Introduction. Strongyloides stercoralis is an intestinal nematode that is endemic in tropical countries. It can have a variable presentation ranging from asymptomatic eosinophilia in immunocompetent hosts to disseminated disease with sepsis in immunocompromised hosts. Case report. We report a case of chronic diarrhoea and decreased appetite in a 53-year-old man. He was a chronic alcoholic with diabetes, hypertension and dyslipidaemia and had earlier been treated for pulmonary tuberculosis. He was treated symptomatically for loose stools at a primary health care facility without relief. Following referral to our tertiary care centre, microscopic examination of the stool showed numerous larvae and a few eggs of Strongyloides stercoralis. Additionally, Aeromonas sobria was isolated from stool culture. The patient was discharged following improvement with a combination therapy of ivermectin, albendazole and ciprofloxacin. However, within 3 days, he was readmitted and succumbed to Escherichia coli sepsis. Conclusion. Strongyloidiasis can be diagnosed easily using a very simple but often neglected investigation, namely stool microscopy. This provides an early diagnosis, based on which prompt treatment with the appropriate antihelminthics can be started, thereby reducing the probability of disseminated infection. Disseminated strongyloidiasis is a medical emergency with a poor prognosis, especially in an immunocompromised state. Such patients should be treated aggressively with antihelminthics. They must be monitored for sufficient duration in the hospital for early signs of complication. Their discharge from hospital should be planned based on a negative stool microscopy report in addition to clinical improvement, so as to decrease the mortality reported for both untreated and treated individuals.
Tuberculoma of the brain is one of the most severe extrapulmonary forms that affect patients less than 40 years of age. They are space-occupying masses of granulomatous tissue that result from haematogenous spread from a distant focus of tuberculous infection by Mycobacterium tuberculosis. Symptoms and radiologic features being nonspecific usually leads to misdiagnosis and mimics a variety of other infectious diseases. Anti- Tubercular drugs are essential for the successful treatment of cerebral tuberculomas. A 52-year-old woman with known co-morbidities and chronic kidney disease presented with complaints of disoriented talk, vomiting, fever, and decreased response since 1 day. The initial radiological imaging showed ring-enhancing lesions and a differential diagnosis of septic emboli, vasculitis, and tuberculosis was considered. A repeat MRI suggested Tuberculoma. CSF studies showed predominant lymphocytes with elevated protein. CBNAAT & AFB smears of CSF were negative. The patient was started on anti-tuberculous drugs and steroids. But did not respond to the treatment and twelve days later, a brain biopsy was taken and sent for cultures. She deteriorated progressively and died 14 days after admission. Twelve days after her demise, the Mycobacterial culture of the brain biopsy specimen grew Mycobacterium tuberculosis.
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