RESUMO
Central nervous system (CNS) strongyloidiasis is a known but rare form of disseminated infection. The diagnosis is often made postmortem, with only five published cases of an antemortem diagnosis. We report two fatal cases of CNS strongyloidiasis diagnosed antemortem, with Strongyloides stercoralis larvae visualized in the CNS sample in one case. Risk factors for disseminated strongyloidiasis common to both cases included origination from the Caribbean, underlying human T-lymphotropic virus-1 infection, and recent prednisone use. Both cases occurred in Canada, where the occurrence of Strongyloides is uncommon, and serve as a reminder to maintain a high index of suspicion in patients with epidemiologic or clinical risk factors for dissemination.
Assuntos
Sistema Nervoso Central/parasitologia , Diagnóstico , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Idoso , Animais , Canadá , Região do Caribe , Evolução Fatal , Feminino , Infecções por HTLV-I/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/efeitos adversos , Fatores de Risco , Estrongiloidíase/sangueRESUMO
Successful screening for neuropathy in patients with diabetes is available using the 10 g Semmes-Weinstein monofilament (Mid-Delta Health Systems, Inc., Belzoni, MS) (touch/pressure sensation) and the Neurothesiometer (Horwell Scientific, London, UK; vibration perception threshold). In healthy volunteers and patients with a broad range of diabetic sensorimotor neuropathy, we show that the predictive value of either test for diabetic sensorimotor neuropathy depends on the toe surface tested. These results establish the importance of standardized screening methods for diabetic sensorimotor neuropathy in the clinic and in clinical research trials.