Case Reports in Infectious Diseases最新文献

We report the case of a 55-year-old male with AIDS who developed severe thrombocytopenia following initiation of trimethoprim-sulfamethoxazole. Despite drug discontinuation and supportive measures, thrombocytopenia persisted, leading to the patient's death. This case highlights the complexities of drug-induced immune thrombocytopenia in immunocompromised patients and emphasizes the risks associated with trimethoprim-sulfamethoxazole.

Severe fever with thrombocytopenia syndrome (SFTS), primarily a tick-borne disease, can also cause fatal human-to-human transmission. This report analyzes a cluster of six SFTS cases identified in China in 2022, involving one index patient and five secondary infections, with an overall mortality of 83%. All secondary cases occurred in elderly individuals (aged 66-85 years) following unprotected exposure to the index patient's body fluids during bedside care or traditional postmortem rituals, without documented tick bites. The high fatality rate underscores the potential severity of secondary transmission, particularly among elderly adults. More critically, this outbreak exposes systemic delays in early diagnosis even within an endemic area, highlighting fundamental gaps in the clinical management of undifferentiated fever. Effective prevention, therefore, relies on establishing a clinical system for early detection, rapid diagnosis, and prompt isolation while implementing culturally adapted community interventions to reliably interrupt transmission.

Malaria-associated acute kidney injury (MAKI) is a formidable and potentially fatal complication of malaria. Early recognition and timely management can significantly reduce morbidity and mortality, particularly in resource-limited settings. This case series describes five patients with imported Plasmodium falciparum complicated by MAKI who were treated at Kilimanjaro Christian Medical Center (KCMC) in northeastern Tanzania between December 2023 and January 2024. The cohort comprised of four males and one female, with a mean age of 38.2 ± 18.6 years. All patients presented with a history of fever and a recent history of travel to high-endemic regions. The mean serum creatinine and urea levels at admission were 736 ± 346.4 μmol/L and 23.1 ± 14.1 mmol/L, respectively. Four patients required hemodialysis, and one experienced malaria recrudescence. Overall survival was 100%. This case series highlights pathophysiological mechanisms, clinical presentations, diagnostic challenges, and management outcomes of MAKI, illustrating its modified natural history. Despite advances in understanding MAKI, early diagnostic and treatment challenges persist. This case series aimed to elucidate the underrecognized burden and patterns of MAKI in a resource-limited, low-endemic region within an endemic country.

Background: Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is a bloodstream infection that can lead to a wide range of complications, from localized skin infections to serious and systemic conditions. While MSSA remains susceptible to beta-lactam antibiotics, its potential for hematogenous dissemination poses significant clinical challenges impacting multiple organ systems and causing substantial morbidity.

Clinical presentation: We present the case of a 61-year-old male patient who developed disseminated MSSA bacteremia following suspected soft tissue inoculation events. His clinical course was complicated by spinal epidural abscess, right atrial thrombus, chest wall abscess, septic arthritis, prevertebral abscess, left psoas abscess, and gluteal abscess. He underwent T6 laminectomy with evacuation of the epidural abscess, debridement of the chest wall abscess, percutaneous thromboembolectomy, and multiple incisions and drainage procedures. A multidisciplinary approach was essential in achieving clinical improvement.

Conclusion: This case underscores the aggressive potential of disseminated MSSA bacteremia to spread beyond its initial source, resulting in widespread organ involvement. Early recognition through imaging, prompt source control, and targeted antimicrobial therapy are critical in managing the complex sequelae of this condition.

Candida inconspicua is an uncommon opportunistic yeast, increasingly reported in immunocompromised patients. We describe a case of asymptomatic Candiduria caused by C. inconspicua in a 43-year-old woman with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia undergoing chemotherapy. During multiple episodes of high-risk febrile neutropenia, urine cultures repeatedly isolated C. inconspicua, identified via MALDI-TOF MS and exhibiting high fluconazole resistance (MIC: 16.0 μg/mL). Despite these findings, no antifungal therapy was administered due to the absence of urinary symptoms and resolution of fever with antibacterial treatment. This case illustrates the clinical dilemma posed by rare, drug-resistant Candida species in asymptomatic infections, emphasizing the importance of precise microbiological identification and antimicrobial stewardship. The emergence of C. inconspicua, with potential for resistance and biofilm formation, underscores the need for careful evaluation in hemato-oncological patients, particularly when considering the risks and benefits of initiating antifungal therapy in the absence of clinical symptoms.

Mycobacterium marinum is an acid-fast bacterium (AFB) associated with exposure to water and aquatic species. When inoculated, infection can result in nodular cutaneous lesions. In the absence of detailed history or culture data, these nodular skin lesions can be mistaken for noninfectious orthopedic conditions. We present a case of M. marinum mistaken for a giant cell tumor. This case illustrates the overlap in these conditions, as well as the utility of QuantiFERON Gold testing to provide supportive evidence for the diagnosis of Mycobacterium marinum.

The paradigm of renal involvement in HIV patients has changed in recent years, from HIV-associated nephropathy to nephroangiosclerosis, due to the increased survival of these patients and their comorbidities. Some of these are leishmaniasis and hepatitis C and their treatments, especially direct-acting antivirals, which may induce reconstitution of the cellular immunity and activate a latent autoinflammatory disease. Case presentation: We present a 51-year-old Caucasian patient with chronic HCV liver disease and HIV Stage A3 who suffered from kidney disease throughout his life. In the first episode, he debuted with nephrotic proteinuria when he was not taking any treatment for HIV. Renal biopsy showed focal segmental glomerulosclerosis that could be due to HIV or other infectious-related disease such as leishmaniasis. Whatever it is, the proteinuria responded to treatment for both infectious diseases. Nine years later, while the patient was on treatment with a new antiviral for HCV, he presented a complete nephrotic syndrome flare. A second biopsy showed amyloidosis A. The first biopsy was then reviewed, and minimal traces of amyloid were detected. Conclusions: Kidney involvement in HIV patients should be examined with high precision to detect any sign of different renal pathologies that may coexist. Comorbidities and their treatments might challenge and add to the differential diagnosis.

Lactobacilli are Gram-positive, facultatively aerobic, rod-shaped bacteria that are a normal part of the human microbiota and rarely cause infections in immunocompetent hosts. Lactobacillus casei and Lactobacillus rhamnosus are the most common human pathogens within this genus and are also frequently used in probiotics. Both species are inherently resistant to vancomycin, and penicillin-sometimes in combination with aminoglycosides-remains the primary treatment for infections caused by these organisms. Management becomes particularly challenging in patients with severe penicillin allergies, such as anaphylaxis. Although daptomycin has demonstrated in vitro activity against these pathogens, clinical data on its use are limited. Here, we present a case of Lactobacillus rhamnosus endocarditis successfully treated with 6 weeks of intravenous daptomycin.

Hemodialysis patients are at a greater risk of severe disease from COVID-19. Of the 600 maintenance hemodialysis patients who were regular attendees at the Tripoli Hemodialysis Center in Tripoli, Libya, 12 patients tested positive for SARS-CoV-2 infection. The patients' ages ranged from 48 to 80 years. Three were female (25%), and four (33.3%) reported prior contact with a confirmed case. The most common symptoms were fever (66.7%), dry cough (66.7%), dyspnea (91.7%), and fatigue (83.3%). Chest computed tomography revealed radiological features consistent with COVID-19 pneumonia, including ground-glass opacities and pulmonary consolidation in all patients. Four of the patients died (33.3%). COVID-19 represents a significant comorbidity in maintenance hemodialysis patients and is associated with a notably high mortality rate. In the absence of specific operational guidelines, tailored protocols should be developed, or existing guidelines-such as those from the CDC-should be adapted to fit the local healthcare context.

We present a lethal case of Bourbon virus infection in a 63-year-old Caucasian, diabetic male who was previously in good health. The patient had spent time in the wooded areas of Bourbon County, Kansas, and removed three ticks from his body 5 days prior to presentation. The patient had acute multisystem organ failure requiring multiple inotropes and pressor agents, renal replacement therapy, and venoarterial extracorporeal membrane oxygenation (VA-ECMO). This report describes the presentation, clinical outcomes, and background on Bourbon virus infection.