Volume 24, Number 12—December 2018
Research Letter
Strongyloidiasis and Culture-Negative Suppurative Meningitis, Japan, 1993–2015
Mitsuru Mukaigawara
, Izumi Nakayama, and Koichiro Gibo
, Izumi Nakayama, and Koichiro Gibo
Table
Demographic, clinical, and laboratory characteristics of patients with atypical suppurative meningitis, Japan, 1993–2015*
| Characteristic | All cases, no. (%), n = 37 | Culture-positive, no. (%), n = 14 | Culture-negative, no. (%), n = 23 |
|---|---|---|---|
| Demographic and clinical | |||
| Sex | |||
| M | 22 (59.5) | 9 (64.2) | 13 (56.5) |
| F | 15 (40.5) | 5 (35.8) | 10 (43.5) |
| Chief complaints | |||
| Headache | 24 (64.9) | 6 (42.9) | 18 (78.3) |
| Fever | 22 (59.5) | 9 (64.2) | 13 (56.5) |
| Altered mental status | 8 (21.6) | 5 (35.7) | 3 (13.0) |
| Nausea/vomiting | 8 (21.6) | 1 (7.1) | 7 (30.4) |
| Immunocompromised status | |||
| HTLV-1 infection† | 22 (71.0) | 8 (61.5) | 14 (77.8) |
| Diabetes mellitus | 3 (8.1) | 2 (14.3) | 1 (4.3) |
| Cirrhosis | 3 (8.1) | 3 (21.4) | 0 |
| Steroid use | 4 (10.8) | 1 (7.1) | 3 (13.0) |
| Strongyloidiasis infection type | |||
| Nonsystemic strongyloidiasis | 14 (42.4) | 5 (35.7) | 9 (47.4) |
| Hyperinfection | 3 (9.1) | 3 (21.4) | 0 |
| Dissemination | 1 (3.0) | 0 | 1 (5.3) |
| Not analyzed | 4 | 0 | 4 |
| Died |
5 (13.5) |
3 (21.4) |
2 (8.7) |
| CSF | |||
| Neutrophils/mm3 | |||
| 500–2,999 | 24 (64.9) | 6 (42.9) | 18 (78.3) |
| 3,000–5,999 | 4 (10.8) | 1 (7.1) | 3 (13.0) |
| 6,000–9,999 | 2 (5.4) | 1 (7.1) | 1 (4.3) |
| >10,000 | 3 (8.1) | 2 (14.3) | 1 (4.3) |
| Glucose <40 mg/dL |
14 (37.8) |
7 (50.0) |
7 (30.4) |
| Bacteriologic | |||
| Blood culture | |||
| Klebsiella pneumoniae | 7 (18.9) | 5 (35.7) | 2 (8.7) |
| Streptococcus gallolyticus | 4 (10.8) | 4 (28.6) | 0 |
| Escherichia coli | 3 (8.1) | 2 (14.3) | 1 (4.3) |
| Streptococcus infantarius | 1 (2.7) | 1 (7.1) | 0 |
| Campylobacter fetus | 1 (2.7) | 1 (7.1) | 0 |
| Negative | 21 (56.8) | 1 (7.1) | 20 (87.0) |
| CSF culture | |||
| K. pneumoniae | 5 (35.7) | 5 (35.7) | 0 |
| S. gallolyticus | 1 (7.1) | 1 (7.1) | 0 |
| E. coli | 1 (7.1) | 1 (7.1) | 0 |
| S. infantarius | 1 (7.1) | 1 (7.1) | 0 |
| C. fetus | 1 (7.1) | 1 (7.1) | 0 |
| Bacteroides fragilis | 1 (7.1) | 1 (7.1) | 0 |
*Patient median age (range): all, 60 y (19–91 y); culture-positive, 57 y (27–91 y); culture-negative, 58 y (19–90 y). CSF, cerebrospinal fluid; HTLV-1, human T-cell lymphotropic virus type 1.
†HTLV-1 serology results were available for 93% (13/14) of culture-positive patients and 78% (18/23) of culture-negative patients.
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