E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis

An Unusual Case of Escherichia Coli Meningitis in an Immunocompetent Adult

Spontaneous meningitis caused by Gram-negative bacilli is rare in adults. It typically occurs after a neurosurgical procedure or head injury but may also be related to the presence of a neurosurgical device, cerebrospinal fluid (CSF) leak syndrome, or seen in immunosuppressed patients. Escherichia coli (E. coli) is the leading cause of Gram-negative bacilli meningitis. We describe the case of a 47-year-old man who was hospitalized for spontaneous, community-acquired E. coli meningitis, which is unusual to see in an immunocompetent adult. CSF analysis was consistent with bacterial meningitis; his blood culture was positive for E. coli. Within 24 hours of initiation of antibiotics, his status improved.

Coinfection of Strongyloides stercoralis and Aspergillus sp

BACKGROUND

Strongyloides stercoralis has the ability to proliferate in its hosts for a long time. In most patients with a competent immune system, the infection remains asymptomatic.

OBJECTIVES

Herein, we report a case of concomitant infection of Strongyloides and Aspergillus. Similar cases reported previously were reviewed in the literature and discussed in terms of diagnosis, clinical presentation, and treatment.

METHODS

The patient was a 55-year-old man who had a medical history of two masses in his lung and was treated with corticosteroids six months before the presentation.

RESULTS

Using the parasitological methods, massive actively motile larvae of S. stercoralis were seen in the patient's faecal sample. Aspergillus infection was isolated from his fresh bronchoalveolar lavage (BAL) sample and confirmed by observing the septate, dichotomously branched hyphae in direct microscopic examination and also the isolation of the fungus from the culture medium. Molecular analysis revealed that the fungal species isolated from the patient are A. flavus and A. niger. Conclusion. The case highlights the features of concomitant infection of S. stercoralis and Aspergillus in immunocompromised patients and the importance of screening patients for strongyloidiasis before initiation of immunosuppressive therapy.