Wee Liang En, Hnin Su Wai Khin, Xu Zheyu, Lee Lawrence Soon-U
Singhealth Infectious Diseases Residency, Singapore 168753, Singapore.
Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore.
Trop Med Infect Dis. 2020 Mar 12;5(1):44. doi: 10.3390/tropicalmed5010044.
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.
一名无旅行史的新加坡老年男性因发热和精神状态改变入院。血培养有结果，鉴于之前有使用类固醇和外周嗜酸性粒细胞增多的病史，怀疑发生了超感染。粪便标本连续四天检出幼虫阳性，在开始使用伊维菌素之前，清晨鼻胃管抽吸标本中也分离出幼虫。脑脊液检查结果符合部分治疗的细菌性脑膜炎，神经影像学显示存在脑室炎。鉴于持续发热，进行了进一步的影像学评估，结果显示双侧肺炎以及罕见的产气性肺气肿性脊椎间盘炎和左腰大肌脓肿。尽管早期怀疑有超感染，使用了适当的抗生素和抗蠕虫药，菌血症的微生物清除以及粪便中幼虫的清除，但患者仍死于感染，入院11天后去世。
