Combination therapy for disseminated strongyloidiasis with associated vancomycin‐resistant, linezolid‐intermediate Enterococcus faecium meningitis: A case report

Abstract

The rhabditid nematode (roundworm) Strongyloides stercoralis is the major causative agent of strongyloidiasis in humans. 1 Transmission occurs primarily in tropical and subtropical regions but has also been found to be globally distributed. Although the true prevalence is unknown, Strongyloides has been estimated to infect 30 to 100 million people worldwide. The most common risk factors for developing Strongyloides infections include contact with contaminated soil and immunosuppression. 1,2 Strongyloides infection ranges from subclinical in acute and chronic infections to severe or potentially fatal in those with hyperinfection syndrome and disseminated strongyloidiasis (DS).If untreated, the mortality rate approaches 90%. 1 Many cases of Strongyloides stercoralis present as asymptomatic. Although symptoms can occur due to the parasite's larval form migrating through various organs of the body. In hyperinfection syndrome, the parasite's larval form can migrate to the gastrointestinal tract and the lungs, whereas in DS the larvae invade numerous organs. 1 For either clinical presentation, immediate treatment with an antiparasitic agent is warranted due to the limited treatment options and lack of appropriate diagnostic tests. The treatment of choice for all types of Strongyloides infections is ivermectin therapy with alternatives including albendazole or thiabendazole. 2Patients with impaired host immunity are at the highest risk of developing severe Strongyloides infections as this accelerates autoinfection and increases larvae migration. This most frequently effects patients receiving high-dose corticosteroids for the treatment of asthma or chronic obstructive pulmonary disease (COPD). 3,4 In rare cases, DS can present as neurologic symptoms as a result of