Strongyloides Hyperinfection Associated with Enterococcus faecalis Bacteremia, Meningitis, Ventriculitis and Gas-Forming Spondylodiscitis: A Case Report

Abstract

An elderly Singaporean male with no travel history was hospitalized for fever and altered mental status. Blood cultures grew Enterococcus faecalis, and given a preceding history of steroid use and peripheral eosinophilia, Strongyloides hyperinfection was suspected. Stool specimens were positive for Strongyloides stercoralis larvae over four days, and larvae were also isolated in an early morning nasogastric aspirate specimen prior to initiation of ivermectin. A cerebrospinal fluid examination was consistent with partially treated bacterial meningitis and ventriculitis was demonstrated on neuroimaging. In view of a persistent fever, a further imaging evaluation was performed, which demonstrated bilateral pneumonia as well as the unusual finding of gas-forming emphysematous spondylodiscitis and left psoas abscesses. Despite the early suspicion of Strongyloides hyperinfection, commencement of appropriate antibiotics and anti-helminthics, microbiological clearance of bacteremia as well as clearance of S. stercoralis from the stool, the patient still succumbed to infection and passed away 11 days after admission.

A case of disseminated strongyloidiasis after multiple courses of immunosuppression

“…1,2,4 For the same reason, bacteremia with E. faecalis, a common commensal of the human gastrointestinal tract, is described in SHS or dissemination. 11 Of note, no roundworms were identified when the previous surgical pathology slides from the patient's Roux-en-Y procedure and cholecystectomy were re-examined.…”

Cas de strongyloïdose disséminée après plusieurs traitements immunosuppresseurs

“…La récurrence de septicémie à Gram négatif ou de méningite inexpliquée devrait éveiller les soupçons d'une infestation par Strongyloides, car les organismes entériques adhèrent au parasite durant la migration tissulaire 1,2,4 . C'est également pourquoi la bactériémie à E. faecalis, qui fait partie de la flore commune du tractus digestif humain, est décrite dans le SHS ou la dissémination 11 . Fait à noter, aucun nématode n'a été identifié lorsqu'on a réexaminé les clichés d'anatomopathologie chirurgicale du patient à la suite de son intervention de Roux-en-Y et de sa cholécystostomie.…”

Concurrent and Subsequent Co-Infections of Clostridioides difficile Colitis in the Era of Gut Microbiota and Expanding Treatment Options

“…A potential frightening complication of CDI is the development of concurrent or subsequent infections due to a large spectrum of microbial entities, including other bacteria, viruses, and fungi. The contribution of microbial translocation to co-infections occurrence in other infectious diseases such as Strongyloides stercoralis hyperinfection or severe Dengue has already been detailed [ 14 , 15 ]. Little is known about the mechanisms and frequency of concurrent and subsequent infections, as well as their impact on the overall clinical outcomes of Cdiff infection in terms of survival, complications, and recurrence.…”