Combination therapy for disseminated strongyloidiasis with associated vancomycin-resistant, linezolid-intermediate Enterococcus faecium meningitis: A case report

J Clin Pharm Ther. 2022 Jan;47(1):121-124. doi: 10.1111/jcpt.13448. Epub 2021 Jun 2.

Abstract

What is known and objective: The rhabditid nematode Strongyloides stercoralis is the major causative agent of disseminated strongyloidiasis (DS). In rare cases, DS has caused enterococcal meningitis. If DS-associated vancomycin-resistant Enterococcus faecium (VRE) meningitis is suspected, combination antibiotic therapy should be considered.

Case summary: We present a case of a 61-year-old male who developed DS associated with vancomycin-resistant and linezolid-intermediate E. faecium meningitis after receiving corticosteroids. The VRE meningitis was treated with high-dose daptomycin 12 mg/kg, linezolid, tigecycline and quinupristin/dalfopristin. Despite negative cultures, the patient expired.

What is new and conclusion: In patients with DS-associated VRE meningitis, early use of combination therapy may be warranted to improve patient outcomes.

Keywords: Strongyloides stercoralis; hyperinfection syndrome; meningitis; strongyloides; strongyloidiasis; vancomycin-resistant enterococcus.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Dose-Response Relationship, Drug
  • Drug Resistance, Multiple, Bacterial*
  • Drug Therapy, Combination
  • Enterococcus faecium
  • Gram-Positive Bacterial Infections / drug therapy*
  • Humans
  • Male
  • Meningitis, Bacterial / drug therapy*
  • Microbial Sensitivity Tests
  • Middle Aged
  • Strongyloidiasis / chemically induced
  • Strongyloidiasis / drug therapy*
  • Vancomycin Resistance

Substances

  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents