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Streptococcus pyogenes bacteremia and toxic shock syndrome related to Strongyloides stercoralis hyperinfection: a
Regev Cohen1,2, Talya Finn3, Frida Babushkin3
1Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel. regevco@gmail.com.
Background:
We describe a patient with Strongyloides stercoralis hyperinfection associated with Streptococcus pyogenes and with streptococcal toxic shock syndrome. To the best of our knowledge this association has not been previously described.
Case Presentation:
A 78 year-old Israeli man, who was born in Iraq but lived in Israel for 66 years, presented with multi-organ failure including acute kidney and hepatic injury, coagulopathy, and lactic acidosis. He had a medical history including aortic valve replacement, diabetes mellitus, spinal stenosis, and low back pain treated with repeated local steroid injections. Blood cultures were positive for Streptococcus pyogenes and antibiotic treatment was switched to penicillin G, clindamycin, and intravenous immunoglobulins. Repeated physical examinations failed to identify the source of the bacteremia. On day 12 of hospitalization the serology results for Strongyloides stercoralis sent on admission, because of chronic eosinophilia, came back positive. A microscopic stool examination and stool polymerase chain reaction were positive for Strongyloides stercoralis. Ivermectin therapy was commenced and continued for a total of 4 weeks. He was discharged for rehabilitation after 25 days. He had no exposure to endemic countries or to immigrants. During many years he had multiple gastrointestinal symptoms, respiratory symptoms, cutaneous symptoms, chronic eosinophilia, and high immunoglobulin E levels. He underwent several operative procedures and numerous hospitalizations and medical encounters with different experts but a parasitic infection was not considered. His asymptomatic daughter was also found to be serologically positive.
Conclusions:
Strongyloides stercoralis hyperinfection associated with Streptococcus pyogenes bacteremia and toxic shock is described for the first time. The case also highlights the importance of history taking and reviewing past laboratory results, the utility of serological tests for Strongyloides stercoralis, and the importance of screening asymptomatic family members of an infected patient. Strongyloides stercoralis hyperinfection must be considered in the differential diagnosis of any patient with Streptococcus pyogenes bacteremia or toxic shock of no clear source as well as in symptomatic patients with chronic or intermittent eosinophilia, even without any epidemiological risk factors.
Insights
This case report details a rare Strongyloides stercoralis hyperinfection linked with Streptococcus pyogenes and toxic shock syndrome. Early diagnosis and treatment are crucial for patients with eosinophilia and unexplained bacteremia.
Area of Science:
- Infectious Diseases
- Parasitology
- Critical Care Medicine
Background:
- Strongyloides stercoralis hyperinfection is a severe condition often associated with immunosuppression.
- Streptococcus pyogenes can cause severe invasive infections, including toxic shock syndrome.
- The co-occurrence of these infections has not been previously documented.
Observation:
- A 78-year-old man presented with multi-organ failure, Streptococcus pyogenes bacteremia, and toxic shock syndrome.
- Despite extensive workup, the source of bacteremia remained unclear until Strongyloides stercoralis hyperinfection was diagnosed via serology and stool examination.
- The patient had a history of chronic eosinophilia and various non-specific symptoms over many years.
Findings:
- The patient was successfully treated with antibiotics and ivermectin for Strongyloides stercoralis hyperinfection.
- His asymptomatic daughter also tested positive for Strongyloides stercoralis, highlighting the need for family screening.
- This case represents the first reported instance of Strongyloides stercoralis hyperinfection associated with Streptococcus pyogenes and toxic shock syndrome.
Implications:
- Clinicians should consider Strongyloides stercoralis hyperinfection in patients with Streptococcus pyogenes bacteremia or toxic shock of unknown origin.
- Reviewing past laboratory results, particularly for chronic eosinophilia, is vital for diagnosing Strongyloides stercoralis.
- Serological testing for Strongyloides stercoralis and screening of asymptomatic family members are important diagnostic and public health measures.
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