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HIV positive patient with GBS-like syndrome. HIV阳性的gbs样综合征患者。
Pub Date : 2017-08-01 DOI: 10.1099/jmmcr.0.005107
Samantha J Shepherd, Heather Black, Emma C Thomson, Rory N Gunson

Introduction. Guillain-Barré Syndrome (GBS) is an acute demyelinating polyneuropathy which can occur post-infection. Criteria of diagnosis of GBS include areflexia with progressive bilateral weakness in arms and legs. GBS can lead to severe respiratory and cardiac complications. The fatality rate can be up to 5 % in patients, depending on the severity of the symptoms. HIV can cause a range of neurological disorders including, on rare occasions, GBS. GBS can occur at any stage of HIV infection, highlighting the complexity of diagnosis of GBS within HIV patients. Case presentation. A 57 year old female with lumbar back pain radiating to the legs, poor mobility and tiredness, with reports of a viral-like illness four days previously, was initially diagnosed with a lower respiratory tract infection and discharged. Seventeen days later the patient was readmitted to hospital with progressive lower and upper limb weakness, areflexia and sensory loss. She was diagnosed with GBS and was unexpectedly discovered to be HIV-positive. HIV avidity was low indicating a recently acquired HIV infection. The patient was treated with intravenous immunoglobulin for five days for the GBS and commenced antriretrovirals for HIV. The patient was discharge from hospital 53 days after admission with walking aids and regular physiotherapy follow-up.

Conclusion: . This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS, regardless of clinical history should be offered an HIV test. GBS can be the first sign a patient is HIV-positive.

介绍。格林-巴勒综合征(GBS)是一种急性脱髓鞘性多神经病变,可在感染后发生。GBS的诊断标准包括反射性屈曲伴进行性双侧手臂和腿部无力。GBS可导致严重的呼吸和心脏并发症。根据症状的严重程度,患者的死亡率可高达5%。艾滋病毒可引起一系列神经系统疾病,包括在极少数情况下,GBS。GBS可发生在HIV感染的任何阶段,这突出了在HIV患者中诊断GBS的复杂性。案例演示。一名57岁女性腰背部疼痛放射至腿部,活动能力差和疲劳,4天前报告出现病毒样疾病,最初诊断为下呼吸道感染并出院。17天后,患者因进行性下肢和上肢无力、反射屈曲和感觉丧失再次入院。她被诊断出患有GBS,并且意外地被发现是hiv阳性。艾滋病毒感染率低,表明最近感染了艾滋病毒。患者静脉注射免疫球蛋白治疗GBS 5天,并开始使用抗逆转录病毒药物治疗HIV。患者入院后53天出院,辅助行走和定期物理治疗随访。结论:。该病例突出表明,所有临床医生都需要意识到,无论临床病史如何,都应向有GBS症状的患者提供艾滋病毒检测。GBS可能是患者hiv阳性的第一个迹象。
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引用次数: 12
Sinister seafood: bacteraemia secondary to non-O1/O139 Vibrio cholerae infection. 险恶的海鲜:继发于非o1 /O139霍乱弧菌感染的菌血症。
Pub Date : 2017-07-05 eCollection Date: 2017-07-01 DOI: 10.1099/jmmcr.0.005103
Maxime J Billick, Philip W Lam, Isaac I Bogoch

Introduction.Vibrio species are curved, motile Gram-negative bacilli found in estuarine and marine environments, and are known to cause to gastroenteritis, skin and soft tissue infections, and septicaemia. While not responsible for cholera epidemics, non-O1/O139 Vibrio cholerae (NOVC) is increasingly reported as a cause of gastroenteritis. Case presentation. A 66-year-old man presented to an emergency department with a 1 week history of epigastric pain, emesis and fever. Blood cultures drawn on admission initially demonstrated Gram-negative bacilli, and ultimately grew NOVC, which was later confirmed by matrix-assisted laser desorption ionization-time of flight MS. Subsequent history revealed that the patient had eaten fish and seafood prior to falling ill. He was treated with intravenous ceftriaxone and oral doxycycline while admitted, and oral ciprofloxacin and doxycycline upon discharge. His bacteraemia was believed to be secondary to altered gut anatomy from prior surgery and proton-pump inhibitor use. Conclusion. Risk factors for NOVC bacteraemia include cirrhosis, immunosuppression and other forms of liver disease. Cases are often linked to a history of seafood ingestion when water temperatures rise, enabling Vibrio species to proliferate. While the optimal management of NOVC bacteraemia is unclear, a combination of a third-generation cephalosporin with a tetracycline has been suggested. Physicians should maintain a high index of suspicion for this pathogen when evaluating ill patients with a history of liver disease and seafood ingestion.

介绍。弧菌是一种弯曲的、可运动的革兰氏阴性杆菌,存在于河口和海洋环境中,已知可引起肠胃炎、皮肤和软组织感染以及败血症。非o1 /O139霍乱弧菌(NOVC)虽然不是霍乱流行的原因,但越来越多的报道称它是肠胃炎的病因。案例演示。66岁男性,因上腹疼痛、呕吐和发热1周就诊急诊科。入院时的血液培养最初显示革兰氏阴性杆菌,最终出现NOVC,后来通过基质辅助激光解吸电离飞行时间ms证实,随后的病史显示患者在发病前吃过鱼和海鲜。入院时静脉注射头孢曲松和口服强力霉素,出院时口服环丙沙星和强力霉素。他的菌血症被认为是继发于先前手术和使用质子泵抑制剂导致的肠道解剖结构改变。结论。NOVC菌血症的危险因素包括肝硬化、免疫抑制和其他形式的肝脏疾病。病例通常与水温升高时食用海鲜的历史有关,这使得弧菌种类激增。虽然NOVC菌血症的最佳管理尚不清楚,但已建议将第三代头孢菌素与四环素联合使用。医生在评估有肝脏疾病史和海鲜摄入史的病人时,应保持对这种病原体的高度怀疑。
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引用次数: 2
Marked peripheral eosinophilia due to prolonged administration of posaconazole. 由于长期服用泊沙康唑导致明显的外周嗜酸性粒细胞增多。
Pub Date : 2017-06-30 eCollection Date: 2017-06-01 DOI: 10.1099/jmmcr.0.005100
Maher Alharbi, Rae-Kiran Jhinger, Terence Wuerz, Andrew Walkty

Introduction. Posaconazole is a triazole antifungal that is used in the treatment of a variety of fungal infections, as well as in the management of mucormycosis (on an off-label basis). Eosinophilia associated with exposure to azole antifungals has been described rarely in the literature. Case presentation. A 31-year-old male on peritoneal dialysis (PD) for end-stage renal disease, secondary to diabetic nephropathy, presented to hospital with abdominal pain after a trip to St Lucia. He was taken to the operating room, where the PD catheter was removed and an abdominal-wall abscess was debrided. Rhizopus species was recovered on culture of the abdominal-wall tissue, and the patient was started on amphotericin B deoxycholate. He was subsequently stepped down to posaconazole, for a planned treatment duration of 12 months. Approximately 43 days after the initiation of posaconazole, it was noted that his peripheral eosinophil count started to rise. No other cause for the eosinophilia was identified. Posaconazole was discontinued, and the patient's eosinophil count began to drop 2 days later. The temporal association of eosinophilia following initiation of posaconazole and the subsequent improvement after drug discontinuation suggests a probable causal relationship. Conclusion. At the time of writing, there have been only two other published cases of azole-associated peripheral eosinophilia. In reporting this case, we hope to increase health-care provider awareness of this rare adverse event. For patients receiving prolonged therapy with posaconazole, periodic monitoring of the complete blood count with differential may be considered.

介绍。泊沙康唑是一种三唑类抗真菌药物,用于治疗多种真菌感染,以及毛霉病的治疗(在标签外使用)。与暴露于唑类抗真菌药物有关的嗜酸性粒细胞病在文献中很少被描述。案例演示。31岁男性,因继发于糖尿病肾病的终末期肾病接受腹膜透析(PD)治疗,在圣卢西亚旅行后因腹痛就诊。他被带到手术室,在那里取出了PD导管,并清理了腹壁脓肿。在腹壁组织培养中恢复根霉种,患者开始使用两性霉素B脱氧胆酸。随后,他被降级到泊沙康唑,计划治疗时间为12个月。泊沙康唑开始治疗约43天后,患者外周血嗜酸性粒细胞计数开始升高。没有发现嗜酸性粒细胞增多的其他原因。泊沙康唑停用,2天后患者嗜酸性粒细胞计数开始下降。开始服用泊沙康唑后嗜酸性粒细胞增多的时间相关性和停药后的改善表明可能存在因果关系。结论。在撰写本文时,只有两个其他已发表的与唑相关的外周嗜酸性粒细胞增多的病例。在报告此病例时,我们希望提高卫生保健提供者对这一罕见不良事件的认识。对于长期接受泊沙康唑治疗的患者,可考虑定期监测全血细胞计数。
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引用次数: 5
Rash and hepatosplenomegaly in a newborn. 新生儿皮疹和肝脾肿大。
Pub Date : 2017-06-30 eCollection Date: 2017-06-01 DOI: 10.1099/jmmcr.0.005098
Eimear Kitt, Rebecca M May, Andrew P Steenhoff
A newborn male infant, with an estimated gestational age of 35weeks, was born via spontaneous vaginal delivery to a 28year-old mother, who presented in active labour with a macular rash on her hands and feet noted at the time of delivery, as shown in Fig. 1(c–e). Maternal history was significant for illicit drug use and scant prenatal care, without thorough serological evaluation performed prior to delivery. Physical examination at birth revealed a small-for-gestational-age infant in moderate respiratory distress. He had a distended abdomen with hepatosplenomegaly. Dermatological examination demonstrated dry flaky skin throughout and some scattered petechiae. Laboratory evaluation was notable for haemoglobin of 13.3 g dl , leukocytosis of 81 000 μl 1 (55% segmented neutrophils, 19% monocytes, 21% lymphocytes, 1% bands and 2% eosinophils) and thrombocytopenia of 15 000 μl 1 . The C-reactive protein level was markedly elevated at 47.8mg l . Liver function tests unearthed a transaminitis and significant hyperbilirubinaemia at time of birth, which subsequently peaked at 16.6 μmol l 1 (direct 9.9, indirect 6.2). Radiographs of extremities revealed a ‘somewhat serrated appearance of proximal femoral and humeral metaphyses’. Brain imaging with head ultrasound was normal. Abdominal ultrasound confirmed enlargement of the liver. Treatment was started for a suspected congenital infection – confirmed based on the images of the placental tissue (Fig. 1a, b). He received two platelet transfusions, one red blood cell transfusion and was started on ursodiol for treatment of conjugated hyperbilirubinaemia, at a dose of 8 mg kg 1 divided twice daily. He responded to treatment and was well when discharged home at 2 weeks of life.
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引用次数: 1
A case of Exophiala dermatitidis infection in a child after allogeneic stem cell transplantation: case report and literature review of paediatric cases. 异基因干细胞移植后儿童外表皮皮炎感染1例:儿科病例报告及文献复习。
Pub Date : 2017-06-26 eCollection Date: 2017-06-01 DOI: 10.1099/jmmcr.0.005102
Dominika Tanuskova, Julia Horakova, Darina Buzassyova, Miroslava Poczova, Ivana Bodova, Peter Svec, Alica Chocholova, Jaroslava Adamcakova, Tomas Sykora, Miroslava Pozdechova, Lucia Geczova, Alexandra Kolenova

Introduction.Exophiala dermatitidisis a relatively common environmental black yeast with worldwide distribution and is a rare cause of fungal infection, mostly in patients with certain predisposing factors. Due to the rarity of the infection, little is known about the specific predisposing factors, way of infection or treatment. Case presentation. Here, we report what is to our knowledge the first case of E. dermatitidis infection in a child after allogeneic stem cell transplantation. We also review all paediatric cases reported in the literature since 1993. Conclusion. This is, to our knowledge, the first reported case of E. dermatitidis infection in a child after allogeneic stem cell transplantation. This report should increase the awareness of E. dermatitidis in immunocompromised paediatric patients, particularly after stem cell transplantation.

介绍。外源性皮炎是一种比较常见的环境黑酵母,分布在世界各地,是一种罕见的真菌感染原因,主要发生在具有某些易感因素的患者中。由于感染的罕见性,对具体的易感因素,感染方式或治疗方法知之甚少。案例演示。在这里,我们报告什么是我们所知的第一例皮炎杆菌感染的儿童后异体干细胞移植。我们还回顾了自1993年以来文献报道的所有儿科病例。结论。据我们所知,这是第一例异体干细胞移植后儿童皮炎杆菌感染的报道。该报告应提高免疫功能低下的儿科患者,特别是干细胞移植后对皮炎的认识。
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引用次数: 8
Cutaneous fungal infection in an immunocompromised host. 免疫力低下人群的皮肤真菌感染。
Pub Date : 2017-06-21 eCollection Date: 2017-06-01 DOI: 10.1099/jmmcr.0.005101
David Sotello, Mark Cappel, Tamara Huff, Diana Meza, Salvador Alvarez, Claudia R Libertin
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引用次数: 0
Acute diarrhoea due to a Shiga toxin 2e-producing Escherichia coli O8 : H19. 由产志贺毒素2的大肠杆菌O8: H19引起的急性腹泻。
Pub Date : 2017-06-14 eCollection Date: 2017-06-01 DOI: 10.1099/jmmcr.0.005099
Angela Saupe, Birgit Edel, Wolfgang Pfister, Bettina Löffler, Ralf Ehricht, Jürgen Rödel

Introduction. Identification of non-O157 Shiga-toxin-producing Escherichia coli (STEC) infections may be underestimated in microbiological diagnosis. Case presentation. A 58-year-old woman developed diarrhoea with watery and subsequently mucous stool. Initial multiplex PCR testing revealed a positive result for stx2 . Culture isolation of a STEC was successful only after repeated inoculation of chromogenic E. coli media. Molecular characterization was performed and identified the isolate as stx2e-positive STEC of serotype O8 : H19. The strain harboured lpfA, but not eae. Conclusion. This case highlights the usefulness of initial multiplex PCR for diagnosis of non-O157 STEC infection.

介绍。非o157产志贺毒素大肠杆菌(STEC)感染的鉴定在微生物学诊断中可能被低估。案例演示。一名58岁妇女出现腹泻,随后出现水样便和粘液便。初步多重PCR检测显示stx2阳性。只有反复接种显色大肠杆菌培养基才能成功培养分离出产志毒素大肠杆菌。分子鉴定鉴定该分离株为血清型O8: H19 stx2e阳性产志贺毒素大肠杆菌。该菌株含有lpfA,但不含eae。结论。本病例强调了初始多重PCR对诊断非o157产志在大肠杆菌感染的有用性。
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引用次数: 10
First case of human peritoneal cysticercosis mimicking peritoneal carcinosis: necessity of laparoscopy and histologic assessment for the correct diagnosis. 模拟腹膜癌的人腹膜囊虫病第1例:腹腔镜检查的必要性和正确诊断的组织学评估。
Pub Date : 2017-06-08 eCollection Date: 2017-06-01 DOI: 10.1099/jmmcr.0.005097
Martina Rudelius, Klaus Brehm, Martin Poelcher, Christoph Spinner, Andreas Rosenwald, Clarissa Prazeres da Costa

Introduction. Correct diagnosis of peritoneal infectious disease can be extremely difficult due to non-specific clinical features. Thus, careful assessment with thorough histopathological work-up is essential. Here, we report the first case of human peritoneal cysticercosis mimicking peritoneal carcinosis. Case presentation. The patient presented with recurring ascites and a tumour in the Douglas cavity accompanied by elevated tumour markers. There were no signs of systemic infection. On laparoscopy, the tumour was resected completely. Histology revealed a granulomatous reaction and a diagnosis suspicious of tuberculosis was made. Only after additional sections, avital cestode-fragments were visible and Taenia martis DNA was detected. Further staging by computerized tomography scan of the lung and brain turned out negative and the patient recovered quickly. Conclusion. Laparoscopy and histopathological examination can be extremely helpful for correct diagnosis and management in uncertain recurrent ascites. This case clearly demonstrates that orphan infectious diseases should also be considered. Only complete histopathological examination with serial sections and additional molecular testing can lead to the appropriate diagnosis.

介绍。由于非特异性的临床特征,腹膜传染病的正确诊断非常困难。因此,仔细的评估和彻底的组织病理学检查是必不可少的。在此,我们报告第一例模拟腹膜癌的人腹膜囊虫病。案例演示。患者表现为反复腹水和道格拉斯腔肿瘤伴肿瘤标志物升高。没有全身感染的迹象。腹腔镜下,肿瘤被完全切除。组织学显示肉芽肿反应,诊断疑似肺结核。只有在附加切片后,才能看到重要的囊胚片段,并检测到带绦虫DNA。肺部和脑部电脑断层扫描的进一步分期结果为阴性,患者很快康复。结论。腹腔镜和组织病理学检查对不确定复发性腹水的正确诊断和治疗有很大帮助。这一案例清楚地表明,还应考虑孤儿传染病。只有完整的组织病理学检查与系列切片和额外的分子检测可以导致适当的诊断。
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引用次数: 7
A case of Vibrio vulnificus infection complicated with fulminant purpura: gene and biotype analysis of the pathogen. 创伤弧菌感染并发暴发性紫癜1例:病原菌基因及生物型分析。
Pub Date : 2017-05-19 eCollection Date: 2017-05-01 DOI: 10.1099/jmmcr.0.005096
Masatoshi Hori, Akifumi Nakayama, Daisuke Kitagawa, Hidetada Fukushima, Hideki Asai, Yasuyuki Kawai, Kazuo Okuchi

Introduction.Vibrio vulnificus (V. vulnificus) causes a severe infection that develops in the compromised host. Its pathophysiology is classified into three types: (1) primary septicaemia, (2) gastrointestinal illness pattern and (3) wound infection pattern. Of these, primary septicaemia is critical. V. vulnificus can be classified into three biotypes and two genotypes and its pathogenicity is type-dependent. Case presentation. A 47-year-old man presented to a local hospital with chief complaints of fever, bilateral lower limb pain and diarrhoea. He had no history of foreign travel or known medical problems. He was in septic shock and developed fulminant purpura within 24 h of the onset. High-dose vasopressor and antibiotic administration failed to alter his status and he died 3 days after the onset of symptoms. V. vulnificus was isolated from blood, skin and nasal discharge cultures. Biotype and gene analysis of the microbe isolated identified it as Biotype 3, mainly reported in Israel in wound infections, and Genotype E, implicating an environmental isolate. These typing analyses indicated that the microbe isolated could be classified as a type with low pathogenicity. Conclusion. This case highlighted that Biotype 3 and Genotype E can also cause primary septicaemia. Although the majority of reports on Biotype 3 have been from the Middle East, this experience with the present case provided evidence that the habitat of Biotype 3 V. vulnificus has been extending to East Asia as well.

介绍。创伤弧菌(V. vulnificus)在受损的宿主中引起严重的感染。其病理生理分为三种类型:(1)原发性败血症,(2)胃肠道疾病型和(3)伤口感染型。其中,原发性败血症最为严重。创伤弧菌可分为三种生物型和两种基因型,其致病性具有类型依赖性。案例演示。一名47岁男子以发热、双侧下肢疼痛和腹泻为主诉到当地医院就诊。他没有国外旅行史,也没有已知的健康问题。患者为感染性休克,发病24小时内出现暴发性紫癜。大剂量血管加压剂和抗生素未能改变他的状态,他在出现症状3天后死亡。从血液、皮肤和鼻分泌物培养中分离出创伤弧菌。对分离到的细菌进行生物型和基因分析,鉴定为生物型3(主要报道于以色列的伤口感染)和基因型E(可能是环境分离物)。分型分析表明,分离的微生物可归为低致病性的一类。结论。该病例强调,生物型3和基因型E也可引起原发性败血症。虽然大多数关于生物型3的报告来自中东,但本病例的经验证明,生物型3创伤弧菌的栖息地也已扩展到东亚。
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引用次数: 9
Lower extremity mycotic aneurysm in a patient with Listeria monocytogenes - associated prosthetic valve endocarditis. 单核增生李斯特菌相关人工瓣膜心内膜炎患者下肢真菌性动脉瘤1例。
Pub Date : 2017-05-09 eCollection Date: 2017-05-01 DOI: 10.1099/jmmcr.0.005095
Elham Rahmati, P Jan Geiseler, Rosemary C She

Introduction.Listeria monocytogenes is a rare etiology of infectious endocarditis with only 30 cases of prosthetic valve and about twice as many native valve infections described in the literature. We describe an unusual presentation of an endovascular embolic phenomenon with associated lower extremity mycotic aneurysm due to Listeria monocytogenes prosthetic aortic valve and aortic endograft infection. Case presentation. This is a case of an elderly gentleman with prior history of bioprosthetic aortic valve placement and aortic arch repair who was admitted with several weeks of constitutional symptoms and left lower leg pain. Diagnostic work-up was consistent with thrombosed popliteal artery aneurysm. Blood cultures were positive for Listeria monocytogenes. A transesophageal echocardiogram revealed vegetation on the bioprosthetic valve. The patient underwent arterial bypass and ligation of the aneurysm as well as redoing of his aortic valve and aortic graft replacement. Histopathology of the aortic valve was remarkable for acute inflammation and Gram-positive coccobacilli and bacilli occupying intracellular spaces. The results of broad-range bacterial 16S rRNA PCR and sequence analysis of unfixed aortic valve tissue confirmed detection of L. monocytogenes. Conclusion. Infective endocarditis attributable to species of the genus Listeriais a rare entity. As such, there are no specific guidelines for treatment of Listeria monocytogenesendocarditis. However, combination of penicillin or ampicillin with gentamicin is the most acceptable approach described in the literature. Our patient was treated with ampicillin and gentamicin for 6 weeks followed by life-long amoxicillin suppression therapy. The patient remained asymptomatic at a 6 months follow up visit.

介绍。单核细胞增生李斯特菌是一种罕见的感染性心内膜炎的病因,只有30例人工瓣膜,大约是文献中描述的原生瓣膜感染的两倍。我们描述了一个不寻常的血管内栓塞现象,并伴有下肢真菌性动脉瘤,这是由于单核细胞增生李斯特菌人工主动脉瓣和主动脉内移植物感染引起的。案例演示。这是一位有生物假体主动脉瓣置换术和主动脉弓修复史的老年男士,因几周的体质症状和左下肢疼痛入院。诊断结果与血栓形成的腘动脉动脉瘤一致。血培养单核细胞增生李斯特菌阳性。经食管超声心动图显示生物瓣膜上有植被。患者接受了动脉搭桥术、动脉瘤结扎术、主动脉瓣重做术和主动脉瓣置换术。主动脉瓣的组织病理学表现为急性炎症、革兰氏阳性球菌和占据细胞内间隙的杆菌。广谱细菌16S rRNA PCR和未固定主动脉瓣组织序列分析结果证实检测到单核增生乳杆菌。结论。感染性心内膜炎可归因于李斯特菌属的一种罕见的实体。因此,对于单核细胞增生李斯特菌心内膜炎的治疗尚无具体的指南。然而,青霉素或氨苄西林联合庆大霉素是文献中描述的最可接受的方法。我们的病人接受氨苄西林和庆大霉素治疗6周,随后终生阿莫西林抑制治疗。患者随访6个月无症状。
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引用次数: 3
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JMM case reports
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