Enterococcal meningitis in association with Strongyloides hyperinfection syndrome

Sukhwani, Kalpesh; Bansal, N.K.; Soni, Mamta; Anand, Raktima; Gopalakrishnan, Ram

doi:10.18683/germs.2017.1105

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…[9] Other gut organisms may also be involved. There have been reports of VRE Enterococcus faecium as a cause of secondary infection complicating hyperinfections due to S. stercoralis, [5,11,12] treated with linezolid. The VRE in our patient was also treated with linezolid as per the susceptibility pattern.…”

Section: Discussionmentioning

confidence: 99%

Strongyloides stercoralis hyperinfection complicated by secondary infections in a case of transformed diffuse large B-cell lymphoma

Vira

Dsouza

Bhat

et al. 2019

Indian Journal of Medical and Paediatric Oncology

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We report Strongyloides stercoralis hyperinfection complicated by secondary infections in a case of transformed diffuse large B-cell lymphoma. The hyperinfection was followed by a sequela of candidemia and infection of the peritoneal fluid that was associated with the leakage of gut flora from the bowel damaged by the migration of larvae. This phenomenon has seldom been reported in a case of hematolymphoid cancer such as transformed diffuse large B-cell lymphoma. The complications arising due to S. stercoralis hyperinfection are associated with a high fatality rate in immunocompromised patients, and this should be taken into account in the diagnosis and management of this condition.

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Section: Discussionmentioning

confidence: 99%

Strongyloides stercoralis hyperinfection complicated by secondary infections in a case of transformed diffuse large B-cell lymphoma

Vira

Dsouza

Bhat

et al. 2019

Indian Journal of Medical and Paediatric Oncology

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“…12,13 Meningitis is hypothesized to result from penetration of the blood-brain barrier by larvae as a result of disseminated Strongyloides infection. 13,14 This entity can also cause bacterial meningitis; it facilitates the entry of gram-negative bacteria by damaging the intestinal mucosa, and these can cross the blood-brain barrier. [12][13][14] Hydrocephalus is a severe complication occurring in about 5%-12% of adult bacterial meningitis cases (frequently communicating hydrocephalus due to alterations in the absorption of cerebrospinal fluid) and is an independent risk factor for death and unfavorable outcome.…”

Section: Observationsmentioning

confidence: 99%

“…13,14 This entity can also cause bacterial meningitis; it facilitates the entry of gram-negative bacteria by damaging the intestinal mucosa, and these can cross the blood-brain barrier. [12][13][14] Hydrocephalus is a severe complication occurring in about 5%-12% of adult bacterial meningitis cases (frequently communicating hydrocephalus due to alterations in the absorption of cerebrospinal fluid) and is an independent risk factor for death and unfavorable outcome. 15 Strongyloidiasis should be suspected among patients with relevant epidemiological exposure (e.g., skin contact with contaminated soil in tropical and subtropical regions) and gastrointestinal, respiratory, and/or dermatologic manifestations, especially if they are under immunosuppressive treatment.…”

Section: Observationsmentioning

confidence: 99%

Strongyloides hyperinfection syndrome due to corticosteroid therapy after resection of meningioma: illustrative case

Domínguez¹,

Pérez-López

Sánchez³

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Strongyloidiasis is an underdiagnosed and preventable life-threatening disease caused by infection with the helminth Strongyloides stercoralis. Chronic asymptomatic infection can be sustained for decades, and immunosuppression can lead to disseminated infection, with a mortality rate of 70%–100%. In the neurosurgical population, corticosteroids are the most consistent cause of hyperinfection. OBSERVATIONS The authors present the case of a 33-year-old woman of Paraguayan origin who was diagnosed with sphenoid planum meningioma and treated with a high dose of corticosteroids on the basis of the diagnosis. She underwent surgery, and pathological anatomy reflected grade I meningioma. After the surgery, she started with a history of dyspnea, productive cough, fever, and urticarial rash. Later, she presented with intestinal pseudo-obstruction and bacterial meningitis with hydrocephalus. Serology was positive for Strongyloides (enzyme-linked immunosorbent assay), and she was diagnosed with hyperinfection syndrome. Ivermectin 200 µg/kg daily was established. LESSONS It may be of interest to rule out a chronic Strongyloides infection in patients from risk areas (immigrants or those returning from recent trips) before starting treatment with corticosteroids.

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“…It has been suggested that the enterococcal infections were related to the migration of the Strongyloides larval form from the gastrointestinal tract. [4][5][6][7][8][9][10][11] Vancomycin-resistant enterococcus (VRE) meningitis infections are difficult to treat due to variable CNS penetration and resistance patterns. Linezolid, daptomycin, telavancin, tigecycline and quinupristin/dalfopristin have been historically used for VRE infections.…”

mentioning

confidence: 99%

“…17 Most reported cases of severe Strongyloides infections associated with enterococcal meningitis were vancomycin-susceptible. [4][5][6][7][8][9] Zeana and colleagues reported the first case of DS with concomitant vancomycin-resistant Enterococcus faecalis meningitis, which was successfully treated with linezolid. 10…”

mentioning

confidence: 99%

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

Tobin

Dougherty

Ratliff

et al. 2021

Clinical Pharmacy Therapeu

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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

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Enterococcal meningitis in association with Strongyloides hyperinfection syndrome

Abstract: Our cases highlight the importance of suspecting hyperinfection syndrome in cases of community acquired enterococcal bacteremia and meningitis.

Cited by 6 publications

References 10 publications

Strongyloides stercoralis hyperinfection complicated by secondary infections in a case of transformed diffuse large B-cell lymphoma

Strongyloides stercoralis hyperinfection complicated by secondary infections in a case of transformed diffuse large B-cell lymphoma

Strongyloides hyperinfection syndrome due to corticosteroid therapy after resection of meningioma: illustrative case

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

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