Volume 92, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We describe a case of persistent strongyloidiasis complicated by recurrent meningitis, in a human T cell lymphotropic virus type 1 (HTLV-1) seropositive Peruvian migrant adult resettled in Italy. He was admitted with signs and symptoms of acute bacterial meningitis, reporting four other meningitis episodes in the past 6 years, with an etiological diagnosis of and in two cases. He had been previously treated with several antihelmintic regimens not including ivermectin, without eradication of strongyloidiasis, and he had never been tested for HTLV before. During the described episode, the patient was treated for meningitis with broad-spectrum antibiotic therapy and 200 μg/kg/dose oral ivermectin once daily on day 1, 2, 15 and 16 with full recovery and no further episodes of meningitis. The presented case underlines several critical points concerning the management of poorly known neglected diseases such as strongyloidiasis and HTLV infection in low-endemic areas. Despite several admissions for meningitis and strongyloidiasis, the parasitic infection was not adequately treated and the patient was not previously tested for HTLV. The supply of ivermectin and the choice of treatment scheme was challenging since ivermectin is not approved in Italy and there are no standardized guidelines for the treatment of severe strongyloidiasis in HTLV seropositive subjects.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Buonfrate D, Angheben A, Gobbi F, Munoz J, Requena-Mendez A, Gotuzzo E, Mena MA, Bisoffi Z, , 2012. Imported strongyloidiasis: epidemiology, presentations, and treatment. Curr Infect Dis Rep 14: 256262.[Crossref] [Google Scholar]
  2. Keiser PB, Nutman TB, , 2004. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17: 208217.[Crossref] [Google Scholar]
  3. Buonfrate D, Requena-Mendez A, Angheben A, Munoz J, Gobbi F, Van Den Ende J, Bisoffi Z, , 2013. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 13: 78.[Crossref] [Google Scholar]
  4. Woll F, Gotuzzo E, Montes M, , 2013. Strongyloides stercoralis infection complicating the central nervous system. Handb Clin Neurol 114: 229234.[Crossref] [Google Scholar]
  5. Verdonck K, Gonzalez E, Van Dooren S, Vandamme AM, Vanham G, Gotuzzo E, , 2007. Human T-lymphotropic virus 1: recent knowledge about an ancient infection. Lancet Infect Dis 7: 266281.[Crossref] [Google Scholar]
  6. Carvalho EM, Da Fonseca Porto A, , 2004. Epidemiological and clinical interaction between HTLV-1 and Strongyloides stercoralis . Parasite Immunol 26: 487497.[Crossref] [Google Scholar]
  7. Bon B, Houze S, Talabani H, Magne D, Belkadi G, Develoux M, Senghor Y, Chandenier J, Ancelle T, Hennequin C, , 2010. Evaluation of a rapid enzyme-linked immunosorbent assay for diagnosis of strongyloidiasis. J Clin Microbiol 48: 17161719.[Crossref] [Google Scholar]
  8. Boscolo M, Gobbo M, Mantovani W, Degani M, Anselmi M, Monteiro GB, Marocco S, Angheben A, Mistretta M, Santacatterina M, Tais S, Bisoffi Z, , 2007. Evaluation of an indirect immunofluorescence assay for strongyloidiasis as a tool for diagnosis and follow-up. Clin Vaccine Immunol 14: 129133.[Crossref] [Google Scholar]
  9. van Doorn HR, Koelewijn R, Hofwegen H, Gilis H, Wetsteyn JC, Wismans PJ, Sarfati C, Vervoort T, van Gool T, , 2007. Use of enzyme-linked immunosorbent assay and dipstick assay for detection of Strongyloides stercoralis infection in humans. J Clin Microbiol 45: 438442.[Crossref] [Google Scholar]
  10. Carneiro-Proietti AB, Catalan-Soares BC, Castro-Costa CM, Murphy EL, Sabino EC, Hisada M, Galvao-Castro B, Alcantara LC, Remondegui C, Verdonck K, Proietti FA, , 2006. HTLV in the Americas: challenges and perspectives. Rev Panam Salud Publica 19: 4453.[Crossref] [Google Scholar]
  11. Furtado KC, Costa CA, Ferreira L de S, Martins LC, Linhares A da C, Ishikawa EA, Batista E de J, Sousa MS, , 2013. Occurrence of strongyloidiasis among patients with HTLV-1/2 seen at the outpatient clinic of the Nucleo de Medicina Tropical, Belem, State of Para, Brazil. Rev Soc Bras Med Trop 46: 241243.[Crossref] [Google Scholar]
  12. Gotuzzo E, Terashima A, Alvarez H, Tello R, Infante R, Watts DM, Freedman DO, , 1999. Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru. Am J Trop Med Hyg 60: 146149. [Google Scholar]
  13. Khan TT, Elzein F, Fiaar A, Akhtar F, , 2014. Recurrent Streptococcus bovis meningitis in Strongyloides stercoralis hyperinfection after kidney transplantation: the dilemma in a non-endemic area. Am J Trop Med Hyg 90: 312314.[Crossref] [Google Scholar]
  14. Argelich R, Pujol MT, Alvarez-Martinez MJ, , 2011. Relapsing meningitis in a 69-year-old male. Med Clin (Barc) 136: 167174.[Crossref] [Google Scholar]
  15. 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] [Google Scholar]
  16. Kishaba T, Suginohara K, Tamaki K, Miyara Y, Endo K, Taira K, , 1989. Culture-negative suppurative meningitis seems to be due to occult disseminated strongyloidiasis. Okinawa Med J (Okinawa Igakkai Zasshi) 26: 219221. [Google Scholar]
  17. Hirata T, Uchima N, Kishimoto K, Zaha O, Kinjo N, Hokama A, Sakugawa H, Kinjo F, Fujita J, , 2006. Impairment of host immune response against Strongyloides stercoralis by human T cell lymphotropic virus type 1 infection. Am J Trop Med Hyg 74: 246249. [Google Scholar]
  18. Suputtamongkol Y, Premasathian N, Bhumimuang K, Waywa D, Nilganuwong S, Karuphong E, Anekthananon T, Wanachiwanawin D, Silpasakorn S, , 2011. Efficacy and safety of single and double doses of ivermectin versus 7-day high dose albendazole for chronic strongyloidiasis. PLoS Negl Trop Dis 5: e1044.[Crossref] [Google Scholar]
  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] [Google Scholar]
  20. Requena-Mendez A, Chiodini P, Bisoffi Z, Buonfrate D, Gotuzzo E, Munoz J, , 2013. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoS Negl Trop Dis 7: e2002.[Crossref] [Google Scholar]
  21. Porto AF, Oliveira Filho J, Neva FA, Orge G, Alcantara L, Gam A, Carvalho EM, , 2001. Influence of human T-cell lymphocytotropic virus type 1 infection on serologic and skin tests for strongyloidiasis. Am J Trop Med Hyg 65: 610613. [Google Scholar]
  22. Schaffel R, Nucci M, Carvalho E, Braga M, Almeida L, Portugal R, Pulcheri W, , 2001. The value of an immunoenzymatic test (enzyme-linked immunosorbent assay) for the diagnosis of strongyloidiasis in patients immunosuppressed by hematologic malignancies. Am J Trop Med Hyg 65: 346350. [Google Scholar]
  23. Heath T, Riminton S, Garsia R, MacLeod C, , 1996. Systemic strongyloidiasis complicating HIV: a promising response to ivermectin. Int J STD AIDS 7: 294296.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 14 Nov 2014
  • Accepted : 21 Jan 2015
  • Published online : 03 Jun 2015

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