Volume 92, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Although meningitis secondary to chronic strongyloidiasis is a rare complication, it is associated with a high mortality rate. Recurrent meningitis can occur if the underlying parasitic infection is left untreated. We report five cases of recurrent meningitis related to chronic strongyloidiasis that were associated with human T-lymphotropic virus type 1 (HTLV-1) infection. Common causative organisms are , , and . One patient died during the second episode of meningitis. Three patients showed significant gastrointestinal and respiratory symptoms before developing headache and fever. In four cases, patients developed multiple recurrences even with the treatment of thiabendazol. Ivermectin seems to be a better agent compared with thiabendazol to achieve eradication of strongyloidiasis.


Article metrics loading...

Loading full text...

Full text loading...



  1. Adriani KS, van de Beek D, Brouwer MC, Spanjaard L, de Gans J, , 2007. Community-acquired recurrent bacterial meningitis in adults. Clin Infect Dis 45: e46e51.[Crossref]
  2. Mejia R, Nutman TB, , 2012. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis . Curr Opin Infect Dis 25: 458463.[Crossref]
  3. Vadlamudi RS, Chi DS, Krishnaswamy G, , 2006. Intestinal strongyloidiasis and hyperinfection syndrome. Clin Mol Allergy 4: 8.[Crossref]
  4. Keiser PB, Nutman TB, , 2004. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17: 208217.[Crossref]
  5. Somin M, Neogolani V, Zimhony O, Wolpart A, Sokolowski N, Malnick S, , 2008. Fatal recurrent bacterial meningitis: a complication of chronic Strongyloides infection. Eur J Intern Med 19: e42e43.[Crossref]
  6. Link K, Orenstein R, , 1999. Bacterial complications of strongyloidiasis: Streptococcus bovis meningitis. South Med J 92: 728731.[Crossref]
  7. Schär F, Trostdorf U, Giardina F, Khieu V, Muth S, Marti H, Vounatsou P, Odermatt P, , 2013. Strongyloides stercoralis: global distribution and risk factors. PLoS Negl Trop Dis 7: e2288.[Crossref]
  8. Siddiqui AA, Berk SL, , 2001. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 33: 10401047.[Crossref]
  9. Berk SL, Verghese A, Alvarez S, Hall K, Smith B, , 1987. Clinical and epidemiologic features of strongyloidiasis. A prospective study in rural Tennessee. Arch Intern Med 147: 12571261.[Crossref]
  10. Sasaki Y, Taniguchi T, Kinjo M, McGill RL, McGill AT, Tsuha S, Shiiki S, , 2013. Meningitis associated with strongyloidiasis in an area endemic for strongyloidiasis and human T-lymphotropic virus-1: a single-center experience in Japan between 1990 and 2010. Infection 41: 11891193.[Crossref]
  11. Mak DB, , 1993. Recurrent bacterial meningitis associated with Strongyloides hyperinfection. Med J Aust 159: 354.
  12. Vandebosch S, Mana F, Goossens A, Urbain D, , 2008. Strongyloides stercoralis infection associated with repetitive bacterial meningitis and SIADH: a case report. Acta Gastroenterol Belg 71: 413417.
  13. Hayashi J, Kishihara Y, Yoshimura E, Furusyo N, Yamaji K, Kawakami Y, Murakami H, Kashiwagi S, , 1997. Correlation between human T cell lymphotropic virus type-1 and Strongyloides stercoralis infections and serum immunoglobulin E responses in residents of Okinawa, Japan. Am J Trop Med Hyg 56: 7175.
  14. Satoh M, Toma H, Sato Y, Takara M, Shiroma Y, Kiyuna S, Hirayama K, , 2002. Reduced efficacy of treatment of strongyloidiasis in HTLV-I carriers related to enhanced expression of IFN-gamma and TGF-beta1. Clin Exp Immunol 127: 354359.[Crossref]
  15. Requena-Méndez A, Chiodini P, Bisoffi Z, Buonfrate D, Gotuzzo E, Muñoz J, , 2013. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoS Negl Trop Dis 7: e2002.[Crossref]
  16. Marra NM, Chiuso-Minicucci F, Machado GC, Zorzella-Pezavento SF, França TG, Ishikawa LL, Amarante AF, Sartori A, Amarante MR, , 2010. Fecal examination and PCR to detect Strongyloides venezuelensis in experimentally infected Lewis rats. Mem Inst Oswaldo Cruz 105: 5761.[Crossref]
  17. Karunajeewa H, Kelly H, Leslie D, Leydon J, Saykao P, Biggs BA, , 2006. Parasite-specific IgG response and peripheral blood eosinophil count following albendazole treatment for presumed chronic strongyloidiasis. J Travel Med 13: 8491.[Crossref]
  18. Biggs BA, Caruana S, Mihrshahi S, Jolley D, Leydon J, Chea L, Nuon S, , 2009. Management of chronic strongyloidiasis in immigrants and refugees: is serologic testing useful? Am J Trop Med Hyg 80: 788791.
  19. Bisoffi Z, Buonfrate D, Angheben A, Boscolo M, Anselmi M, Marocco S, Monteiro G, Gobbo M, Bisoffi G, Gobbi F, , 2011. Randomized clinical trial on ivermectin versus thiabendazole for the treatment of strongyloidiasis. PLoS Negl Trop Dis 5: e1254.[Crossref]
  20. Grove DI, , 1982. Strongyloides ratti and S. stercoralis: the effects of thiabendazole, mebendazole, and cambendazole in infected mice. Am J Trop Med Hyg 31: 469476.

Data & Media loading...

  • Received : 07 Sep 2014
  • Accepted : 24 Nov 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error