IDCases最新文献

Klebsiella pneumonia is known to cause hospital-acquired infections, primarily in immunocompromised patients. Recently, a distinct syndrome of community-acquired invasive Klebsiella pneumonia infection has been observed, mainly in the Southeast Asian population. This syndrome is associated with disseminated infection and the formation of multiple organ abscesses. Affected organs include the liver, the meninges, the brain, the eyes, and rarely the skin and soft tissue. Most of the affected patients suffer from diabetes mellitus. We present a case of invasive community-acquired Klebsiella pneumonia infection with the skin as the primary source. The patient was found to have multiple abscesses involving the skin, the liver, the right lung, and the brain. Cultures from the wound, the liver abscess, and the blood all revealed Klebsiella pneumonia. The liver abscess was drained, and the patient received a prolonged course of antibiotics based on the sensitivity. One month later, the patient achieved full recovery. Our report highlights the emerging syndrome of invasive community-acquired Klebsiella pneumonia infection and the need for timely diagnosis and treatment to achieve favorable outcomes.

Enterobacter cloacae is the leading cause of morbidity and mortality in the genus Enterobacter. It mostly causes nosocomial infections, especially in children, the elderly and those with underlying diseases. However, cases of community-acquired bacteraemia caused by E. cloacae have been reported. The increasing inclination of E. cloacae to cause multidrug-resistant infections has made it particularly challenging to treat. A 25-month-old male child presented to a rural hospital in The Gambia with a one-week history of persistent high-grade fever, dyspnoea, and anorexia. Two days before presentation, he began to have generalized tonic-clonic seizures. On examination, he was found to be febrile, dyspnoeic, pale, and tachycardic. He had a modified Glasgow Coma Scale score of 9/15. Investigations revealed an elevated C-reactive protein, low haemoglobin, and elevated white blood cell count. Cerebrospinal fluid culture did not yield any growth. E. cloacae was isolated from a blood culture taken on the day of admission. The pathogen was resistant to all available antibiotics. He was transfused with whole blood and initially treated empirically with amoxicillin-clavulanic acid and gentamicin. The former was changed to cefuroxime because the child had not improved. The child died nine days after admission. Although E. cloacae is primarily known for causing nosocomial infections, fatal community-acquired infections also occur. This case report demonstrates the difficulty in treating multidrug-resistant E. cloacae in a low-resource setting and its propensity to cause fatal infections.

We report the case of a 56-year-old female with a past medical history of multiple sclerosis on disease-modifying therapy of fingolimod who presented with disseminated Coccidioides infection, initially of the ankles bilaterally before progressing to the central nervous system. CNS coccidiomycosis has thus far not been associated with any pharmacological therapy for multiple sclerosis. Clinicians should have a high degree of suspicion for Coccidioides infection in immunosuppressed patients living in endemic areas.

Background

Recurrent acute cholangitis (RAC) is a relatively uncommon entity that presents significant management difficulties. We present the case of a patient with RAC in whom the number of episodes was reduced after a novel therapeutic procedure.

Case report

A 93-year-old male who in June 2019 was admitted for chills without fever, shivering, epigastric abdominal pain and moderate jaundice. Both abdominal ultrasound and CT scan showed intrahepatic and extrahepatic duct dilatation up to the papilla with no evidence of mass at that level. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and abundant biliary sludge was removed. E. coli was identified as the cause of several of the episodes. Some isolates were shown to produce extended spectrum beta-lactamase (ESBL). Papillotomy was performed and plastic prosthesis and later a metallic prosthesis were implanted. Several months later a surgical bypass of the biliary tract was performed due to persistent episodes of cholangitis. When the chronic suppressive antibiotic treatment subsequently instituted to prevent new episodes of cholangitis failed, it was decided to perform a fecal microbiota transplant from a healthy donor and to suspend the chronic suppressive treatment. Since then, she has not presented new episodes of RAC for more than 10 months of clinical follow-up. BLEE-producing E. coli in the gastrointestinal tract could not be eradicated.

Comment

Chronic colonization of the biliary tract by certain enterobacteria such as E. coli has been identified as a relevant pathogenic factor in cases of RAC. FMT may be a promising tool to improve the clinical course of patients with RAC.

HSV-1 encephalitis (HSE) is the most common cause of fatal sporadic encephalitis in the United States. HSE in adults is most commonly due to the reactivation of HSV in the central nervous system (CNS) which results in CNS necrosis leading to neurological compromise. The most common symptoms include altered mentation, fever, seizures, and focal neurological deficits. HSE most commonly involves damage to the temporal lobes however can rarely involve other CNS structures such as the brainstem and cerebellum. Immunocompromised status may increase the risk of atypical HSE. HSE involvement of the brainstem, particularly the pons, most commonly cause neuro-ocular and neuro-bulbar deficits. Rarely can HSV brainstem encephalitis cause quadriplegia or locked-in syndrome. We present a case of HSV-1 rhombencephalitis complicated by locked-in syndrome in a patient with CLL.

Introduction

Extrapulmonary legionella disease is rare and occasionally reported in immunocompromised patients; it includes lymphadenitis, panniculitis, hepatitis, atrio-ventricular block, arthritis, prosthetic valve endocarditis and myocarditis. In this article, we report a rare case of legionella suppurative lymphadenitis in an immunocompetent patient.

Case

53-year-old female patient from the Philippines, non-smoker, previously healthy who presented to our facility for chills and respiratory distress following a course of corticosteroid intake. She was admitted for respiratory failure and septic shock, and was diagnosed with legionella infection associated with extrapulmonary dissemination (lymphadenitis) leading to her death 72 h after admission.

Discussion

Legionella is an important cause of community acquired pneumonia (CAP) and a delay in appropriate antibiotic therapy was associated with an increased mortality rate. Since legionnaire’s disease is indistinguishable from other forms of pneumonia without diagnostic testing, empiric antibiotic therapy regimen should cover legionella species. In unfortunate cases, a delay in the diagnosis and treatment may lead to extrapulmonary manifestations such as lymphadenitis and will be associated with worse patient outcomes.

Conclusion

Legionella is an important cause of community acquired pneumonia which if left untreated can become complicated with extrapulmonary manifestations such as lymphadenitis and become eventually fatal to patients. A prompt early diagnosis and appropriate antimicrobial therapy covering legionella should be considered whenever treating community acquired pneumonia.

Adult haemophagocytic lymphohistiocytosis (HLH) is an infrequent and life-threatening condition. The most common triggers of HLH are malignancy and virus, and bacterial infections are rarely implicated. We present a case of HLH secondary to Staphylococcus aureus infection and systemically searched the PubMed database for publications on HLH associated with Staphylococcus aureus infection and reviewed nine cases from seven studies. A marked third of patients had infective endocarditis, while the mortality rate was 44 %. HLH developed in our case despite elimination of MRSA from the bloodstream, leading to eventual demise of our patient, suggesting that prolonged hyperimmune response may persist even after the elimination of initial triggering factor. Our case highlights the necessity of high clinical suspicion and prompt diagnosis of HLH.

Escherichia coli (E. coli) is a facultative anaerobic gram-negative rod bacterium, which can acquire pathogenicity through the acquisition of additional genetic material. We present a case of E. coli ST1193, an emerging global multidrug-resistant (MDR) high-risk clone, causing native valve endocarditis and septic brain and splenic emboli in a 67-year-old woman.

Purpose

This study presents a rare case of primary tubercular osteomyelitis of the zygoma, and addresses how combined surgical and medical treatments are effective managing rare presentations of tubercular osteomyelitis in facial bones.

Methods

A 57-year-old man presented with pain and purulent discharge from the right malar region following trauma. Initial treatments with empirical antibiotics had poor response, hence further investigations were done. Comprehensive diagnostic workup included lab tests, Computed tomography with contrast, and histopathological examination. The patient underwent surgical debridement of the zygomatic bone through an intraoral approach, and debrided tissue was sent for microbiological and histopathological examination, which confirmed tubercular osteomyelitis. Post-surgery, the patient was treated with a four-drug anti-tubercular regimen.

Results

Following anti-tubercular therapy, the patient showed significant improvement, with no signs of disease recurrence after a year of follow-up.

Conclusion

Primary tubercular osteomyelitis of the zygoma is extremely rare but should be considered in differential diagnoses of facial swellings and discharging sinuses. This case underscores the importance of a multidisciplinary approach in treating rare presentations of tubercular osteomyelitis.