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1.
Centers for Disease Control and Prevention, 2014. Parasites—Strongyloides. Available at: https://www.cdc.gov/parasites/strongyloides/. Accessed April 9, 2018.
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2.
Boggild A, Libman M, Greenaway C, McCarthy A; on behalf of the Committee to Advise on Tropical Medicine and Travel (CATMAT), 2016. CATMAT statement on disseminated strongyloidiasis: prevention, assessment and management guidelines. Can Comm Dis Rep 42: 12–19.
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3.
Keiser PB, Nutman TB, 2004. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17: 208–217.
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4.
Lim S, Katz K, Krajden S, Fuksa M, Keystone JS, Kain KC, 2004. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. Can Med Assoc J 171: 479–484.
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Bradley SL, Dines DE, Brewere NS, 1978. Disseminated Strongyloides stercoralis in an immunosuppressed host. Mayo Clin Proc 53: 332–335.
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6.
Neefe LI, Pinilla O, Garagusi VF, Bauer H, 1973. Disseminated strongyloidiasis with cerebral involvement: a complication of corticosteroid therapy. Am J Med 55: 832–838.
-
7.
Meltzer RS, Singer C, Armstrong D, Mayer K, Knapper WH, 1979. Antemortem diagnosis of central nervous system strongyloidiasis. Am J Med Sci 277: 91–98.
-
8.
Belani A, Leptrone D, Shands JW, 1987. Strongyloides meningitis. South Med J 80: 916–918.
-
9.
Dutcher JP, Marcus SL, Tanowitz H, Wittner M, Fuks JZ, Wiernik PH, 1990. Disseminated strongyloidiasis with central nervous system involvement diagnosed antemortem in a patient with acquired immunodeficiency syndrome and Burkitts lymphoma. Cancer 66: 2417–2420.
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Dokmeci O, Forshay B, Scholand SJ, 2013. Worms on the brain: fatal meningoencephalitis from disseminated strongyloides infection. Conn Med 77: 31–34.
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Purtilo DT, Meyers WM, Connor DH, 1974. Fatal strongyloidiasis in immunosuppressed patients. Am J Med 56: 488–493.
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Montes M et al. 2009. Regulatory T cell expansion in HTLV-1 and strongyloidiasis co-infection is associated with reduced IL-5 responses to Strongyloides stercoralis antigen. PLoS Negl Trop Dis 3: e456.
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Igra-Siegman Y, Kapila R, Sen P, Kaminski ZC, Louria DB, 1981. Syndrome of hyperinfection with Strongyloides stercoralis. Rev Infect Dis 3: 397–407.
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Case Report: Central Nervous System Strongyloidiasis: Two Cases Diagnosed Antemortem
Jennifer Tam
Jennifer Tam
Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada;
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Kevin L. Schwartz
Kevin L. Schwartz
Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada;
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;
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Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;
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Jay Keystone
Jay Keystone
Tropical Disease Unit, Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada;
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Dimitri Dimitrakoudis
Dimitri Dimitrakoudis
Division of Neurology, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada
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Mark Downing
Mark Downing
Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada;
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Sigmund Krajden
Sigmund Krajden
Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada;
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Central nervous system (CNS) strongyloidiasis is a known but rare form of disseminated infection. The diagnosis is often made postmortem, with only five published cases of an antemortem diagnosis. We report two fatal cases of CNS strongyloidiasis diagnosed antemortem, with Strongyloides stercoralis larvae visualized in the CNS sample in one case. Risk factors for disseminated strongyloidiasis common to both cases included origination from the Caribbean, underlying human T-lymphotropic virus-1 infection, and recent prednisone use. Both cases occurred in Canada, where the occurrence of Strongyloides is uncommon, and serve as a reminder to maintain a high index of suspicion in patients with epidemiologic or clinical risk factors for dissemination.
Author Notes
Authors’ addresses: Jennifer Tam, Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada, E-mail: jennifer.tam@sickkids.ca. Kevin Schwartz, Dimitri Dimitrakoudis, Mark Downing, and Sigmund Krajden, Division of Infectious Diseases, St. Joseph’s Health Centre, Toronto, Ontario, Canada, E-mails: Kevin.schwartz@oahpp.ca, ddimitri@stjoestoronto.ca, mdowning@stjoestoronto.ca, and krajds@stjoe.on.ca. Jay Keystone, Tropical Disease Unit, Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada, E-mail: jay.keystone@utoronto.ca.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Centers for Disease Control and Prevention, 2014. Parasites—Strongyloides. Available at: https://www.cdc.gov/parasites/strongyloides/. Accessed April 9, 2018.
-
2.
Boggild A, Libman M, Greenaway C, McCarthy A; on behalf of the Committee to Advise on Tropical Medicine and Travel (CATMAT), 2016. CATMAT statement on disseminated strongyloidiasis: prevention, assessment and management guidelines. Can Comm Dis Rep 42: 12–19.
-
3.
Keiser PB, Nutman TB, 2004. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17: 208–217.
-
4.
Lim S, Katz K, Krajden S, Fuksa M, Keystone JS, Kain KC, 2004. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. Can Med Assoc J 171: 479–484.
-
5.
Bradley SL, Dines DE, Brewere NS, 1978. Disseminated Strongyloides stercoralis in an immunosuppressed host. Mayo Clin Proc 53: 332–335.
-
6.
Neefe LI, Pinilla O, Garagusi VF, Bauer H, 1973. Disseminated strongyloidiasis with cerebral involvement: a complication of corticosteroid therapy. Am J Med 55: 832–838.
-
7.
Meltzer RS, Singer C, Armstrong D, Mayer K, Knapper WH, 1979. Antemortem diagnosis of central nervous system strongyloidiasis. Am J Med Sci 277: 91–98.
-
8.
Belani A, Leptrone D, Shands JW, 1987. Strongyloides meningitis. South Med J 80: 916–918.
-
9.
Dutcher JP, Marcus SL, Tanowitz H, Wittner M, Fuks JZ, Wiernik PH, 1990. Disseminated strongyloidiasis with central nervous system involvement diagnosed antemortem in a patient with acquired immunodeficiency syndrome and Burkitts lymphoma. Cancer 66: 2417–2420.
-
10.
Dokmeci O, Forshay B, Scholand SJ, 2013. Worms on the brain: fatal meningoencephalitis from disseminated strongyloides infection. Conn Med 77: 31–34.
-
11.
Purtilo DT, Meyers WM, Connor DH, 1974. Fatal strongyloidiasis in immunosuppressed patients. Am J Med 56: 488–493.
-
12.
Montes M et al. 2009. Regulatory T cell expansion in HTLV-1 and strongyloidiasis co-infection is associated with reduced IL-5 responses to Strongyloides stercoralis antigen. PLoS Negl Trop Dis 3: e456.
-
13.
Igra-Siegman Y, Kapila R, Sen P, Kaminski ZC, Louria DB, 1981. Syndrome of hyperinfection with Strongyloides stercoralis. Rev Infect Dis 3: 397–407.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 512 | 341 | 21 |
| Full Text Views | 622 | 11 | 1 |
| PDF Downloads | 228 | 16 | 1 |