IDCases最新文献

{"title":"Ethical use of AI in infectious diagnostic decision and therapeutic stewardship","authors":"Prasan Kumar Panda,&nbsp;Sukanya Ghosh","doi":"10.1016/j.idcr.2025.e02356","DOIUrl":"10.1016/j.idcr.2025.e02356","url":null,"abstract":"<div><div>Artificial intelligence (AI) is rapidly reshaping healthcare, offering transformative potential in infectious diagnostics and antimicrobial stewardship through enhanced accuracy, efficiency, and predictive capabilities. However, its integration into clinical practice raises significant ethical challenges. These include transparency of decision-making, protection of patient privacy, algorithmic fairness, accountability, and the preservation of human oversight. Global and national bodies have developed guidance to address these concerns: the World Health Organization (WHO) emphasizes autonomy, inclusiveness, and equity; the U.S. Food and Drug Administration (FDA) regulates adaptive AI as medical devices; the European Union AI Act classifies medical AI as “high-risk”; and the Indian Council of Medical Research (ICMR) highlights accountability, data security, and cultural sensitivity. Drawing on these frameworks, this perspective discusses the ethical imperatives of deploying AI responsibly in infectious diagnostic and therapeutic stewardship. Best practices are outlined to ensure that innovation enhances patient trust, safety, and equity while mitigating risks of misuse or bias.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02356"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of brucellosis with perinephritis presented as abdominal and low back pain in China","authors":"Hang Li ,&nbsp;Xiang Gao ,&nbsp;Zi-yang Li ,&nbsp;Xia Xu ,&nbsp;Jian-ping Chen","doi":"10.1016/j.idcr.2025.e02372","DOIUrl":"10.1016/j.idcr.2025.e02372","url":null,"abstract":"<div><h3>Background</h3><div>Human brucellosis, a zoonotic infection, typically manifests as fever, fatigue, anorexia, and osteoarticular pain. We report a rare case of brucellosis complicated by perinephritis, presenting with abdominal and low back pain.</div></div><div><h3>Case presentation</h3><div>A 74-year-old male presented with fever, abdominal and low back pain. Initial lumbar magnetic resonance imaging (MRI) demonstrated L4–5 disc herniation with foraminal and spinal canal stenosis, while abdominal computed tomography (CT) revealed perinephric inflammation without structural abnormalities. Upon developing intermittent fever (38 °C), epidemiological history uncovered chronic consumption of uninspected sheep meat. Brucellosis with perinephritis was confirmed via supportive <em>Brucella</em> agglutination test and blood culture.</div></div><div><h3>Conclusions</h3><div>Perinephritis is an uncommon complication of brucellosis, and atypical abdominal pain warrants consideration of zoonotic exposure. Serological testing (agglutination test) and blood culture remain critical for timely diagnosis in high-risk patients.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02372"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasopharyngeal swab for the diagnosis of SARS-CoV-2 (COVID-19) infection complicated by severe pneumococcal meningitis","authors":"Comlan Affo ,&nbsp;Jeanne Tisseau des Escotais ,&nbsp;Antoine Bosquet ,&nbsp;Isabelle Mahé","doi":"10.1016/j.idcr.2025.e02381","DOIUrl":"10.1016/j.idcr.2025.e02381","url":null,"abstract":"<div><div>The nasopharyngeal swab is the reference test for diagnosing coronavirus disease 2019 (COVID-19) and other respiratory pathogens. Although this procedure appears to be risk free and was performed thousands of times daily during peaks of the COVID-19 pandemic, as well as during influenza and bronchiolitis outbreaks, it can be associated with minor to serious risks. These range from simple epistaxis to breaches of the meninges and skull stalks. Some breaches occur in the presence of anomalies such as congenital, traumatic or surgical encephaloceles. Neuro-meningeal breaches can be complicated by bacterial infections. We report the case of a 57-year-old woman diagnosed with <em>Streptococcus pneumoniae</em> meningitis following a nasopharyngeal swab for reverse transcription polymerase chain reaction testing. She had been experiencing cerebrospinal fluid leakage for 1 year after a nasopharyngeal swab performed on an unidentified encephalocele. Antibiotic treatment followed by surgical repair of the encephalocele led to full recovery. Although nasopharyngeal swab tests seem simple, clear instructions are essential for both sample collectors and patients, and any complication, even minor, must be carefully considered. Bacterial meningitis is a serious disease that can cause death or irreversible neurological sequelae. The presence of clear fluid flow after a nasopharyngeal swab should prompt investigation for a meningeal breach. Detecting such a breach may reveal a pre-existing or newly formed malformation, allowing for specialized care to prevent severe complications such as meningitis.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02381"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemorrhagic shock and encephalopathy syndrome with hyper-inflammation and elevation of IL-6 and GDF-15 following COVID-19: A case report","authors":"Yoshinori Yokono ,&nbsp;Takeshi Ebihara ,&nbsp;Shinya Onishi ,&nbsp;Yusuke Takahashi ,&nbsp;Hisatake Matsumoto ,&nbsp;Kentaro Shimizu ,&nbsp;Satoshi Kutsuna ,&nbsp;Jun Oda","doi":"10.1016/j.idcr.2025.e02390","DOIUrl":"10.1016/j.idcr.2025.e02390","url":null,"abstract":"<div><div>Hemorrhagic shock and encephalopathy syndrome (HSES) is a life-threatening condition predominantly reported in children and often associated with viral infections such as influenza. We describe a case of HSES in a 21-year-old woman following Coronavirus disease-2019 (COVID-19) infection. She presented with a sore throat, nocturnal chills, and arthralgia one day before admission. On the day of admission, she developed fever and dyspnea and contacted emergency services. Upon arrival, her Glasgow Coma Scale score was E1V1M1 with tachycardia and hypotension. Tachycardia, hypotension, and lactate elevation persisted throughout the early phase of hospitalization. Orotracheal intubation and mechanical ventilation were initiated. Computed tomography revealed no intracranial lesions or pneumonia. A COVID-19 antigen test was positive, and cerebrospinal fluid analysis showed no meningitis. Despite intensive care, shock persisted with critical coagulopathy. Hemodynamic stabilization was achieved with vasopressors and fresh frozen plasma. On day 2, mydriasis developed, and head computed tomography revealed severe cerebral edema and extensive low-density areas consistent with HSES. Despite the administration of steroids and supportive care, the patient died on day 17. The patient’s interleukin-6 (IL-6) and growth differentiation factor (GDF)-15 levels were markedly elevated, with IL-6 peaking at 37,489 ng/mL and GDF-15 at 19,936 pg/mL, exceeding levels observed in other COVID-19 cases at our institution. HSES following COVID-19 infection can progress rapidly, accompanied by marked inflammatory cytokine elevation. Rapid onset of consciousness disorder, coagulopathy, and IL-6 elevation in COVID-19 or other viral infections should raise suspicion for HSES. Early recognition may aid in understanding its pathogenesis and guiding clinical care.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02390"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation recall reactions triggered by COVID-19 infection in a patient with buccal cancer; A clinical report and review of the literature","authors":"Yuto Takada ,&nbsp;Hiroshi Doi ,&nbsp;Yuko Kinoshita ,&nbsp;Miku Kawaguchi ,&nbsp;Yukino Numata ,&nbsp;Akifumi Enomoto","doi":"10.1016/j.idcr.2025.e02392","DOIUrl":"10.1016/j.idcr.2025.e02392","url":null,"abstract":"<div><div>A case of a patient who developed a radiation recall reaction (RRR) triggered by coronavirus disease 2019 (COVID-19) infection following surgery and chemoradiotherapy for carcinoma of the buccal mucosa is reported. A 75-year-old woman presented in October 2023 with pyrexia and erythema extending from the left cheek to the anterior chest area. In December 2021, she had undergone surgery to remove a carcinoma of the left buccal mucosa (pT2N0M0), followed by left comprehensive neck dissection for delayed cervical lymph node metastasis in June 2022, with subsequent adjuvant chemoradiotherapy. Her course was uneventful until September 2023, when she developed COVID-19. Twenty-three days after COVID-19 infection had been confirmed, she developed systemic pyrexia with erythema and a heat sensation from her left cheek to the left anterior chest. On presentation, her temperature was 39 ºC, and she had a mild sore throat. Erythema and a heat sensation were apparent from the left cheek to the neck and anterior chest, corresponding to the previously irradiated area. Laboratory tests showed a white blood cell count of 11,760/μl, and C-reactive protein of 16.0 mg/dl. Computed tomography did not show any obvious abscess formation or infection source. An RRR was diagnosed, and she was admitted for treatment with intravenous sulbactam/ampicillin and intravenous hydrocortisone sodium succinate. Five days after admission, the inflammatory reaction had improved, and she was discharged. Her subsequent course has been uneventful, with no flareup of the RRR. This case is presented along with a review of relevant literature.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02392"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"False-positive treponemal syphilis serology linked to EBV-related heterophile antibodies: Insights from a multi-platform diagnostic","authors":"Mengjie Luo,&nbsp;Yi Wu,&nbsp;Qiling Lin,&nbsp;Chunlei Zhang","doi":"10.1016/j.idcr.2025.e02403","DOIUrl":"10.1016/j.idcr.2025.e02403","url":null,"abstract":"<div><h3>Background</h3><div>Syphilis serological false positives associated with interference from heterophile antibodies induced by Epstein–Barr virus (EBV) remain rarely reported. This report aims to document a rare case of syphilis serology discordance ultimately attributed to EBV infection, imitating syphilis serology.</div></div><div><h3>Case Presentation</h3><div>A 34-year-old woman presented with facial skin lesions and underwent syphilis screening. Initial testing revealed reactive <em>Treponema pallidum</em> (<em>T. pallidum</em>) antibody (TP-Ab), positive <em>T. pallidum</em> particle agglutination assay (TPPA), and negative toluidine red unheated serum test (TRUST). Subsequent testing, including chemiluminescent platforms, immunofluorescence (FTA-ABS), Western blot, and colloidal gold methods, was non-reactive. Comprehensive workup for autoimmune and endocrine disorders was unremarkable. Further investigation revealed elevated antiphospholipid antibodies and positive EBV serologies. EBV DNA was detected. After heterophilic antibody blocking, TPPA and TP-Ab returned to negative, confirming false-positive results.</div></div><div><h3>Conclusion</h3><div>This case illustrates that heterophile antibody interference can simultaneously affect both particle agglutination and chemiluminescence-based treponemal assays, leading to false-positive results. It emphasizes the necessity of interpreting serological findings in conjunction with clinical history and, when appropriate, confirmatory molecular testing, in order to prevent misdiagnosis and unnecessary treatment.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02403"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ophthalmoplegia and vision loss in extrapulmonary tuberculosis with bilateral cavernous sinus involvement","authors":"Bilal Hassouneh ,&nbsp;Francesco Genderini ,&nbsp;Joachim G. Schulz ,&nbsp;Stelianos Kampouridis ,&nbsp;François Willermain ,&nbsp;Tom Buelens","doi":"10.1016/j.idcr.2025.e02386","DOIUrl":"10.1016/j.idcr.2025.e02386","url":null,"abstract":"<div><div>We report the case of a 41-year-old woman who initially presented with headache, right hemifacial hypoesthesia, and a right abducens palsy. Initial external investigations failed to identify an etiology, and cerebral MRI was considered normal, although later review revealed subtle meningeal thickening. Approximately two months later, she developed a right pupil-involving oculomotor nerve palsy, followed by progressive visual loss in the right eye, a right inferior quadrantanopia, and a left abducens palsy. Repeat MRI demonstrated a new contrast-enhancing lesion in the right cavernous sinus, vasculitis involving the intracavernous segment of the left internal carotid artery, FLAIR hyperintensity involving the optic chiasm and left optic tract, and dural thickening with contrast enhancement consistent with pachymeningitis. Tuberculosis was suspected based on a positive QuantiFERON-TB Gold test. Cerebrospinal fluid analysis showed mild lymphocytic pleocytosis but was negative for <em>Mycobacterium tuberculosis</em> (<em>M. tuberculosis</em>) by staining, culture, and PCR. Chest imaging was normal; however, 18F-FDG PET-CT identified a hypermetabolic iliac lymph node. Excision revealed epithelioid cell granulomas with caseous necrosis, and PCR testing (Xpert MTB/RIF Ultra) detected <em>M. tuberculosis</em>, confirmed by culture as drug-sensitive. The patient was treated with a four-drug antitubercular regimen combined with corticosteroids, leading to clinical improvement. She experienced neurological worsening during corticosteroid tapering, which resolved after dose escalation. Cavernous sinus involvement is a rare manifestation of tuberculosis, typically occurring without pulmonary disease and with nonspecific imaging or CSF findings. High clinical suspicion is essential, and identification of an accessible extracranial biopsy site may enable definitive diagnosis while avoiding invasive neurosurgical procedures.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02386"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scalp to make you squirm: Cutaneous myiasis hiding a unique presentation of disseminated coccidioidomycosis","authors":"Jared Miguel Duldulao ,&nbsp;Nina Modanlo ,&nbsp;Sushma Boppana ,&nbsp;Kristina Adachi ,&nbsp;Huan Vinh Dong ,&nbsp;Ishminder Kaur ,&nbsp;Karin Nielsen-Saines ,&nbsp;Jessica Terrell ,&nbsp;Carol E. Cheng ,&nbsp;Sanchi Malhotra","doi":"10.1016/j.idcr.2025.e02417","DOIUrl":"10.1016/j.idcr.2025.e02417","url":null,"abstract":"<div><div>Coccidioidomycosis is predominantly a pulmonary disease, however dissemination can include unique cutaneous presentations. We report a previously healthy 11-year-old female with delayed diagnosis of cutaneous scalp coccidioidomycosis with disseminated disease with secondary wound myiasis and bacterial superinfection. She required extensive surgical debridement, eventually requiring a skin graft and prolonged hospitalization for antifungal therapy, experiencing a unique adverse effect.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02417"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical pulmonary tuberculosis and haemophilus influenzae co-infection presenting as refractory postpartum fever: Diagnostic utility of next-generation sequencing","authors":"Yingchun Xiang,&nbsp;Biao Xiong,&nbsp;Li Qin,&nbsp;Hui Xu","doi":"10.1016/j.idcr.2025.e02415","DOIUrl":"10.1016/j.idcr.2025.e02415","url":null,"abstract":"<div><div>Pulmonary tuberculosis (TB) remains a pressing global health issue, with atypical presentations complicating diagnosis, particularly in postpartum women who undergo significant immunological changes. This case report presents a postpartum woman experiencing persistent fever following spontaneous abortion, initially unresponsive to empirical antimicrobial therapy. Notably, the patient exhibited no classical respiratory symptoms, and traditional tests for diagnosing TB, including acid-fast staining and PCR, all showed negative results. Ultimately, through next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) clinicians identified Mycobacterium tuberculosis and Haemophilus influenzae, suggesting that the patient had a mixed infection. Following targeted anti-tubercular treatment, the patient demonstrated rapid clinical improvement, underscoring the therapeutic significance of accurate pathogen identification. This case highlights the limitations of traditional diagnostic modalities in detecting atypical TB presentations and the critical role of advanced molecular techniques in refractory postpartum infections. Remind clinicians of the necessity of expanding differential diagnosis and the criticality of incorporating NGS into diagnostic methods for postpartum fever cases that unresponsive to empirical treatment. Furthermore, the co-infection of Mycobacterium tuberculosis and Haemophilus influenzae indicates the complex infectious milieu in immunologically altered postpartum patients, necessitating multidisciplinary collaboration for optimal outcomes. Despite challenges in accessing advanced diagnostics, this report underscores the need to recognize non-classical TB presentations. The diagnosis of atypical TB was based on the following: (1) absence of classic symptoms, including chronic cough, night sweats, weight loss, or hemoptysis; (2) negative routine TB tests—acid-fast staining and PCR of respiratory samples; and (3) chest imaging showing bilateral lower-lobe consolidation without cavitation or upper-lobe predominance. These features diverged from those of typical TB pneumonia. Moreover, NGS co-detected Haemophilus influenzae, supporting a mixed infection and reinforcing the atypical presentation. This case offers valuable insight for improving diagnosis of complex postpartum infections and warrants further study into immune mechanisms of TB reactivation postpartum.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02415"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored management of chronic bacterial prostatitis with sequential fluoroquinolones and adverse effect mitigation strategies: A case report","authors":"Thao D. Nguyen","doi":"10.1016/j.idcr.2025.e02410","DOIUrl":"10.1016/j.idcr.2025.e02410","url":null,"abstract":"<div><div>Chronic bacterial prostatitis (CBP) presents diagnostic and therapeutic challenges, particularly in patients with drug allergies and atypical symptom profiles. This case describes a retired male healthcare professional with exclusive penile pain and urinary symptoms, diagnosed with CBP. Management involved sequential fluoroquinolone therapy—ciprofloxacin followed by moxifloxacin—over 6.5 weeks, guided by clinical condition and pharmacokinetic/ pharmacodynamic (PK/PD) considerations. To mitigate adverse drug reaction (ADR) risks, the patient incorporated probiotics, tendon support measures, and QT monitoring. The individualized approach resulted in significant symptomatic improvement without complications. Follow-up focused on prostate-specific antigen (PSA) monitoring, symptom tracking, and referral to pelvic floor physical therapy. This case’s approach combining sequential fluoroquinolone therapy with structured ADR-prevention strategies and a patient-engaged, shared decision-making model underscores the importance of individualized, multidisciplinary care in CBP.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02410"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}