Strongyloides stercoralishyperinfection syndrome with cerebral involvement

Abstract

Strongyloidiasis is a disease caused by the intestinal helminth Strongyloides stercoralis. When the immune system of infected individuals is compromised, larvae may migrate from the gastrointestinal tract to other tissues, causing S. stercoralis hyperinfection syndrome, which has a reported mortality of 71%. In this case, we report a patient with S. stercoralis hyperinfection syndrome with central nervous system (CNS) involvement. An elderly South East Asian male tourist presented with pulmonary symptoms, fever and infiltrates on chest X-ray. He later developed symptoms of CNS infection. S. stercoralis larvae were found in a stool sample. Microbiological examination of cerebrospinal fluid revealed S. stercoralis-specific DNA. The patient was treated with oral and rectal ivermectin and albendazole. The condition was complicated by sepsis, bacteraemia and hypereosinophilia. Unfortunately, the patient eventually died from pulmonary oedema and insufficiency. This case highlights the global importance of Strongyloides CNS infection in endemic and non-endemic regions.

A Rare Case of Strongyloides stercoralis Hyperinfection in a Diabetic Patient from Romania—Case Report and Review of the Literature

“…The results are presented in Table 1. A few cases were excluded due to the high probability of bias on account of unclear or missing data regarding immunosuppression or the diagnosis of severe strongyloidiasis: local corticosteroid injections [57], multiple myeloma in remission and corticosteroid treatment after hospital admission [58], possible untreated rheumatoid arthritis and short corticosteroid treatment after hospital admission [59], unclear corticoid treatment for asthma and emphysema [60], unclear asthma treatment [61], previous single-dose corticoid treatment [62], previously undiagnosed diabetes and short corticoid treatment after hospital admission [63], possible corticosteroid treatment and partial gastrectomy surgery [64], unclear severe strongyloidiasis diagnosis [65,66].…”

Zoonotic parasites with significant importance for tropical dermatology

“…In disseminated strongyloidiasis, the distinctive skin lesions are extensive petechiae and purpura [146] . In severe conditions skin lesions might be associated with neurologic involvement [147] . Serpiginous dermatological lesions with unexplained eosinophilia and pulmonary and gastrointestinal manifestations are characteristic [148] .…”

Emerging and Re-Emerging Parasitic Infections of the Central Nervous System (CNS) in Europe

“…Nevertheless, the occurrence of CNS involvement in strongyloidiasis is exceedingly rare, particularly in non-endemic countries. A mere eight antemortem cases have been documented in such regions, reflecting the exceptional nature of this presentation [87]. Notably, the majority of these cases involve individuals with compromised immune systems, often linked to factors like corticosteroid therapy, malignancy, or chemotherapy.…”

“…Notably, the majority of these cases involve individuals with compromised immune systems, often linked to factors like corticosteroid therapy, malignancy, or chemotherapy. The prognosis for disseminated strongyloidiasis with CNS engagement remains bleak, marked with elevated mortality rates [87]. Alarmingly, the diagnosis of CNS-associated strongyloidiasis (Figure 2) is frequently postmortem, underlining the diagnostic challenges and the advanced disease state often encountered [88].…”

“…The treatment approach for S. stercoralis infection is a matter of debate and evidence scarcity. Recommendations vary from a two-dose ivermectin regimen to single or multiple doses, particularly in uncomplicated cases, while hyperinfection requires prolonged ivermectin use with a possible antibiotic combination [87]. In CNS-involved cases, evidence remains limited, with treatments including albendazole, ivermectin, and their combination showing mixed outcomes [84].…”