Detection of Strongyloides stercoralis in the cerebrospinal fluid of a patient with acquired immunodeficiency syndrome

Takayanagui, O. M.; Lofrano, M.; Araujo, María Beatriz; Chimelli, Leila

doi:10.1212/wnl.45.1.193

Cited by 28 publications

(21 citation statements)

References 13 publications

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“…Chronic inflammation or necrosis (79) frequently surrounds the larvae, but tissue reactions, even in the same patient, are also frequently absent (79,119).…”

Section: Other Manifestationsmentioning

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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“…Chronic inflammation or necrosis (79) frequently surrounds the larvae, but tissue reactions, even in the same patient, are also frequently absent (79,119).…”

Section: Other Manifestationsmentioning

confidence: 99%

Strongyloides stercoralisin the Immunocompromised Population

2004

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“…We have been able to identify only four cases in the literature of HIV-infected patients with disseminated strongyloidiasis and CNS involvement evidenced by direct finding of filariform larvae in CSF [6, 7], in meningeal vessels [8], or in meningeal spaces [9]. We report a case of Strongyloides stercoralis hyperinfection syndrome and disseminated cryptococcosis, in a patient with late HIV infection in whom S. stercoralis larvae and Cryptococcus neoformans were isolated antemortem from cerebrospinal fluid.…”

Section: Discussionmentioning

confidence: 99%

“…Despite geographic overlaps, less than the expected number of cases of HIV-associated hyperinfection syndrome have been published [3–5]. Central nervous system (CNS) infection by S. stercoralis is uncommon, and the filariform larvae are found directly in the cerebrospinal fluid (CSF) rarely [6]. Here, we report a patient with late HIV-infection who had disseminated strongyloidiasis and cryptococcosis with CNS involvement soon after antiretroviral therapy initiation.…”

Section: Introductionmentioning

confidence: 99%

Central Nervous System Strongyloidiasis and Cryptococcosis in an HIV-Infected Patient Starting Antiretroviral Therapy

Rodríguez

Flores

Ahumada

et al. 2012

Case Reports in Medicine

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We report a case of Strongyloides stercoralis hyperinfection syndrome with central nervous system involvement, in a patient with late human immunodeficiency virus (HIV) infection starting antiretroviral therapy, in whom Strongyloides stercoralis larvae and Cryptococcus neoformans were isolated antemortem from cerebrospinal fluid. Our patient was not from an endemic region for the parasite, so strongyloidiasis was not originally suspected. For this reason, we conclude that Strongyloides stercoralis infection should be suspected in HIV-infected patients starting antiretroviral therapy in order to avoid potential fatal outcomes.

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“…We speculate that in this patient the initial symptoms involved the gastroenteric tract, but were later followed by Correspondence to: Maurizio Gulletta, Clinic of Infectious and Tropical Diseases, Piazza Spedali Civili, 1, 25125 Brescia, Italy parasitaemia (® lariform larvae were seen on direct sputum examination, indicating multiorgan involvement) and spread to the meningeal spaces (meningitis with negative CSF culture for bacteria and yeast, the TC imaging and the clinical response to thiabendazole therapy). Disseminated strongyloidiasis with central nervous system involvement is a well described complication 6,7 . Diagnosis was delayed and based on occasional identi® cation of larvae in histological biopsies, as recently described by others 8 : still, it determined substantial bene® t to the patient, who had a rapid recovery under speci® c thiabendazole treatment.…”

Section: Discussionmentioning

confidence: 99%