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Real-time PCR for Strongyloides stercoralis-associated meningitis
Eyal Nadir1, Tamar Grossman2, Pnina Ciobotaro1
1Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel, affiliated to the School of Medicine, Hebrew University and Hadassah, Jerusalem, Israel.
Abstract:
Four immunocompromised patients, immigrants from Ethiopia, presented with diverse clinical manifestations of meningitis associated with Strongyloides stercoralis dissemination as determined by identification of intestinal larvae. The cerebrospinal fluid of 3 patients was tested by a validated (for stool) real-time PCR for S. stercoralis and was found positive, establishing this association.
Insights
Strongyloides stercoralis dissemination can cause meningitis in immunocompromised individuals. Real-time PCR on cerebrospinal fluid confirmed this association in Ethiopian immigrants.
Area of Science:
- Infectious Diseases
- Neurology
- Parasitology
Background:
- Strongyloides stercoralis is a nematode parasite endemic in tropical and subtropical regions.
- Immunocompromised individuals are at higher risk for hyperinfection and dissemination of Strongyloides stercoralis.
- Meningitis is a serious central nervous system infection with various potential causes.
Observation:
- Four immunocompromised patients, immigrants from Ethiopia, presented with meningitis.
- Clinical manifestations were diverse, suggesting a complex presentation.
- Intestinal larvae of Strongyloides stercoralis were identified, indicating dissemination.
Findings:
- Cerebrospinal fluid (CSF) samples from three patients were tested using a validated real-time PCR assay.
- The real-time PCR for Strongyloides stercoralis in CSF was positive in these three patients.
- This confirmed the association between Strongyloides stercoralis dissemination and meningitis in this cohort.
Implications:
- Real-time PCR is a valuable tool for diagnosing Strongyloides stercoralis meningitis, even when validated primarily for stool samples.
- Early diagnosis and treatment are crucial for improving outcomes in patients with disseminated Strongyloides stercoralis.
- Clinicians should consider Strongyloides stercoralis in the differential diagnosis of meningitis in immunocompromised individuals, particularly those from endemic areas.
