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Published on: May 23, 2021
Strongyloides Hyperinfection Associated with Enterococcus faecalis Bacteremia, Meningitis, Ventriculitis and
Liang En Wee1, Su Wai Khin Hnin2, Zheyu Xu2
1Singhealth Infectious Diseases Residency, Singapore 168753, Singapore.
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.
Insights
A fatal case of Strongyloides hyperinfection in an elderly male presented with fever and altered mental status. Despite treatment, the patient developed severe complications including meningitis, pneumonia, and spondylodiscitis, ultimately succumbing to the infection.
Area of Science:
- Infectious Diseases
- Parasitology
- Critical Care Medicine
Background:
- Strongyloides stercoralis hyperinfection is a potentially fatal condition, particularly in immunocompromised individuals.
- Early diagnosis and prompt treatment are crucial for improving outcomes in disseminated strongyloidiasis.
- This case highlights the complex clinical presentation and challenges in managing severe Strongyloides infection.
Observation:
- An elderly Singaporean male presented with fever and altered mental status, later diagnosed with Strongyloides hyperinfection.
- The patient exhibited peripheral eosinophilia, positive stool for Strongyloides stercoralis larvae, and larvae in nasogastric aspirate.
- Complications included bacterial meningitis, ventriculitis, bilateral pneumonia, emphysematous spondylodiscitis, and psoas abscesses.
Findings:
- Blood cultures revealed Enterococcus faecalis bacteremia.
- Cerebrospinal fluid examination indicated partially treated bacterial meningitis.
- Neuroimaging confirmed ventriculitis, pneumonia, and unusual gas-forming emphysematous spondylodiscitis with psoas abscesses.
Implications:
- This case highlights the severe and varied presentations of Strongyloides hyperinfection syndrome.
- Prompt diagnosis and treatment are crucial, but outcomes can still be poor in severe cases.
- The unusual finding of emphysematous spondylodiscitis in this context warrants further investigation.
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