BRIEF REPORT: Acute Terminal Ileitis Associated with Pneumococcal Bacteremia: Case Report and Review of Pneumococcal Gastrointestinal Diseases

Abstract

In this report, we describe a patient with acute terminal ileitis due to Streptococcus pneumoniae, review 3 previously reported cases of isolated enteritis due to S. pneumoniae, and summarize the English-language literature on primary and secondary pneumococcal gastrointestinal diseases. Various theories have been advanced to explain the pathogenesis of this rare and potentially life-threatening form of pneumococcal infection, but the mechanism by which S. pneumoniae causes gastrointestinal disease is still unknown.

Infections in Pediatric Postdiarrheal Hemolytic Uremic Syndrome

“…Although our surveillance may have captured pneumococcal HUS cases because of coincidental presence of mild diarrhea unrelated to S pneumoniae, 4 of 9 children with S pneumoniae infection with data had bloody diarrhea; S pneumoniae infection may be an underrecognized cause of bloody diarrhea. 40 One additional patient had infection with pandemic H1N1 influenza A, a potential trigger for HUS, potentially through its neuraminidase activity or its association with S pneumoniae infection. 41 Some of the enteric pathogens found in children without evidence of STEC infection have been noted as possible causes of DϩHUS.…”

Rare case of Streptococcal enteritis in HIV patient

“…To our knowledge (Table 1), this is the first case report on concurrent severe S. pneumoniae pneumonia and enteritis without any complaints from the respiratory system in a severely immunosuppressed patient in the last 26 years (1993-2018) [24][25][26][27][28], for the reasons discussed below. Due to the patient's CD4+ count < 100 cells/ml, he was vulnerable to a plenty of causes, including opportunistic infections.…”

“…The pathophysiology of streptococcal invasion to the gastrointestinal system have been attributed to: 1) direct invasion of the gut wall via hematogenous seeding; 2) direct infection via mucosal translocation; 3) enterotoxin production from S. pneumoniae strains stimulating a secretory diarrhea; 4) ascending invasion through the fallopian tubes in females [25].…”

“…There was no epidemiologic exposure history (travels, food, anal intercourses, etc.) leading to another diagnosis, but there are risk factors for streptococcal infection (smoking, immune defect) [25]. It is also noticeable that the patient was not vaccinated against pneumococcal bacteria as recommended, due to poor compliance.…”

Streptococcus pneumoniae: An Unusual Pathogen Seen In High Vaginal Swab

“…Pneumococci have rarely been isolated as an intestinal pathogen [8] but may colonize the perineum and introitus vaginae giving rise to bartholinitis, colonization of vagina and cervix leading to infection.  Infection via lymphatics: clinical possibility, but no evidence exists.…”