Higashiyama Y, Sakata H, Obase Y, Sakata S, Shimafuji T, Mori M, Ishino T, Kohno S, Saito A, Hara K
Hokusho Chuo Hospital, Nagasaki.
Kansenshogaku Zasshi. 1997 Jul;71(7):680-3. doi: 10.11150/kansenshogakuzasshi1970.71.680.
A 75-year-old female with diabetes mellitus, who was born and lived in West north Kyusyu, was admitted to our hospital, because of unconsciousness and loss of appetite. The physical examination showed neck stiffness and a high fever. The laboratory data showed accentuation of inflammatory reaction and azotemia and positive HTLV-1 antibody. The spinal fluid showed increase of cell count and amount of protein. A stool and sputum smear revealed rhabditis form larvae of the nematode. Antibiotics and ivermectin were administered for the bacterial meningitis and hyperinfection of the strongyloides, respectively. Consequently, meningitis and strongyloidiasis improved. It was considered that the patient was infected with strongyloides from her husband who serve in the army during World-War II, and hyperinfection of strongyloides resulted from the immunosuppressive state of diabetes mellitus. Ivermectin, and anti-strongyloides agent, was effective, and no side effects were seen. However, the therapeutic resistance in this case was associated with the positive HTLV-1 antibody.
一名75岁患有糖尿病的女性，出生并居住在日本九州岛西北部，因意识不清和食欲不振入住我院。体格检查发现颈部僵硬和高热。实验室检查显示炎症反应加重、氮质血症以及HTLV-1抗体阳性。脑脊液显示细胞计数和蛋白量增加。粪便和痰液涂片发现线虫的杆状蚴。分别给予抗生素治疗细菌性脑膜炎，伊维菌素治疗类圆线虫的高度感染。结果，脑膜炎和类圆线虫病均得到改善。据认为，该患者是在二战期间从其服役的丈夫那里感染了类圆线虫，而类圆线虫的高度感染是由糖尿病的免疫抑制状态导致的。抗类圆线虫药物伊维菌素有效，且未观察到副作用。然而，该病例中的治疗抵抗与HTLV-1抗体阳性有关。
