Pub Date : 2025-01-01DOI: 10.1016/j.clinpr.2025.100408
Mohammad Hadi Tajik Jalayeri , Rahmat Allah Sharifi far , Narges Lashkarbolouk , Mahdi Mazandarani
Background
Lophomonas blattarum is an emerging important cause of bronchopulmonary infections in immunocompromised patients. Moreover, Tuberculosis (TB) continues to be a significant factor in the mortality of infectious diseases, particularly in developing nations, serving as a primary cause of pneumonia.
Cases presentation
Our study reported six cases of lophomoniasis with tuberculosis co-infection. The median age of all cases reported was 51.83 years old, and 50 % of patients were male. All the adult patients had respiratory signs, with common symptoms of fever and dyspnea. The presence of leukocytes and anemia in the patients was common. We treated them with metronidazole 500 mg twice a day for two weeks and a combination of TB regimens.
Conclusion
We recommended identifying lophomoniasis during differential diagnoses of patients with pulmonary tuberculosis. Moreover, Timely diagnosis and treatment of lophomonas is crucial, as it requires a different treatment approach from pneumonia or TB. Clinical laboratories should consider the active search for this protozoan in these patients’ bronchoalveolar and tracheal liquid samples.
{"title":"The co-infection of lophomoniasis and tuberculosis in patients with respiratory symptoms; case series and literature review","authors":"Mohammad Hadi Tajik Jalayeri , Rahmat Allah Sharifi far , Narges Lashkarbolouk , Mahdi Mazandarani","doi":"10.1016/j.clinpr.2025.100408","DOIUrl":"10.1016/j.clinpr.2025.100408","url":null,"abstract":"<div><h3>Background</h3><div><em>Lophomonas blattarum</em> is an emerging important cause of bronchopulmonary infections in immunocompromised patients. Moreover, Tuberculosis (TB) continues to be a significant factor in the mortality of infectious diseases, particularly in developing nations, serving as a primary cause of pneumonia.</div></div><div><h3>Cases presentation</h3><div>Our study reported six cases of lophomoniasis with tuberculosis co-infection. The median age of all cases reported was 51.83 years old, and 50 % of patients were male. All the adult patients had respiratory signs, with common symptoms of fever and dyspnea. The presence of leukocytes and anemia in the patients was common. We treated them with metronidazole 500 mg twice a day for two weeks and a combination of TB regimens.</div></div><div><h3>Conclusion</h3><div>We recommended identifying lophomoniasis during differential diagnoses of patients with pulmonary tuberculosis. Moreover, Timely diagnosis and treatment of lophomonas is crucial, as it requires a different treatment approach from pneumonia or TB. Clinical laboratories should consider the active search for this protozoan in these patients’ bronchoalveolar and tracheal liquid samples.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"25 ","pages":"Article 100408"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinpr.2025.100413
Yewande Adegeye, Anna Wild, Karmel BandyWebb
Klebsiella pneumoniae is a highly pathogenic and resilient Gram negative bacterium often found colonising the gastrointestinal (GI) tract in humans. The hypervirulent strain of bacterium possesses unique virulence mechanisms which can cause primary liver abscesses with septic metastatic complications. In recent decades, there has been a continual rise in global health concern regarding the emergence of antimicrobial resistance for this organism.
We present a case of a hypervirulent Klebsiella pneumoniae infection with liver abscesses and central nervous system (CNS) embolic disease which was treated successfully with the monobactam aztreonam. Although the isolate tested sensitive to a wide range of antibiotics including third-generation cephalosporins and carbapenems, her treatment regime was altered due to a lack of clinical response and adverse drug reactions. The patient made significant improvement clinically, biochemically and radiologically on aztreonam, despite lesser use in CNS disease than conventional beta-lactams.
{"title":"Successful treatment with aztreonam of a patient with disseminated hypervirulent Klebsiella pneumoniae infection","authors":"Yewande Adegeye, Anna Wild, Karmel BandyWebb","doi":"10.1016/j.clinpr.2025.100413","DOIUrl":"10.1016/j.clinpr.2025.100413","url":null,"abstract":"<div><div><em>Klebsiella pneumoniae</em> is a highly pathogenic and resilient Gram negative bacterium often found colonising the gastrointestinal (GI) tract in humans. The hypervirulent strain of bacterium possesses unique virulence mechanisms which can cause primary liver abscesses with septic metastatic complications. In recent decades, there has been a continual rise in global health concern regarding the emergence of antimicrobial resistance for this organism.</div><div>We present a case of a hypervirulent <em>Klebsiella pneumoniae</em> infection with liver abscesses and central nervous system (CNS) embolic disease which was treated successfully with the monobactam aztreonam. Although the isolate tested sensitive to a wide range of antibiotics including third-generation cephalosporins and carbapenems, her treatment regime was altered due to a lack of clinical response and adverse drug reactions. The patient made significant improvement clinically, biochemically and radiologically on aztreonam, despite lesser use in CNS disease than conventional beta-lactams.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"25 ","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinpr.2024.100398
Tembe Carveth-Johnson , Benjamin McLoughlin , Daniel Rice-Wilson , Fiona Chatterjee , Teresa Cutino-Moguel , Matthew Buckland , Apeksha Shah , David Harrington
A 66-year-old man presented to hospital in London, United Kingdom, with back pain and reduced mobility shortly after returning from Chandigarh, India. Examination revealed flaccid paralysis in his lower limbs with absent reflexes and an initially normal upper limb neurological exam. He subsequently developed upper limb weakness with areflexia and truncal, bulbar, and respiratory weakness, and was intubated and ventilated. MRI brain showed features of a brainstem encephalitis centred on the ventral medulla. Neurophysiology showed widespread peripheral acute axonal degeneration, consistent with Guillain-Barré syndrome (acute motor sensory axonal neuropathy variant). He had positive serum chikungunya IgG and IgM and the virus remained detectable by PCR at 34 days post-symptom onset. He had detectable anti-cytokine antibodies. He was treated with high dose steroids, intravenous immunoglobulins, and plasma exchange. He made a good clinical recovery with near normal upper limb and bulbar function, and mild residual leg weakness. In this case we describe a unique neurological presentation of chikungunya infection resulting in concurrent brainstem encephalitis and axonal Guillain-Barré syndrome, associated with a protracted viraemia. Immunological investigations revealed the presence of anti-cytokine antibodies, highlighting the need for improved understanding of host susceptibility to severe manifestations of chikungunya infection.
{"title":"A case of brainstem encephalitis with acute neuropathy associated with prolonged chikungunya viraemia","authors":"Tembe Carveth-Johnson , Benjamin McLoughlin , Daniel Rice-Wilson , Fiona Chatterjee , Teresa Cutino-Moguel , Matthew Buckland , Apeksha Shah , David Harrington","doi":"10.1016/j.clinpr.2024.100398","DOIUrl":"10.1016/j.clinpr.2024.100398","url":null,"abstract":"<div><div>A 66-year-old man presented to hospital in London, United Kingdom, with back pain and reduced mobility shortly after returning from Chandigarh, India. Examination revealed flaccid paralysis in his lower limbs with absent reflexes and an initially normal upper limb neurological exam. He subsequently developed upper limb weakness with areflexia and truncal, bulbar, and respiratory weakness, and was intubated and ventilated. MRI brain showed features of a brainstem encephalitis centred on the ventral medulla. Neurophysiology showed widespread peripheral acute axonal degeneration, consistent with Guillain-Barré syndrome (acute motor sensory axonal neuropathy variant). He had positive serum chikungunya IgG and IgM and the virus remained detectable by PCR at 34 days post-symptom onset. He had detectable anti-cytokine antibodies. He was treated with high dose steroids, intravenous immunoglobulins, and plasma exchange. He made a good clinical recovery with near normal upper limb and bulbar function, and mild residual leg weakness. In this case we describe a unique neurological presentation of chikungunya infection resulting in concurrent brainstem encephalitis and axonal Guillain-Barré syndrome, associated with a protracted viraemia. Immunological investigations revealed the presence of anti-cytokine antibodies, highlighting the need for improved understanding of host susceptibility to severe manifestations of chikungunya infection.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"25 ","pages":"Article 100398"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinpr.2024.100400
Ameeka Thompson , Aysha Jameel , Christina Petridou , N Claire Gordon
Background
Orf virus is a member of the genus parapoxvirus. Orf is an infection of sheep and goats but humans can become infected after direct contact with an infected mammal. It is normally a self-limiting cutaneous infection but it has the potential to cause more severe infection in immunosuppressed individuals.
Case Report
We report two cases of delayed diagnosis of orf. The first case was a fifty-year-old sheep farmer who presented with a painful lesion on her finger. The second patient was a twenty-five-year-old veterinary nurse who presented with a painful lesion on her finger after being bitten by a lamb. Both cases were mis-diagnosed by a number of different clinicians and the second case received multiple courses of inappropriate anti-microbial therapy.
Results
Skin swabs from both cases were sent to the UKHSA Porton Rare and Imported Pathogens Laboratory (RIPL) for parapoxvirus PCR. Parapoxvirus DNA was detected in both cases, indicating presumptive orf infection.
Conclusion
A thorough history, including occupation and animal exposure, is key to making a prompt diagnosis of orf. Early recognition is required in order to prevent unnecessary anti-microbial therapy and surgical intervention, and to allow for prompt treatment in those severe cases where it is required.
{"title":"Delayed diagnosis of parapoxvirus infections and a review of pox infections other than mpox in the United Kingdom","authors":"Ameeka Thompson , Aysha Jameel , Christina Petridou , N Claire Gordon","doi":"10.1016/j.clinpr.2024.100400","DOIUrl":"10.1016/j.clinpr.2024.100400","url":null,"abstract":"<div><h3>Background</h3><div>Orf virus is a member of the genus parapoxvirus. Orf is an infection of sheep and goats but humans can become infected after direct contact with an infected mammal. It is normally a self-limiting cutaneous infection but it has the potential to cause more severe infection in immunosuppressed individuals.</div></div><div><h3>Case Report</h3><div>We report two cases of delayed diagnosis of orf. The first case was a fifty-year-old sheep farmer who presented with a painful lesion on her finger. The second patient was a twenty-five-year-old veterinary nurse who presented with a painful lesion on her finger after being bitten by a lamb. Both cases were mis-diagnosed by a number of different clinicians and the second case received multiple courses of inappropriate anti-microbial therapy.</div></div><div><h3>Results</h3><div>Skin swabs from both cases were sent to the UKHSA Porton Rare and Imported Pathogens Laboratory (RIPL) for parapoxvirus PCR. Parapoxvirus DNA was detected in both cases, indicating presumptive orf infection.</div></div><div><h3>Conclusion</h3><div>A thorough history, including occupation and animal exposure, is key to making a prompt diagnosis of orf. Early recognition is required in order to prevent unnecessary anti-microbial therapy and surgical intervention, and to allow for prompt treatment in those severe cases where it is required.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"25 ","pages":"Article 100400"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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