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[A case report of meningitis and sepsis due to Enterococcus faecium complicated with strongyloidiasis]
Abstract:
A 80 year-old male was transferred to our department on 18th Aug. 1988, for high fever and clouding of the consciousness. He had been treated with steroid hormone (betamethasone 3.0 mg/day for 15 days) for his uveitis. Enterococcus faecium was isolated from both blood and spinal fluid, and then Strongyloides sterocoralis was revealed both in the sputum and stool. Anti-Human T-cell leukemia virus 1 (HTLV-1) antibody was also positive serologically. At first, beta-lactam antibiotics were used for the treatment of purulent meningitis and sepsis, but after performing sensitivity tests for E. faecium, the antibiotics were changed to rifampicin (RFP), fosfomycin (FOM) and ofloxacin (OFLX) for their excellent activity against the organism. After the clinical symptoms, subsided, thiabendazole was used for disseminated strongyloidiasis in daily doses of 2,500 mg for six days initially. The drug was used three times with two week intervals. Both bacterial and parasite infections subsided and no recurrence has been noticed until now. This is the first case of meningitis caused by E. facium complicated with strongyloidiasis.
Insights
This case report details a rare instance of meningitis caused by Enterococcus faecium complicated by Strongyloides stercoralis infection in an immunocompromised patient. Successful treatment involved tailored antibiotics and antiparasitic therapy, leading to full recovery.
Area of Science:
- Infectious Diseases
- Neurology
- Parasitology
Background:
- A patient with uveitis treated with corticosteroids developed severe infections.
- Opportunistic infections can arise in immunocompromised individuals.
Observation:
- An 80-year-old male presented with fever and altered consciousness.
- Enterococcus faecium was identified in blood and cerebrospinal fluid.
- Strongyloides stercoralis was found in sputum and stool.
- The patient tested positive for Human T-cell leukemia virus 1 (HTLV-1) antibodies.
Findings:
- The patient was diagnosed with purulent meningitis and sepsis due to E. faecium.
- Treatment was initiated with beta-lactam antibiotics, then switched to rifampicin, fosfomycin, and ofloxacin based on sensitivity testing.
- Disseminated strongyloidiasis was treated with thiabendazole.
- Both bacterial and parasitic infections resolved without recurrence.
Implications:
- This is the first reported case of Enterococcus faecium meningitis co-occurring with strongyloidiasis.
- Highlights the importance of considering opportunistic infections in immunocompromised patients.
- Demonstrates the efficacy of targeted antibiotic and antiparasitic therapy for complex co-infections.