Strongyloidiasis stercoralisis a soil-transmitted nematode, whose prevalence rate is estimated to be 10-40% worldwide, mainly in the Tropics. Although the development of ivermectin increased its survival rate, the mortality was reported to be up to 87% with disseminated strongyloidiasis, when complicated by sepsis or meningitis. Few studies have succeeded to describe systemic strongyloidiasis and its neurological complications. The study aim was to determine clinical features of systemic strongylodiasis and meningitis.
We reviewed the charts of patients diagnosed with strongyloidiasis and meningitis from 1975 through 2015 at Okinawa Chubu Hospital, the largest teaching hospital in a strongyloidiasis-endemic area in Japan. Patients with concurrent diagnoses of meningitis and strongyloidiasis (defined as larvae detected from stool, sputum, cerebrospinal fluid (CSF), ascites, gastric juice, or urine) were eligible.
Of 71 cases (8 recurrences), 27 were CSF-culture positive (CP); 44 negative (CN). Mean age was 55 (CP) and 59 (CN) years. CSF culture was positive for 9 Escherichia coli (E. coli), 6 Klebsiella pneumoniae (K. pneumoniae), 5 Streptococcus gallolyticus (S. gallolyticus), and others. All CN cases exhibited either one of the following characteristics of bacterial meningitis: a neutrophil predominance, CSF glucose < 40 mg/dL, or a positive Gram stain result (6 Gram negatives and 3 Gram positives). 51.9% (CP) and 36.4% (CN) cases were associated with systemic strongyloidiasis, defined as the finding of larvae from at least two distinct sites. Mortality was 29.6% (CP) and 20.5% (CN), respectively. All patients were treated with thiabendazole or ivermectin when the diagnosis of strongyloidiasis was confirmed.
Meningitis associated with strongyloidiasis was characterized by uncommon causative organisms (E. coli, K. pneumoniae, S. gallolyticus); and high rates of CN cases suggestive of bacterial meningitis. Such atypical characteristics for community-acquired bacterial meningitis were suggestive of potentially disseminated strongyloidiasis in our population. A high index of suspicion of potential dissemination is warranted in patients presenting with atypical, purulent meningitis.
S. Shiiki, None
Y. Takayama, None
S. Takakura, None