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Abstract:
Acute pyogenic meningitis occurred in a 46-year-old woman receiving long-term steroid therapy. Cultures for bacteria and fungi were negative, and the meningitis failed to respond to broad spectrum antibiotics. Abundant Strongyloides stercoralis larvae were found in the patient's feces a sputum, and a filariform larva was found in a hanging drop preparation from centrifuged cerebrospinal fluid. Therapy with thiabendazole eradicated the Strongyloides from feces and sputum. The abnormal CSF values returned toward normal, and the patient has had no recurrence of illness.
Insights
A woman on long-term steroids developed meningitis. Strongyloides stercoralis infection was diagnosed via larvae in stool, sputum, and cerebrospinal fluid, and successfully treated with thiabendazole.
Area of Science:
- Infectious Diseases
- Neurology
- Parasitology
Background:
- Long-term steroid therapy can suppress immune function, increasing susceptibility to opportunistic infections.
- Acute pyogenic meningitis is a serious condition often caused by bacterial or fungal pathogens.
Observation:
- A 46-year-old woman on long-term steroids presented with meningitis unresponsive to antibiotics.
- Cultures for bacteria and fungi were negative.
- Strongyloides stercoralis larvae were identified in stool, sputum, and cerebrospinal fluid.
Findings:
- The patient's meningitis was caused by Strongyloides stercoralis hyperinfection.
- Treatment with thiabendazole effectively eradicated the parasite.
- Cerebrospinal fluid abnormalities resolved following antiparasitic therapy.
Implications:
- Strongyloides stercoralis should be considered in immunocompromised patients presenting with meningitis of unknown etiology.
- Early diagnosis and treatment of strongyloidiasis are crucial to prevent severe complications.
- Steroid-induced immunosuppression is a significant risk factor for hyperinfection syndrome.