Strongyloides stercoralis hyperinfestation syndrome with Escherichia coli meningitis: report of two cases.

Smallman, Lesley A.; Young, Jonathan; Shortland-Webb, W R; Carey, Matthew; Michael, J

doi:10.1136/jcp.39.4.366

Cited by 36 publications

(22 citation statements)

References 11 publications

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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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Section: Case Reportmentioning

confidence: 99%

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

et al. 2015

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“…Enteric gram-negative bacteria gain access to the circulatory system together with the larvae as they penetrate the mucosa. Larvae may be found in CSF or CNS tissues, but eosinophilic meningitis does not occur (143,215,263).…”

Section: Strongyloidiasismentioning

confidence: 99%

Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

2009

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SUMMARY Eosinophilic meningoencephalitis is caused by a variety of helminthic infections. These worm-specific infections are named after the causative worm genera, the most common being angiostrongyliasis, gnathostomiasis, toxocariasis, cysticercosis, schistosomiasis, baylisascariasis, and paragonimiasis. Worm parasites enter an organism through ingestion of contaminated water or an intermediate host and can eventually affect the central nervous system (CNS). These infections are potentially serious events leading to sequelae or death, and diagnosis depends on currently limited molecular methods. Identification of parasites in fluids and tissues is rarely possible, while images and clinical examinations do not lead to a definitive diagnosis. Treatment usually requires the concomitant administration of corticoids and anthelminthic drugs, yet new compounds and their extensive and detailed clinical evaluation are much needed. Eosinophilia in fluids may be detected in other infectious and noninfectious conditions, such as neoplastic disease, drug use, and prosthesis reactions. Thus, distinctive identification of eosinophils in fluids is a necessary component in the etiologic diagnosis of CNS infections.

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“…Con frecuencia esta diseminación se acompaña de estado séptico grave por gérmenes gram-negativos entéricos (7,8). Este tipo de infección parasitaria se denomina hiperinfección o estrongiloidiasis diseminada (ED) y es fatal en el 50% de los casos (7).…”

Section: El Strongiloides Stercoralis Es Un Nemátodounclassified

“…La experiencia hospitalaria en pacientes con ED, en los países con alto nivel de vida, muestra frecuentemente el hallazgo de bacteremia y meningitis por gram-negativos (7,8). Se han postulado tres mecanismos de bacteremia persistente en la ED:…”

Section: Discusionunclassified

Estrongiloidiasis diseminada

Panqueba

Rodríguez²,

Téllez³

1986

biomedica

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La estrongiloidiasis diseminada (ED) es una afección frecuentemente fatal debida a la autoinfección interna con larvas de Strongiloides stercoralis, oportunjsta ante alteraciones de la inmunidad del huésped, como inmunosupresión farmacológica en pacientes transplantados o con enfermedad neoplásica o autoinmune. Revisamos la ED en los archivos de autopsias del Hospital San Juan de Dios y La Misericordia de Bogotá, para conocer la entidad básica facilitadora de la diseminación larvaria y averiguar si la ED ha aumentado recientemente. Se encontraron sólo 12 enfermos en más de 14.000 protocolos revisados desde 1954 a 1986 con edades entre 1 y 62 aríos. Los pacientes presentaron diarrea crónica, fétida o sanguinolenta, vómito, dolor abdominal, anorexia y tos, a veces hemoptoica. Todos tenían desnutrición avanzada y sólo uno había recibido tratamiento inmunosupresor con esteroides y ciclosfosfamida para glomérulonefritis progresiva. Un paciente recibió esteroides para "colitis ulcerativa" que luego se comprobó era debida a estrongiloidiasis. Sólo una vez se hizo diagnóstico clínico de ED. En tres pacientes se encontraron larvas en la materia fecal pero no se consideró la posibilidad de ED. Los diagnósticos clínicos considerados fueron: desnutrición, síndrome anémico, carcinoma gástrico, TBC pulmonar e intestinal, parasitismo y síndrome meníngeo. Una enferma presentó endocarditis bacteriana tricuspídea y dos meningoencefalitis, unidas al cuadro gastrointestinal. La meningitis fue de tipo bacteriano, aguda, sin granulomas ni larvas. Se encontraron larvas con inflamación severa granulomatosa en intestino delgado, colon, pulmón, hígado y ganglios linfáticos. En cuatro pacientes fue llamativo el hallazgo de trombosis de grandes venas: cava, femoral, mesentérica y de seno longitudinal superior. La ED si bien no es frecuente y no ha aumentado entre nosotros como consecuencia de inmunosupresión, debe tenerse en cuenta en todo paciente desnutrido con síndrome diarréico. La eosinofilia sólo se presentó en 2 pacientes, fue leve (5 y 7%) y no es criterio esencial de diagnóstico.

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Strongyloides stercoralis hyperinfestation syndrome with Escherichia coli meningitis: report of two cases.

Abstract: Two cases of Strongyloides stercoralis hyperinfestation syndrome accompanied by Gram negative bacteraemia and meningitis were studied. Both occurred in non-immunosuppressed West Indian women.

Cited by 36 publications

References 11 publications

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

Estrongiloidiasis diseminada

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