IDCases最新文献

Pyopericardium is a rare cause of cardiac tamponade. We present a case of a dengue fever patient who presented with cellulitis of the upper limbs, later manifesting cardiac tamponade, which was fatal. Although echocardiography on admission revealed a small pericardial effusion only, it later manifested as tamponade, causing cardiogenic shock. Staphylococcus pyopericardium was found later. Early identification could be possible with bedside point-of-care ultrasonography and echocardiography. Emergent pericardiocentesis or pig tail drain placement is life saving.

Bacillus subtilis var. natto, a low-pathogenic bacterium used in the traditional Japanese food "natto" (fermented soybeans), has rarely been reported as a pathogen of infectious diseases in humans. Herein, we report the first case of persistent bacteremia caused by B. subtilis var. natto in an immunocompetent patient without any gastrointestinal involvement. A 53-year-old Japanese woman who had been consuming natto every day was admitted to our hospital with complaints of fever and chills. B. subtilis was isolated from blood cultures collected during the initial visit. Abdominal contrast-enhanced computed tomography (CT) showed multiple low-absorption areas in the liver and spleen. Treatment commenced with vancomycin; however, Bacillus sp. was re-detected in the blood culture on day 4 after treatment initiation. The blood culture on day 8 was negative. Subsequently, the treatment was switched to ampicillin-sulbactam and oral amoxicillin-clavulanic acid, and the patient recovered after 28 days of treatment from the time the blood cultures became negative. Contrast-enhanced CT of the abdomen at the end of treatment showed that the multiple low-absorption areas in the liver and spleen had disappeared. Later, the variant of the bacteria was identified as B. subtilis var. natto by DNA analysis. B. subtilis var. subtilis and B. subtilis var. natto cannot be distinguished using matrix-assisted laser desorption/ionization-time of flight mass spectrometry or 16S rRNA analysis. Biotin auxotrophy of B. subtilis var. natto is used to distinguish between the two variants.

Staphylococcus epidermidis is a typically indolent pathogen that is often considered a blood culture contaminant. It is a rare and unexpected cause of osteomyelitis, especially in the absence of recent surgical intervention or orthopedic implants. We highlight a case in which a 90-year-old Caucasian male with no recent spine surgery was found to have osteomyelitis of the lumbar spine and repeat positive blood cultures for methicillin resistant Staphylococcus epidermidis (MRSE). Further investigation revealed a history of mitral valve replacement and a new diagnosis of endocarditis leading to persistent bacteremia and seeding of his lumbar vertebrae. This case demonstrates that S. epidermidis can cause vertebral osteomyelitis resulting in severe complications that are more similar to highly pathogenic bacteria. We describe the steps to diagnosing this chronic undetected infection and related comorbidities.

Aspergillosis is an infrequent infection in the Central Nervous System with a mortality rate higher than 95 %. Early diagnosis is challenging and crucial. In this report, we present the case of a six-year-old female with an intense headache accompanied by left hemiparesis, gaze deviation, horizontal nystagmus, and vomiting of mucous content on five occasions. After several approaches, a cerebrospinal fluid PCR resulted positive for Aspergillus spp., and then management started with amphotericin B at 2.6 mg/kg/day and was managed to have voriconazole. She survived, and two years after her first hospital admission, she suffered from cerebral aspergillosis sequelae. An area of improvement is the coordination between the request and delivery of studies outside the institution. In this case, the patient´s mother did not report the analysis results on time, delaying the diagnosis.

Antiretroviral (ARV) absorption in persons living with human immunodeficiency virus (PLWH, HIV) with short bowel syndrome is limited. We describe a case of a 28-year-old male with newly diagnosed HIV and plasmablastic lymphoma with proximal jejunostomy necessitating parenteral nutrition. ARV therapy with dolutegravir 50 mg twice daily and once daily tenofovir/emtricitabine was initiated with documented malabsorption and delayed virologic suppression (VS). Dolutegravir dose titration with therapeutic drug monitoring (TDM) resulted in VS at month 12. ARV TDM with dose titration is an option for PLWH with malabsorptive states to maintain VS.

Histoplasma vascular graft infection (VGI) is rarely reported, with only a handful of instances documented in the existing literature. Reporting Histoplasma VGI cases is important as they demonstrate previous treatment strategies and their outcomes. In this paper, we report a case of disseminated histoplasmosis with ascending aortic graft infection. Conservative therapy was attempted initially but failed, and our patient eventually required surgical graft explantation. Our case demonstrates the challenges in diagnosing and managing VGI caused by Histoplasma capsulatum.

Clostridial gas gangrene (CGG) is among the most rapidly spreading infections in humans, with mortality rates approaching 100 % if not treated promptly. Most cases follow traumatic inoculation, although spontaneous infections occur in a minority of patients with immunodeficiency. Spontaneous CGG is primarily caused by Clostridium septicum, whereas traumatic infection is associated with Clostridium perfringens. Patients with CGG present abruptly with rapidly progressive symptoms, underscoring the importance of early recognition, prompt surgical intervention, and appropriate antimicrobial therapy. We describe an illustrative case of spontaneous CGG caused by C. perfringens in a polymorbid 73-year-old female patient. Despite aggressive medical and surgical management, she succumbed to metastatic infection within 48 h of presentation.

Azoles are frequently used to treat systemic mycoses but have been associated with a number of adverse effects of the skin and skin appendages. Herein we describe two cases of chronic paronychia in pediatric patients receiving fluconazole for coccidioidomycosis. Their clinical characteristics are described, and the literature reviewed.

Melioidosis is an emerging tropical infectious disease in travelers. We present a case of travel related melioidosis in a 65-year-old man with chronic obstructive pulmonary disease and end stage renal disease following a two-week business trip to Thailand and attendance of the Songkran festival. This case emphasizes that vigilance, heightened clinical suspicion, and use of appropriate microbiology diagnostic tools are of paramount importance for a timely diagnosis and successful management. With the ever-increasing global travel, infectious diseases specialists, microbiologists, and public health professionals are constantly challenged by unfamiliar infections in returned travelers.

71-year-old male with history of obstructive sleep apnea presented with persistent drainage from the surgical incision site over the recently implanted hypoglossal nerve stimulator. Wound cultures from device pocket identified the pathogen as Turicella otitidis. Clinical course included treatment with broad-spectrum intravenous antibiotics and device explantation. This case is the first known T. otitidis device associated infection.