Two Cases of Meningitis Associated with Gram Negative Bacteremiae and Strongyloidiasis

Abstract

Background: Strongyloidiasis is a neglected tropical disease and is widely distributed. HTLV-1 coinfection is frequent, and this disease increases the risk of hyper infestation. Disseminated strongyloidiasis often causes severe enterobacteria infection. Case Presentation: We report the cases of two patients presenting with meningial syndrome. The meningitis was associated with a Gram negative bacteremiae. The investigations performed proved an infection or a previous contact with Strongyloides stercoralis. The infectious outcome was favorable after antibiotic treatment and antiparasitic treatment but one of them was also co-infected with HTLV-1 and died after a lymphoma occurred. Discussion: S. stercoralis infects the intestinal mucosa, and chronic infection of this pathogen induces inflammation of the intestinal mucosa. Enteric bacteria can gain systemic access and be responsible of organ involvement, including Central Nervous System. HTLV-1 infection increases the prevalence of strongyloidiasis, the rate of treatment failure, and the risk of hyperinfestation. Conclusions: Strongyloidiasis should not be underdiagnosed, as a specific treatment with antiparasitic drugs is available. We should perform direct microscopy of the stool to detect S. stercoralis in patients who develop severe enterobacterial infection when patients are from an endemic area.