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Case Reports
. 2019 Apr-Jun;22(2):234-237.
doi: 10.4103/aian.AIAN_321_18.

Disseminated Strongyloidiasis: Breaking Brain Barriers

Ivy Anne Sebastian  1 , Jeyaraj Durai Pandian  1 , Aroma Oberoi  2 , Mahesh Pundlik Kate  1 , Vineeth Jaison  1 , Smriti Bose  1 , Rajeshwar Sahonta  1 , Shavi Nagpal  2 , Indira Brar  3
Affiliations
Case Reports

Disseminated Strongyloidiasis: Breaking Brain Barriers

Ivy Anne Sebastian et al. Ann Indian Acad Neurol. 2019 Apr-Jun.

Abstract

Strongyloides stercoralis (SS) is one of the most overlooked helminthic infections despite being highly endemic in tropical and subtropical areas. In immunocompromised patients, especially those on long-term steroids, infection can often escalate to fatal dissemination into major organs. We present a compendium of two immunocompromised patients, who were on high-dose steroids and presented with worsening neurological status. Cerebrospinal fluid analysis was notable for larvae of SS as diagnosed by direct visualization. A syndrome of SS hyperinfection with dissemination was made after stool, and sputum samples also revealed SS larvae. SS is an elusive disease and should be considered early on, especially in endemic regions like India. Early diagnosis and prompt initiation of antihelminthic therapy is indispensable for favorable outcomes.

Keywords: Dissemination; Strongyloides stercoralis; hyperinfection; immunocompromised; meningitis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Magnetic resonance imaging of the brain demonstrates T2-fluid attenuated inversion recovery hyperintensity in the right temporoparietal, right thalamic, and pulvinar areas. (b) Electroencephalography showing right temporal spikes with intermittent attenuation of background
Figure 2
Figure 2
(a) Larvae of Strongyloides stercoralis seen in wet mount preparation of cerebrospinal fluid. (b) Wet mount preparation of sputum showing larvae of Strongyloides stercoralis. (c) Wet mount preparation in stool revealing larva of Strongyloides stercoralis
Figure 3
Figure 3
Cerebrospinal fluid smear showing larvae of Strongyloides stercoralis on direct microscopic visualization
See this image and copyright information in PMC

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