Halicephalobus gingivalis: A Rare Cause of Fatal Meningoencephalomyelitis in Humans

Bhavesh Papadi University of South Alabama Medical Center, Mobile, Alabama; Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Carole Boudreaux University of South Alabama Medical Center, Mobile, Alabama; Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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J. Allan Tucker University of South Alabama Medical Center, Mobile, Alabama; Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Blaine Mathison University of South Alabama Medical Center, Mobile, Alabama; Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Henry Bishop University of South Alabama Medical Center, Mobile, Alabama; Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Mark E. Eberhard University of South Alabama Medical Center, Mobile, Alabama; Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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The genus Halicephalobus consists of eight species of free-living nematodes. Only one species (H. gingivalis) has been reported to infect vertebrates. Human infection is extremely rare, and only four cases have been reported in the literature. These nematodes seem to exhibit neurotropism, but their life cycle, mode of infection, and risk factors are poorly understood. Neurohelminthiases are not commonly recognized in the United States and when they do occur, pose great diagnostic challenges because of lack of appropriate non-invasive screening and/or confirmatory tests. We report a challenging case of meningoencephalomyelitis caused by a Halicephalobus sp., in which the patient had a rapidly deteriorating clinical course. The case did not raise any clinical suspicion of neurohelminthiases, although increased eosinophils were present in the cerebrospinal fluid. This case presents an opportunity to highlight the importance of considering parasitic infection in meningoencephalitis or meningoencephalomyelitis presenting atypically.

Author Notes

* Address correspondence to Bhavesh Papadi, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room 2A19, Bethesda, MD 20892. E-mail: bhavesh2papadi@yahoo.com

Authors' addresses: Bhavesh Papadi, National Cancer Institute, National Institutes of Health, Bethesda, MD, E-mail: bhavesh2papadi@yahoo.com. Carole Boudreaux and J. Allan Tucker, Pathology Department, University of South Alabama Medical Center, Mobile, AL, E-mails: cboudrea@usouthal.edu and atucker@usouthal.edu. Blaine Mathison, Henry Bishop, and Mark E. Eberhard, Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: gqa4@cdc.gov, hsb2@cdc.gov, and mle1@cdc.gov.

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