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Bacterial complications of strongyloidiasis: Streptococcus bovis meningitis
1Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Department of Medicine, Virginia Commonwealth University, Medical College of Virginia, Richmond, USA.
Abstract:
We report the case of a 64-year-old veteran who had Streptococcus bovis meningitis as a result of a long latent Strongyloides infection that became acute when he was treated with prednisone. We reviewed 38 reported cases of serious bacterial infections associated with strongyloidiasis. Patients most frequently had nonspecific gastrointestinal symptoms. Of these 38 patients, 21 (55%) had meningitis, and 28 (73%) had bacteremia that was polymicrobial in 3 cases (8%). Other sites of infection included lung, bone marrow, ascites, mitral valve, and lymph node. Most infections were due to enteric gram-negative bacteria. There is one previously reported case of S bovis meningitis. Thirty-four of the patients (89%) were immunosuppressed; 21 of these (55%) were taking pharmacologic doses of adrenal corticosteroids. Thirty-three of the 38 (87%) patients died. Patients with enteric bacterial infection without an obvious cause should be tested for the presence of strongyloidiasis.
Insights
A latent Strongyloides infection can lead to severe bacterial infections, including Streptococcus bovis meningitis, especially when patients are treated with prednisone. Early testing for Strongyloides is crucial in patients with unexplained bacterial infections.
Area of Science:
- Infectious Diseases
- Immunology
Background:
- Strongyloidiasis is a parasitic infection often asymptomatic for years.
- Immunosuppression, particularly with corticosteroids, can reactivate latent Strongyloides.
Observation:
- A 64-year-old veteran developed Streptococcus bovis meningitis due to reactivated Strongyloides infection after prednisone treatment.
- A review of 38 cases revealed Strongyloides-associated serious bacterial infections, frequently presenting with gastrointestinal symptoms.
Findings:
- Meningitis occurred in 55% of reviewed cases, with bacteremia in 73%.
- Enteric gram-negative bacteria were the most common pathogens.
- 89% of patients were immunosuppressed, with 55% on corticosteroids.
Implications:
- Patients with unexplained enteric bacterial infections should be screened for Strongyloides.
- Prompt diagnosis and treatment of Strongyloides can prevent life-threatening bacterial coinfections.
- Corticosteroid use in potentially infected individuals requires careful consideration.