Case Report: Central Nervous System Strongyloidiasis: Two Cases Diagnosed Antemortem

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.