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Persistent strongyloidiasis complicated by recurrent meningitis in an HTLV seropositive Peruvian migrant resettled in

Lorenzo Zammarchi, Francesca Montagnani, Giacinta Tordini

    The American Journal of Tropical Medicine and Hygiene
    |April 8, 2015
    PubMed

    Insights

    Persistent strongyloidiasis in an HTLV-1 positive migrant caused recurrent meningitis. Ivermectin treatment successfully resolved both infections, highlighting challenges in managing neglected diseases in non-endemic areas.

    Area of Science:

    • Infectious Diseases
    • Tropical Medicine
    • Clinical Case Study

    Background:

    • Persistent strongyloidiasis is a neglected tropical disease.
    • Human T-cell lymphotropic virus type 1 (HTLV-1) infection can exacerbate parasitic infections.
    • Recurrent meningitis poses significant health risks.

    Observation:

    • A case of persistent strongyloidiasis complicated by recurrent meningitis in an HTLV-1 seropositive Peruvian migrant in Italy.
    • Previous treatments with antihelmintics failed to eradicate strongyloidiasis.
    • The patient experienced multiple episodes of bacterial meningitis (Escherichia coli, Enterococcus faecium).

    Findings:

    • Successful treatment of recurrent meningitis and persistent strongyloidiasis was achieved with a specific oral ivermectin regimen.
    • Ivermectin is not approved in Italy, and standardized treatment guidelines for severe strongyloidiasis in HTLV-1 positive individuals are lacking.
    • The case highlights diagnostic and therapeutic challenges in managing neglected diseases in low-endemic settings.

    Implications:

    • This case underscores the importance of considering and adequately treating neglected tropical diseases, like strongyloidiasis, especially in immunocompromised individuals or those with co-infections like HTLV-1.
    • It highlights the need for updated clinical guidelines and improved access to essential medicines like ivermectin for treating severe parasitic infections.
    • Effective management requires a multidisciplinary approach, particularly in regions where these diseases are not commonly encountered.

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