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Area of Science:

  • Neurology
  • Infectious Diseases
  • Parasitology

Background:

  • Central nervous system (CNS) strongyloidiasis is a rare but severe manifestation of *Strongyloides stercoralis* infection.
  • Antemortem diagnosis of CNS strongyloidiasis is exceptionally uncommon, with limited documented cases.
  • Disseminated strongyloidiasis often occurs in immunocompromised individuals or those with specific epidemiological risk factors.

Observation:

  • This report details two fatal cases of CNS strongyloidiasis diagnosed antemortem in Canada.
  • In one case, *Strongyloides stercoralis* larvae were identified within the CNS sample.
  • Both patients shared risk factors: Caribbean origin, human T-lymphotropic virus-1 (HTLV-1) infection, and recent prednisone therapy.

Findings:

  • The study identified specific risk factors associated with disseminated CNS strongyloidiasis.
  • The presence of *Strongyloides stercoralis* larvae in CNS tissue confirmed the diagnosis antemortem.
  • The cases underscore the importance of considering strongyloidiasis in at-risk patients, even in regions where the parasite is uncommon.

Implications:

  • These findings emphasize the need for a high index of suspicion for CNS strongyloidiasis in patients presenting with relevant risk factors.
  • Early antemortem diagnosis, though challenging, is crucial for potential therapeutic intervention.
  • The study contributes to the limited literature on antemortem diagnosis and risk factors for this rare condition.