Community-acquired Enterobacteriaceae infection and culture-negative meningitis are rare and atypical subtypes of meningitis in adults. Of 37 patients who had atypical suppurative meningitis during 1993-2015 in Okinawa, Japan, 54.5% had strongyloidiasis, of which 9.1% cases were hyperinfections and 3.0% dissemination. Strongyloidiasis should be considered an underlying cause of atypical suppurative meningitis.
Keywords: Enterobacteriaceae; HTLV-1; Japan; Okinawa; Strongyloidiasis; bacteria; culture-negative suppurative meningitis; meningitis/encephalitis; parasites.