Diagnosis of Central Nervous System Strongyloidiasis in a Patient with Advanced Human Immunodeficiency Infection with Quantitative Polymerase Chain Reaction: Improving Detection and Clinical Management

Strongyloides stercoralis is a soil-transmitted nematode that leads to asymptomatic or mild infections in immunocompetent hosts; however, in immunocompromised individuals, it can lead to hyperinfection and disseminated strongyloidiasis that can be fatal. Central nervous system (CNS) involvement is rare but can result in severe complications, such as meningitis. Diagnosis is challenging because of the low sensitivity of conventional microscopy. Molecular techniques, such as quantitative polymerase chain reaction (qPCR), are more sensitive, especially for detecting S. stercoralis in cerebrospinal fluid (CSF). We report a case of a 28-year-old female with newly diagnosed advanced HIV infection with CD4 counts of 54 cells/µL presenting with disseminated strongyloidiasis and CNS involvement. She subsequently developed Escherichia coli bacteremia and meningitis. Although microscopy of stool and sputum detected the infection, S. stercoralis qPCR in CSF was crucial for diagnosing CNS involvement. This case underscores the importance of molecular diagnosis of CNS strongyloidiasis among high-risk patients to enable timely appropriate therapeutic intervention.