E. coliMeningitis Presenting in a Patient with DisseminatedStrongyloides stercoralis

Abstract

Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell's palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β-lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.

Acute meningitis and emphysematous pyelonephritis due to extended-spectrum beta-lactamase-producing E. coli

“…The patient died from complications [9]. Common risk factors for GNB meningitis include cirrhosis, alcoholism, malignancy, diabetes mellitus, immunosuppressive drugs and HIV infection [10]. The presented case was a known case of ITP, and was on prednisolone 5mg/d.…”

An Unusual and Rare Cause of Meningitis in An Adult Renal Transplant Patient

“…In another interesting case a fit adult, presented with bloody diarrhoea, fever, toxic mega colon and developed meningism and was found to have ECM. Disseminated SS infection leading to ECM was also reported [16][17][18]. While, EC is a facultative anaerobic gramnegative bacillus usually found in large intestine.…”

An Unusual Case of Escherichia Coli Meningitis in an Immunocompetent Adult

“…However, spontaneous E. coli meningitis can occur in patients with several comorbidities [ 6 ], including chronic alcoholism, cirrhosis, human immunodeficiency virus infection (HIV), chronic obstructive lung disease, immunosuppressive medications, and diabetes mellitus [ 7 ]. Strongyloides hyperinfection syndrome can present with E. coli meningitis as the Strongyloides larva migrates from the gastrointestinal mucosa to disseminate through the body carrying E. coli in the process [ 8 ]. In our patient, the Strongyloides antibody test was negative.…”