IDCases最新文献

Burkholderia cepacia complex (BCC) has been recognized as a serious cause of pneumonia in patients with cystic fibrosis. BCC infection has also been reported in non-cystic fibrosis patients. Notably, the mortality rate of bacterial pneumonia caused by BCC is high. Nonetheless, therapeutic management of BCC infection remains to be established. Recent reports have indicated successful treatment of BCC pneumonia with combination antibiotic therapy. However, no reports have detailed the efficacy of combination antibiotic therapy for both initial and recurrent BCC pneumonia management. We herein describe a rare case of BCC pneumonia in a non-cystic fibrosis patient that was successfully treated with a combination of intravenous, inhalational and oral antibiotics. Furthermore, antibiotic therapy including inhaled tobramycin has been continued after discharge from hospital, and no side effects or recurrence of bacterial pneumonia has been observed, although BCC has been detected in sputum. The findings of the present case suggest that combination antibiotic therapy including inhaled tobramycin may be effective for recurrent bacterial pneumonia caused by BCC. In the management of BCC infection, early diagnosis should be made based on sputum culture results, and combination antibiotic therapy should be initiated promptly.

Dengue is a viral disease caused by a single-stranded RNA virus from the Flaviviridae family, primarily transmitted by the Aedes aegypti mosquito, although Aedes albopictus also plays a role as a vector. Clinical features of dengue range from nonspecific symptoms to severe forms like dengue shock syndrome. Among these clinical features, dermatological manifestations are particularly noteworthy, as they can aid in differentiating dengue from other illnesses.

Air leak syndrome, including pneumomediastinum (PM), pneumopericardium, pneumothorax, or subcutaneous emphysema, is primarily caused by chest trauma, cardiothoracic surgery, esophageal perforation, and mechanical ventilation. Secondary pneumomediastinum (SP) is a rare complication, with a much lower incidence reported in patients with coronavirus disease 2019 (COVID-19). Our patient was a 44-year-old nonsmoker male with a previous history of obesity (Body Mass Index [BMI] 35 kg/m²), hyperthyroidism, hypokinetic cardiopathy and atrial fibrillation in treatment with flecainide, who presented to the emergency department with 6 days of fever, cough, dyspnea, and respiratory distress. The COVID-19 diagnosis was confirmed based on a polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After initiation of mechanical ventilation, a chest computed tomography (CT) on the first day revealed bilateral multifocal ground-glass opacities, consolidation and an extensive SP and pneumoperitoneum. Our therapeutic strategy was initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) as a bridge to recovery after positioning 2 drains (mediastinal and pleural), for both oxygenation and carbon dioxide clearance, to allow protective and ultra-protective ventilation to limit ventilator-induced lung injury (VILI) and the intensity of mechanical power for lung recovery. After another chest CT scan which showed a clear reduction of the PM, 2 pronation and neuromuscular relaxation cycles were also required, with improvement of gas exchange and respiratory mechanics. On the 15th day, lung function recovered and the patient was then weaned from VV-ECMO, and ultimately made a good recovery and was discharged. In conclusion, SP may be a reflection of extensive alveolar damage and should be considered as a potential predictive factor for adverse outcome in critically ill SARS-CoV2 patients.

Carbapenem resistance due to metallo-beta-lactamases (MBLs) is a global phenomenon and an important challenge for antibiotic therapy (Boyd et al., 2020 [1]). While previous reports have demonstrated both in vitro and in vivo synergy using the combination of ceftazidime-avibactam and aztreonam against Stenotrophomonas maltophilia, an MBL-harboring organism, this treatment strategy has not been reported during pregnancy (Mojic et al., 2017 [2], [3], Mojica et al., 2016 [4], Alexander et al., 2020 [5]). We describe a 33-year-old pregnant female with polymicrobial, bilateral pyelonephritis caused by Stenotrophomonas maltophilia and other gram-negative bacteria. The organisms were eradicated with the combination of ceftazidime-avibactam and aztreonam followed by successful delivery with no observed adverse effects in either mother or child post-partum.

Trichosporon asahii is considered an opportunistic pathogen, capable of causing superficial infections in humans and invasive deep-seated infections in immunocompromised hosts. Pneumocystis jirovecii can cause life-threatening pneumonia in immunosuppressed patients. Both Trichosporon and Pneumocystis jirovecii are highly lethal in immunocompromised individuals. Here we present a case of invasive Trichosporon asahii co-infection with Pneumocystis jiroveci in a renal transplant patient.

Hypervirulent K. pneumoniae infection has been raising worldwide and is one of the major causes of community-acquired pyogenic liver abscess. We described a case report of pyogenic liver abscess caused by an atypical hypervirulent (non-hypermucoviscous) K. pneumoniae K1 ST23 in a diabetic Asian patient who resided in Mexico. The susceptibility to antimicrobials, pathogenicity, molecular and genomic analysis were determined. A man from Guangdong (China) with a recent diagnosis of diabetes mellitus was admitted to the hospital, and he denied traveling in the last 3 months. A computed tomography revealed a right lobe liver abscess. On the third day after admission a Klebsiella pneumoniae isolate (14652) was obtained. The isolate corresponded to a susceptible K. pneumoniae with capsular type K1 and ST23 (CG23) and exhibited a non-hypermucoviscous phenotype. The isolate 14652 was genetically related to the globally distributed lineage ST23-KL1. This study describes the first case in Mexico of K. pneumoniae capsular type K1 and ST23 with an atypical hypervirulent phenotype.

Kaposi Sarcoma (KS) commonly manifests with multiple vesicular cutaneous and mucosal nodules, with four subtypes clinically recognized. Although commonly seen in younger men, our patient presented with presumed epidemic KS at an older age. Additionally, our patient presented with Kaposi sarcoma during primary HIV infection which is atypical for Kaposi sarcoma presentation. The patient’s clinical course is important to follow, as his rectal involvement indicates the patient would benefit from systemic therapy. Furthermore, our case highlights the need for a keen clinical index of suspicion in all patients with new HIV diagnosis and new onset suspicious lesions, regardless of age.

Q fever is frequently associated with the development of antiphospholipid antibodies though rarely causes thromboses. A 44-year-old man presented with diarrhea and fevers and was found to have a splenic infarct. Infectious work-up revealed acute Q fever as well as high anticardiolipin antibody titers. He was treated with doxycycline and hydroxychloroquine and suffered no further thromboembolic complications. The optimal management of thromboembolic complications is uncertain given the rarity of documented cases. However, the presence of these antibodies has been associated with increased risk of complications. Further investigation into the management of patients with Q fever associated hypercoagulability is needed.

Streptococcal toxic shock syndrome (STSS) has a dramatic clinical course and high mortality rate. Here, we report a case of STSS complicated by primary peritonitis and bilateral empyema. A previously healthy young woman was diagnosed with STSS complicated by primary peritonitis and bilateral empyema. Blood culture results on admission were negative. Sever shock, respiratory failure, systemic inflammation, thrombocytopenia, renal failure, ascites, and pleural effusion occurred, mimicking thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure and organomegaly (TAFRO) syndrome. Retesting blood cultures identified Streptococcus pyogenes. Gram staining of ascites and pleural fluid indicated gram-positive cocci in chains. Antibiotics, immunoglobulins, and surgical intervention led to recovery without complications. Ex-post genotypic analyses showed uncommon emm103.0 (cluster E3) of emm long sequence (784 base) and novel sequence type 1363. STSS diagnosis can be difficult as it mimics other systemic inflammatory diseases. Therefore, it is crucial for clinicians to perform microbiological examinations from infection foci, even if the initial culture is negative.