in the literature. A number of these patients had previously received steroids, either as adjunctive treatment for Pneumocystis carinii pneumonia (15,65,100) or as part of a chemotherapeutic regimen for nonHodgkin's lymphoma (28). HTLV-1 infection is generally not commented on in these case reports.…”

Section: Hiv Infectionmentioning

confidence: 99%

Strongyloides stercoralisin the Immunocompromised Population

2004

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Strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. S. stercoralis is unique among intestinal nematodes in its ability to complete its life cycle within the host through an asexual autoinfective cycle, allowing the infection to persist in the host indefinitely. Under some conditions associated with immunocompromise, this autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome, characterized by increased numbers of infective filariform larvae in stool and sputum and clinical manifestations of the increased parasite burden and migration, such as gastrointestinal bleeding and respiratory distress. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid treatment and human T-lymphotropic virus type 1 infection are the two conditions most specifically associated with triggering hyperinfection, but cases have been reported in association with hematologic malignancy, malnutrition, and AIDS. Anthelmintic agents such as ivermectin have been used successfully in treating the hyperinfection syndrome as well as for primary and secondary prevention of hyperinfection in patients whose exposure history and underlying condition put them at increased risk

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“…All human cases of H. gingivalis infections reported to date were diagnosed at autopsy, despite antemortem suspicions of parasitic infection in some cases. Neurological nematodiasis is rare but can involve parasites such as Angiostrongylus cantonensis, Strongyloides stercoralis, Toxocara canis, Trichinella spiralis, and Gnathostoma spinigerum, typically associated with CSF and peripheral eosinophilia (39)(40)(41)(42)(43)(44)(45)(46). During H. gingivalis infection, CSF may initially show only moderate pleocytosis and eosinophilia may be absent (10,11) and larvae are usually not found in CSF obtained by lumbar puncture.…”

Section: Case Reportmentioning

confidence: 99%

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

et al. 2015

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h Halicephalobus gingivalis (previously Micronema deletrix) is a free-living nematode known to cause opportunistic infections, mainly in horses. Human infections are very rare, but all cases described to date involved fatal meningoencephalitis. Here we report the first case of H. gingivalis infection in an Australian human patient, confirmed by nematode morphology and sequencing of ribosomal DNA. The implications of this case are discussed, particularly, the need to evaluate real-time PCR as a diagnostic tool. CASE REPORTA 74-year-old lady from a regional town in the Eyre Peninsula of South Australia with a 4-day history of mental state deterioration, fever, and a loss of coordination was transferred to the Royal Adelaide Hospital. She was moderately immune suppressed by methotrexate and etanercept treatment for rheumatoid arthritis and had a history of diabetes. During the admission, her conscious state deteriorated rapidly, requiring mechanical ventilation and admission to the intensive care unit (ICU). Subsequently, she developed signs of brainstem involvement and exhibited a loss of corneal and gag reflexes. She was administered benzylpenicillin, ceftriaxone, and aciclovir for presumptive meningoencephalitis of bacterial or viral etiology. Cerebrospinal fluid (CSF) obtained by lumbar puncture demonstrated 280 ϫ10 6 polymorphonuclear leukocytes (PMN)/liter, 18 ϫ10 6 mononuclear lymphocytes/liter, elevated CSF protein of 1.59 g/liter, and CSF glucose of 3.3 mmol/ liter; aerobic and anaerobic bacterial culture results were negative, as were PCR results for Streptococcus pneumoniae, Neisseria meningitidis, herpes simplex virus, and varicella-zoster virus. CSF India ink stain and cryptococcal antigen lateral flow assay (Immy, Inc., Norman, OK, USA) results were negative. Magnetic resonance imaging (MRI) of the brain exhibited a left-predominant, asymmetrical meningeal enhancement in the frontoparietal cortex, without any detectable brainstem changes. Two days later, repeated lumbar punctures showed a marked elevation of PMN to 2,500 ϫ10 6 cells/liter and 34 ϫ10 6 mononuclear cells/liter, with no bacteria detected upon Gram staining. CSF stained with DiffQuick (Alere, Brisbane, Australia) showed 99% PMN with very few eosinophils. CSF protein was markedly elevated (5.46 g/liter), and CSF glucose was 1.3 mmol/liter. Microscopic examination of 100 l of unstained CSF was performed after centrifugation at 700 ϫ g for 10 min, but no amoebic trophozoites were detected. With a suspicion of parasitic infection, given the unexplained high PMN counts, the antimicrobial treatment strategy was changed to liposomal amphotericin B, sulfadiazine, pentamidine, and azithromycin to target protists such as amoebae and Toxoplasma gondii. CSF was subjected to PCR for Naegleria fowleri, Acanthamoeba sp., and Balamuthia mandrillaris, but all test results were negative. No anti-Strongyloides serum antibody (IgG) was detected in an enzyme-linked immunosorbent assay using somatic larval antigens from Strongyloides ratti (Bordier Affinity Pr...

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Disseminated strongyloidiasis with central nervous system involvement diagnosed antemortem in a patient with acquired immunodeficiency syndrome and Burkitts lymphoma

Cited by 55 publications

References 24 publications

Toxocariasis of the central nervous system: with report of two cases

Toxocariasis of the central nervous system: with report of two cases

Strongyloides stercoralisin the Immunocompromised Population

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

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