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Strongyloides Hyperinfection Syndrome causing fatal meningitis and septicemia by Citrobacter koseri

Felix Reyes1,2,3, Navneet Singh1, Nigar Anjuman-Khurram2

  • 1Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.

Idcases
|October 25, 2017
PubMed

Insights

This case report details Citrobacter koseri meningitis in an immunocompetent adult, a rare occurrence. The infection was linked to Strongyloides Hyperinfection Syndrome, highlighting a novel association.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Parasitology

Background:

  • Citrobacter koseri is an uncommon gram-negative bacillus causing meningitis and brain abscesses, primarily in children.
  • Central nervous system infections by C. koseri are rare in adults, typically occurring in immunocompromised individuals or those with a compromised host barrier.
  • Strongyloides Hyperinfection Syndrome (SHS) involves massive parasitic invasion, potentially leading to complications like intestinal micro-perforation.

Purpose of the Study:

  • To report the first documented case of C. koseri sepsis in an immunocompetent adult.
  • To explore the association between C. koseri meningitis and Strongyloides Hyperinfection Syndrome (SHS).
  • To emphasize the importance of considering SHS in cases of rare enterobacterial infections.

Main Methods:

  • Case presentation of a 76-year-old male with asthma exacerbation who developed septic shock.
  • Diagnostic procedures included lumbar puncture for cerebrospinal fluid (CSF) analysis and blood cultures.
  • Autopsy was performed to determine the immediate cause of death and identify parasitic burden.

Main Results:

  • Blood and CSF cultures identified Citrobacter koseri with identical antibiotic susceptibilities.
  • Autopsy revealed diffuse alveolar hemorrhage as the cause of death and a significant burden of Strongyloides stercoralis in the gastrointestinal system, lungs, and meninges.
  • The patient, despite broad-spectrum antibiotics, succumbed to multi-organ failure.

Conclusions:

  • This case represents the first documented instance of C. koseri sepsis in an immunocompetent host linked to SHS.
  • Intestinal micro-perforation secondary to Strongyloides infection can serve as a port of entry for C. koseri, leading to meningitis.
  • The findings underscore the necessity of considering SHS in the differential diagnosis of unusual enterobacterial infections, particularly in patients with severe or unexplained conditions.
Keywords:
Citrobacter koserimeningitisstronglyoides hyperinfection syndrome

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