Hyperinfection Associated with Bacteremia, Meningitis, Ventriculitis and Gas-Forming Spondylodiscitis: A Case Report.

An elderly Singaporean male with no travel history was hospitalized for fever and altered mental status. Blood cultures grew , and given a preceding history of steroid use and peripheral eosinophilia, hyperinfection was suspected. Stool specimens were positive for larvae over four days, and larvae were also isolated in an early morning nasogastric aspirate specimen prior to initiation of ivermectin. A cerebrospinal fluid examination was consistent with partially treated bacterial meningitis and ventriculitis was demonstrated on neuroimaging. In view of a persistent fever, a further imaging evaluation was performed, which demonstrated bilateral pneumonia as well as the unusual finding of gas-forming emphysematous spondylodiscitis and left psoas abscesses. Despite the early suspicion of hyperinfection, commencement of appropriate antibiotics and anti-helminthics, microbiological clearance of bacteremia as well as clearance of from the stool, the patient still succumbed to infection and passed away 11 days after admission.