JMM case reports最新文献

Introduction. Endocarditis caused by yeasts is currently an emerging cause of infective endocarditis and, when accompanied byfever of unknown origin, is more severe since interferes with proper diagnosis and endocarditis treatment. Case presentation. The Rio de Janeiro Infective Endocarditis Study Group reports a case of infectious endocarditis (IE) with negative blood cultures in a 45-year-old white female resident in Rio de Janeiro, Brazil, previously submitted to kidney transplantation. After diagnosis and intervention, the valve culture revealed Rhodotorula mucilaginosa. The clinical aspects and overview of endocarditis caused by Rhodotorula spp. demonstrated that R. muscilaginosa have been isolated from the last IE cases from kidney transplanted patients. Conclusion. Though most of the patients (in literature) recovered well from endocarditis caused by Rhodotorula spp., physicians must be aware for diagnosis of fungemia and fungal treatment in kidney transplanted patients suffering of fever of unknown origin in the modern immunosuppressive treatment.

Introduction. Leptospirosis is a zoonotic bacterial disease of global distribution affecting humans and animals. The initial phase of leptospirosis resembles many other febrile illness and due to its broad and biphasic clinical manifestations, selection and implementation of appropriate diagnostic tests can be challenging. Case presentation. This report describes a case investigation of a 14 weeks old male, orphan puppy, presented with generalised jaundice, anemia, weakness, and anorexia. Clinical abnormalities included the evidence of renal and hepatic failure. Antemortem and postmortem diagnostic investigations were conducted to identify the cause of illness. PCR testing and culture of blood was positive for Leptospira sp. Necropsy followed by histopathology evaluation revealed lesions compatible with liver and kidney damage consisting of marked diffuse hepatocellular dissociation, acute renal tubular necrosis, and mild interstitial nephritis. Conclusion. Multiple diagnostic techniques including bacterial isolation confirmed Leptospira infection in this puppy. Whole genome sequencing and analysis identified the Leptospira sp. isolated from this puppy as Leptospira interrogans serovar Copenhageni. To our knowledge, this case report describes the first isolation of Leptospira from Saint Kitts. This case highlights the usefulness of including multiple diagnostic tests for the diagnosis and epidemiological investigation of Leptospira infection. Accurate diagnosis followed by timely intervention can prevent case fatality and mortality in infected patients.

Introduction.Tropheryma whipplei is the causative agent of Whipple's disease. Gastrointestinal and lymphatic tissues are affected in the majority of cases, resulting in diarrhoea, malabsorption and fever. Here, we report a rare case of ocular manifestation in a patient lacking the typical Whipple symptoms. Case presentation. A 74-year-old Caucasian female presented with blurred vision in the right eye over a period of 1-2 months, accompanied by stinging pain and conjunctival hyperaemia for the last 2 days. Upon admission, visual acuity was hand motion in the affected eye. Ophthalmological examination showed typical signs of intraocular inflammation. Diagnostic and therapeutic pars plana vitrectomy including vitreous biopsy and intravitreal instillation of vancomycin and amikacin was performed within hours of initial presentation. Both microscopic analysis and microbial cultures of the vitreous biopsy remained negative for bacteria and fungi. The postoperative antibiotic regime included intravenous administration of ceftriaxone in combination with topical tobramycin and ofloxacin. Due to the empirical therapy the inflammation ceased and the patient was discharged after 5 days with cefpodoxime orally and local antibiotic and steroidal therapy. Meanwhile, the vitreous body had undergone testing by PCR for the eubacterial 16S rRNA gene, which was found to be positive. Analysis of the PCR product revealed a specific sequence of T. whipplei. Conclusion. In our patient, endophthalmitis was the first and only symptom of Morbus Whipple, while most patients with Whipple's disease suffer from severe gastrointestinal symptoms. 16S rDNA PCR should be considered for any intraocular infection when microscopy and standard culture methods remain negative.

Introduction. Infection with the Rasamsonia argillacea species complex represents an emerging problem in human and veterinary medicine with systemic mycoses presenting with significant clinical complications and being a cause of death. Case presentation. In this report, a case of systemic Rasamsonia piperina infection discovered in a 3-year-old male neutered, German shepherd cross dog is described together with the clinical presentation, the course of the disease and diagnosis. This report describes the first case of veterinary mycosis due to R. piperina in Europe and the first case in humans or animals in the UK. Conclusion. Although seemingly rare, R. argillacea species complex infection should be a differential diagnosis for dogs, especially German shepherds with the described presenting signs, and radiographic and ultrasonographic findings.

Introduction. Species of the genus Chryseobacterium are emerging healthcare-associated pathogens, often colonizing the hospital environment. There are no clear guidelines available for antimicrobial susceptibility of this organism. In this report we present the first case, to our knowledge, of simultaneous central-line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) due to Chryseobacterium gleum from India. Case presentation. A 62 years old man with a history of a road traffic accident 1 month previously was referred to our center for further management. He developed features of sepsis and aspiration pneumonia on day 3 of admission. Four blood cultures (two each from central and peripheral lines) and two tracheal aspirate cultures grew pure yellow colonies of bacteria. Both matrix assisted laser desorption ionization time of flight mass spectrometry, (MALDI-TOF MS; bioMérieux, Marcy-L'Etoile, France,) and BD Phoenix (BD Biosciences, Maryland, USA) identified the organism as C. gleum. However, BD Phoenix failed to provide MIC breakpoints. The isolates of C. gleum both from blood and tracheal aspirate showed identical susceptibility patterns: resistant to cephalosporins and carbapenems and susceptible to ciprofloxacin, levofloxacin, amikacin, trimethoprim+sulfamethoxazole, piperacillin-tazobactam, cefoperazone-sulbactam, doxycycline, minocycline and vancomycin. Following levofloxacin therapy, the fever responded within 48 h and procalcitonin levels decreased without removal of the central line or endotracheal tube. However, the patient developed sudden cardiac arrest on day 10 of treatment and could not be resuscitated. Conclusion. Rapid and accurate identification of C. gleum in the laboratory, preferably based on MALDI-TOF, is essential for guiding therapy. C. gleum responds well to fluoroquinolones without the need to remove indwelling catheters.

Introduction. At emergency departments, history taking is often very brief. We present a case of an Aeromonas wound infection, that illustrates the importance of careful history taking. We also report the first successful use of polarized light as additional therapy for healing of this infectious wound. Case presentation. A healthy boy was diagnosed with a wound infection, after a fall onto rocks. At first, it remained unmentioned that there had been contact with ditchwater, so he was treated with amoxicillin-clavulanic acid. Only after the finding of an Aeromonas strain in the wound culture, and treatment with a fluoroquinolone, did he recover. Wound healing was aided with the use of polarized light, and with good effect. To our knowledge, this is the first report on the effect of polarized light on the healing of infectious wounds. Conclusion. Careful history taking is essential for adequate empiric therapy when faced with wounds and wound infections. Aeromonas infections are associated with water exposure, and should be treated with fluoroquinolones. Polarized light seems to have a good result on healing of infectious wounds.

Introduction. Preterm premature rupture of membranes (PPROM) usually has a multifactorial etiology that is often unknown, although the most frequently reported cause is infection by group B Streptococcus. Therefore, the etiology of PPROM, although probably infectious, remains unknown in most cases. This case describes a PPROM caused by infection from oropharyngeal microbiota. Case presentation. We report the case of a 26-yr-old pregnant woman. The gestational age was 32 weeks+5 days. Examinations in the emergency department revealed the release of clear amniotic fluid and a closed multiparous cervix with a length of 22 mm. Endocervical culture evidenced the growth of Staphylococcus aureus, serogroup B Neisseria meningitidis and Haemophilus influenzae. Conclusion. Preventive antibiotic therapy should consider: opportunistic infections by normal genital microbiota, infections due to sexual activity, opportunist microorganisms derived from oral sex, and the hematogenous spread of oral bacteria.

Introduction. This is the first case report of septic abortion due to β-lactamase-negative ampicillin-resistant (BLNAR) non-typeable Haemophilus influenzae infection. In Japan, BLNAR H. influenzae is widespread and has become a clinical concern, especially in paediatrics and otolaryngology, but H. influenzae has not been previously recognized as a causative agent of obstetric or gynaecological infection. Case presentation. A 31-year-old pregnant woman presented at 17 weeks and 6 days of gestation with a high fever; she was admitted with a diagnosis of threatened premature delivery. Despite tocolytic treatment, she aborted spontaneously 2 h after admission and then entered septic shock. BLNAR H. influenzae was detected in both blood and vaginal cultures. Her condition gradually improved after several days of treatment with cefotaxime, and she was ultimately discharged without sequelae or complaints. Conclusion. Although penicillin with a β-lactamase inhibitor is currently recommended for the treatment of septic abortion, this combination will probably lead to treatment failure in the case of BLNAR H. influenzae infection. As this study reveals, H. influenzae can cause septic abortion; hence, future efforts should be undertaken to detect and therapeutically target this pathogen during pregnancy.

Introduction. Coronary artery stents are an uncommon site for infection. Only a handful of case reports describe this condition, and Staphylococcus aureus is the most frequent pathogen. Although rare, coronary stent infections are associated with a high mortality rate. Case presentation. We describe the case of a 50-year-old man with a past medical history of seven prior meticillin-resistant S. aureus (MRSA) infections over the previous 12 months, who presented with fever and was found to have persistent MRSA bacteraemia. During his hospital course, he developed chest pain and underwent coronary angiography, which revealed a left circumflex coronary to left atrium fistula, presumably due to endarteritis/sent infection. He was treated with combination parenteral antibiotics that were succeeded by oral suppressive therapy. Six months after his diagnosis of coronary stent infection, he suffered a fatal cardiac arrest. Conclusion. Coronary artery stents are an infrequent source of infection; when they occur, they are typically due to S. aureus, have a high mortality and ideally are treated with surgical intervention.

Introduction.Mycoplasma pneumoniae is a small cell-wall-lacking bacterium that belongs to the mycoplasma (Mollicutes) prokaryote micro-organisms. It is a common cause of both upper and lower respiratory tract infections in all age groups. Respiratory illness is the most common manifestation of M. pneumoniae infection; however, extrapulmonary involvement may be present or predominant. The skin, mucus membranes, central nervous system, cardiovascular system, haematopoietic system, kidneys and musculoskeletal system are the most commonly involved extrapulmonary sites. Immune thrombocytopenia purpura has been reported as a rare haematological manifestation of mycoplasma infection. Here, we report, with a literature review, the case of a young adult with M. pneumoniae infection, presenting with acute febrile illness, myringitis, erythema multiforme, mild Raynaud's phenomenon symptoms and severe thrombocytopenia. Case presentation. Our patient was a 24-year-old healthy man who presented to an emergency department with acute febrile illness, upper respiratory tract infection symptoms, myringitis, erythema multiforme skin lesions, severe thrombocytopenia, and pale and cold hands. Mycoplasma serology suggested acute M. pneumoniae infection. The patient had a complete resolution of symptoms and gradual recovery from the thrombocytopenia after a course of anti-Mycoplasma therapy with azithromycin. Our case illustrates the multi-system involvement of M. pneumoniae infection. Conclusion.M. pneumoniae is a frequent cause of upper and lower respiratory tract infections in children and young adults. Multi-system involvement including the skin, vascular and haematological systems in young adults with upper or lower respiratory tract infection, as in our patient, should raise the suspicion of Mycoplasma infection. Our case also illustrates an excellent clinical response and recovery from thrombocytopenia shortly after anti-Mycoplasma antimicrobial therapy.