Streptococcus bovis bacteremia associated with Strongyloides stercoralis colitis

Abstract

Strongyloides stercoralis is a source of an endemic parasitosis in tropical and subtropical areas of the world, including the southeastern United States. In the U.S., strongyloidiasis occurs more commonly in immunosuppressed patients, usually presenting with systemic manifestations as Strongyloides hyperinfection syndrome.1-3 Although gram-negative bacteremia has been reported in association with Strongyloides stercoralis,1,4 the association between Streptococcus bovis bacteremia and strongyloidiasis is less clear. Streptococcus bovis bacteremia has been classically associated with colonic neoplasms.5-8 Due to this association, it is recommended that colonoscopy be performed in any patient with Streptococcus bovis bacteremia.6-8 This is a case of a patient with the dual diagnosis of S bovis bacteremia and S stercoralis colitis. An extensive search of published information identified only two other reports where S bovis infection had potentially been associated with strongyloidiasis.9,10 The interesting aspect of our case is that the presence of S bovis bacteremia lead to the diagnosis of Strongyloides colitis. No prior cases with endoscopic-histologic correlation of strongyloidiasis have been reported. This case suggests that strongyloidiasis is not only associated with gram-negative bacteremia, but may also be associated with bacteremia due to gram-positive bacteria such as S bovis.