Five Cases of Recurrent Meningitis Associated with Chronic Strongyloidiasis

Shimasaki, Teppei; Chung, Heath; Shiiki, Soichi

doi:10.4269/ajtmh.14-0564

Cited by 13 publications

(11 citation statements)

References 21 publications

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“…Despite the low mortality rate associated with occult dissemination with culture-negative suppurative meningitis, it is critical for clinicians to identify concomitant strongyloidiasis because patients might later have recurrent meningitis in more critical conditions (18) if not properly treated. Culture-negative suppurative meningitis should prompt the immediate consideration of performing a parasitologic examination in areas where strongyloidiasis and HTLV-1 are endemic.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical complications of disseminated strongyloidiasis are a result of the increasing numbers of autoinfective larvae traveling through the body, with many larvae carrying enteric bacteria from the intestine (9). Penetrated larvae carry enteric organisms to multiple organ systems, causing sepsis (10)(11)(12), pneumonia (10,11,13), and meningitis (10,11,(14)(15)(16)(17)(18).…”

Section: S Trongyloidiasis Is a Nematode Infection Caused Bymentioning

confidence: 99%

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Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975–2017

Mukaigawara¹,

Narita²,

Shiiki³

et al. 2020

Emerg. Infect. Dis.

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Clinical characteristics of disseminated strongyloidiasis, the severest form of strongyloidiasis, are not well described. We conducted a retrospective, consecutive chart review of patients with disseminated strongyloidiasis admitted to Okinawa Chubu Hospital in Okinawa, Japan, during January 1975-December 2017. The 70 patients were classified into 3 clinical phenotypes: dissemination (32 patients [45.7%]), occult dissemination with meningitis caused by enteric organisms (12 patients [17.1%]), and occult dissemination with culture-negative suppurative meningitis (26 patients [37.1%]). Associated mortality rates were 56.3%, 16.7%, and 11.5%, respectively, and sepsis occurred in 40.6%, 58.3%, and 11.5% of cases, respectively. Common symptoms included fever (52.9% of patients), headache (32.9%), and altered mental status (24.3%). Patients were treated with thiabendazole (before 2003) or ivermectin (after 2003). Our findings show that disseminated strongyloidiasis has clinical phenotypes in terms of severity and that identification of occult dissemination, a mild form with prominent neurologic manifestations, is lifesaving. In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/eid; and (4) view/print certificate. For CME questions, see page 637.

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Section: Discussionmentioning

confidence: 99%

Section: S Trongyloidiasis Is a Nematode Infection Caused Bymentioning

confidence: 99%

Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975–2017

Mukaigawara¹,

Narita²,

Shiiki³

et al. 2020

Emerg. Infect. Dis.

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“…Strongyloidiasis has been described as a risk factor for S. gallolyticus meningitis [18,26]. This is due to increased permeability of the bowel wall, through which S. gallolyticus can invade the bloodstream and thus cause sepsis and meningitis.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus gallolyticus meningitis in adults: report of five cases and review of the literature

Samkar¹,

Brouwer²,

Pannekoek³

et al. 2015

Clinical Microbiology and Infection

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We describe the incidence and patient characteristics of Streptococcus gallolyticus meningitis. We identified S. gallolyticus meningitis in a nationwide cohort of patients with community-acquired bacterial meningitis, and performed a systematic review and meta-analysis of all reported adult cases in the literature. Five cases were identified (0.3%) in a cohort of 1561 episodes of bacterial meningitis. In one patient, bowel disease (colon polyps) was identified as a predisposing condition for S. gallolyticus infection, whereas no patients were diagnosed with endocarditis. In a combined analysis of our patients and 37 reported in the literature, we found that the median age was 59 years. Predisposing factors were present in 21 of 42 patients (50%), and mainly consisted of immunosuppressive therapy (seven patients), cancer (four patients), and alcoholism (four patients). Colon disease was identified in 15 of 24 patients (63%) and endocarditis in five of 27 patients (18%). Co-infection with Strongyloides stercoralis was identified in 14 of 34 patients (41%), ten of whom were infected with human immunodeficiency virus or human T-lymphotropic virus. Outcomes were described for 37 patients; eight died (22%) and one (3%) had neurological sequelae. S. gallolyticus is an uncommon cause of bacterial meningitis, with specific predisposing conditions. When it is identified, consultation with a cardiologist and gastroenterologist is warranted to rule out underlying endocarditis or colon disease. Stool examinations for Strongyloides stercoralis should be performed in patients who have travelled to or originate from endemic areas.

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“…According to the literature, the susceptible risk factor for the Streptococcus gallolyticus meningitis was cacotrophy, immunosuppression, endocarditis, colon carcinoma, strongyloidiasis and bibulosity [6][7][8][9][10] . Among the 42 adult patients reported [11] , 43% (18/42) of the patients had the conditions such as immunosuppression, cancer and alcoholism.…”

Section: Discussionmentioning

confidence: 99%