IDCases最新文献

Shigella typically causes gastrointestinal infections, and extra-intestinal manifestations are rare. We report the first known case of pyogenic cervical spondylitis co-infected with Escherichia coli and Shigella flexneri, highlighting the diagnostic challenges and clinical implications. A 53-year-old woman presented with neck pain for one month. MRI revealed C6 and C7 vertebrae abscesses. The patient underwent anterior cervical debridement and bone-graft fusion. Intraoperative pus culture grew Escherichia coli, while metagenomic next-generation sequencing detected both Escherichia coli and Shigella species. Intravenous imipenem 500 mg every 6 h was administered, leading to full wound healing at a 6-month follow-up. This case emphasizes the importance of considering Shigella infection in the differential diagnosis of pyogenic spondylitis and demonstrates the utility of a multi-pronged diagnostic approach.

Alveolar echinococcosis (AE) is a common and significant public health problem caused by the larvae of the Echinococcus multilocularis. The occurrence of epididymal AE is rare and often overlooked in combination with mycobacterium tuberculosis infection. We report a case of a 34-year-old man who presented with right-sided scrotal enlargement with pain. Physical examination revealed an enlarged right scrotum with rupture. CT examination showed a blurred border and non-enhancing lesion on the right epididymis. Postoperative pathology and molecular biology identified an epididymal E. multilocularis infection. We report this rare case to emphasise the difficulty of preoperative diagnosis and the importance of complete surgical excision of the lesion.

One patient with rifampin-resistant tuberculosis underwent emergency left pneumonectomy and thoracic gauze packing for hemoptysis due to recurrent hemoptysis after transcatheter arterial embolization. Vital signs were maintained by mechanical ventilation and medication. Tracheotomy and anti-tuberculosis treatment were performed. After half a year of follow-up, the patient's condition was stable.

Brodie’s abscess is a manifestation of subacute to chronic osteomyelitis, characterized as intraosseous abscess formation, usually on the metaphysis of the long tubular bones in the lower extremities of male pediatric patients. Clinically, Brodie’s abscess presents with atraumatic bone pain of an insidious onset, with absence of systemic findings. Delay in diagnosis is common, as diagnostic imaging, followed by biopsy for culture and histologic examination are generally required to secure a diagnosis of Brodie’s abscess. Treatment of Brodie’s abscess is non-standardized, and usually consists of surgical debridement and antibacterial therapy. Despite the variability in therapeutic approaches, outcomes of Brodie’s abscess treated with surgery and antibiotics are favourable. Herein we report a case of a delayed diagnosis of Brodie’s abscess in the upper extremity of an adult female. While she improved with treatment of Brodie’s abscess, the case serves to remind clinicians to consider this entity in adult individuals who present with atraumatic bone pain.

Purpose

Observations

Conclusions

Introduction

Presentation of case

Discussion

Conclusion

Purpose

Immunizations have long been pivotal in preventing diseases like HZ (herpes zoster), caused by VZV (varicella zoster virus). This study aims to evaluate the efficacy and safety of the RZV (recombinant zoster vaccine) compared to the ZVL (zoster vaccine live) and to report rare adverse events following RZV administration.

Observation

Herein, we report an unusual case of a 59-year-old man who developed a V1-limited rash with a positive HZ PCR (polymerase chain reaction) test following administration of RZV in the United States.

Conclusion

The development of RZV has significantly improved the prevention of HZ compared to ZVL. Nevertheless, rare adverse events, such as dermatomal reactions, underscore the importance of ongoing monitoring and research into the immunomodulatory effects of RZV. Physicians should continue to administer the RZV to patients but be cognizant that reactivation may rarely subsequently occur.

Case Presentation

The patient with a history of benign prostatic hyperplasia was treated at an outside hospital two days after receiving the RZV complaining of paresthesia and a rash on his nasolacrimal area and forehead. The patient presented to the ED (emergency department), 9 days post-vaccination due to persistence of his symptoms despite use of amoxicillin, valacyclovir, and an unidentified eye drop. The dose of valacyclovir was increased, and he completed 1 g TID (three times a day) PO (per orally) for 10 days with subsequent resolution of symptoms. A positive PCR test confirmed the diagnosis of HZ. Topical mupirocin ointment was initiated and the patient was referred for ophthalmologic evaluation.

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.