Case Reports in Infectious Diseases最新文献

Embolic stroke due to prosthetic valve endocarditis (PVE) caused by Candida parapsilosis is a rare and serious complication. Successful management requires a combination of medical and surgical approaches. We present a case full of complexities in diagnosing and managing Candida PVE, emphasizing the importance of a multidisciplinary approach. A 50 year-old male presented to the emergency department with vertigo and low-grade fever and was found to have cerebellar stroke likely from the cardioembolic origin, and the patient had a history of uncontrolled diabetes and double prosthetic valves. The diagnosis was challenging and required transesophageal echocardiography (TEE) which showed two vegetations attached to the mitral valve prosthesis. The management involved antifungal therapy, but surgery was hindered by financial issues. The patient was considered for the AngioVac vegetation aspiration system due to persistent fungemia. Eventually, surgery was not performed, and the patient was discharged with a plan for long-term suppressive antifungal therapy.

Rhodococcus equi is a rare human opportunistic pathogen that has been increasingly reported in recent decades. It mainly affects immunosuppressed patients, and in particular human immunodeficiency virus (HIV)-infected patients, where it typically presents as cavitary pneumonia. Early treatment with combined and effective antimicrobials and antiretroviral therapy after prompt diagnosis is essential to ensure an optimal outcome. We present a case series of three human Rhodococcus equi infections in HIV-infected patients with advanced immune suppression, treated at the University Hospital of Antwerp, Belgium.

Introduction: Broviac catheter is a type of central venous catheter (CVC) used for long-term parenteral nutrition in specific patients, e.g., diagnosed with intestinal failure as short bowel syndrome (SBS). The way of the catheter insertion is conceived to minimalize the risk of infections. However, CVC-related blood stream infections (CVC-BSIs), including infective endocarditis (IE), remain most important complications associated with Broviac catheter. Staphylococcus epidermidis stands out as a prevalent pathogen. The increasing number of CVCs results in an increased incidence of healthcare-associated IE. Complete parenteral treatment is an independent risk that increases the likelihood of IE. Treatment of IE is mainly based on antibiotic therapy, but in certain cases, surgical treatment is needed. Presentation of Case: A 71-year-old female with SBS who had been receiving total parenteral nutrition through the Broviac catheter for several months was admitted in a serious condition with significant weakness, increasing shortness of breath, deteriorating cough, fever, low blood pressure, and heart palpitations. Echocardiography revealed severe aortic valve IE with a large, longitudinal, highly mobile vegetation (up to 40 mm) and massive aortic regurgitation with pulmonary edema. Fast pathogen detection in the patients' blood (S. epidermidis) was obtained using PCR-based multiplex test. Due to life-threatening conditions, emergency surgery with aortic valve replacement was performed. Consistent rehabilitation resulted in good condition achievement. Follow-up echocardiography showed normal function of the aortic valve bioprosthesis. Conclusion: The use of CVC, including Broviac catheter, is associated with an increased risk of infections, including IE. Treatment-resistant severe HF complicating IE requires emergency surgery.

Syphilis is a sexually transmitted infection caused by Treponema pallidum. It progresses in phases and undiagnosed disease can cause considerable morbidity. Tertiary syphilis causes the formation of gummas. Liver involvement is rarely described and usually limited to transaminase elevation during primary syphilis. We present a case of tertiary syphilis in an HIV patient. Microbiological, clinical, and radiological information were retrieved from the patient's record. Gummatous syphilis is rarely described in the literature, and practicing physicians should be aware of its existence and include this manifestation in the differential diagnosis of patients with a positive serology and focal liver lesions.

Ureaplasma parvum is one of the most common endemic mycoplasmas in the genitourinary tract and can cause amniotic fluid infection leading to preterm labor. We report a rare case of Ureaplasma parvum infection ascending from the vagina to the abdominal cavity after hysterectomy, causing vaginal cuff infection, postoperative peritonitis, and small bowel obstruction. A 29-year-old nulliparous woman presented with infected uterine cervical cancer. After radical hysterectomy for uterine cervical cancer, the patient had paralytic ileus with ascites and fever. Peritonitis was suspected; however, all cultures were negative, making it difficult to identify the causative organism. Polymerase chain reaction (PCR) of the ascites revealed Ureaplasma parvum, which could be treated with levofloxacin (LVFX). Open drainage to control the infection revealed a necrotic tissue around vaginal cuff and the small intestine encased in cocoon-like fibers like sclerosing encapsulating peritonitis. After the infection was improved, the bowel obstruction was also improved. Ureaplasma spp. can be difficult to culture. PCR testing for Ureaplasma infection should be considered when urogenital infection is suspected in patients prone to opportunistic infections, such as those with malignant tumors.

Four cases of serious congenital cytomegalovirus (CMV) infections are described in this report. All cases were diagnosed postnatally using cerebrospinal fluid (3/4) or blood PCR (1/4) and histochemical study of the placenta (4/4). All infants were born prematurely. Maternal factors identified as significant were younger age at pregnancy and those from low-income social strata. The major clinical findings among patients with congenital CMV infection were hydrocephalus and persistent thrombocytopenia. The children's clinical condition did not improve over the course of the disease, leading to complications associated with extreme prematurity. Two of the children died, one of whom had severe brain malformations and showed neurological compromise at follow-up, seizures, motor impairment, and severe cognitive delay. It is essential to perform antenatal screening for possible CMV infection among pregnant women, even in countries with high population seropositivity, such as Mexico, to establish prenatal interventions to reduce the risk of fetal damage.

Cryptococcosis, an infection caused by Cryptococcus neoformans and Cryptococcus gattii, predominantly targets the central nervous system (CNS) in patients with AIDS but is not limited to this group. The disease can also occur in individuals with various immunosuppressive conditions, frequently involving the brain or lungs. Cryptococcal meningitis (CM) is the most common form of fungal meningoencephalitis, leading to intracerebral infections, cerebral infarction, or hydrocephalus. The clinical presentation of CM is nonspecific, and imaging features can vary significantly. This case report presents a patient with cerebral infarction, who was HIV-negative but had been on long-term cortisone therapy. Notably, the patient had a history of pulmonary cryptococcosis 15 years prior to cerebral involvement. When initially at our clinic, histology and culture results from brain biopsies were negative and the earlier pulmonary cryptococcosis history was unknown. Subsequently, cryptococcal antigen was detected in both serum and cerebrospinal fluid (CSF), and C. neoformans was cultivated from CSF. This case highlights the critical importance of maintaining a high index of suspicion for CM, particularly in patients with a history of previous cryptococcal infections, and it also demonstrates the possibility of false-negative brain biopsy results due to secondary vascular events associated with CM.

Capnocytophaga canimorsus is a rare cause of serious infections with a high mortality of 10% to 30%. It is usually found in the oral cavity of cats and dogs and can cause severe sepsis in immunocompromised patients. An 81-year-old female Caucasian patient presented with C. canimorsus sepsis after a dog bite in her finger three days before presentation to our emergency department. She initially was presented to us with sepsis, thrombopenia, and schistocytes in her laboratory findings, suggesting the differential diagnoses of the multiple subtypes of thrombotic microangiopathy. She was admitted to the medical intensive care unit of the University Hospital of Saarland because of septic shock with circulatory insufficiency. The patient received plasmapheresis, antibiotics, and dialysis, under which she improved significantly. The fingertip of the affected finger developed necrosis and had to be amputated. Furthermore, the patient was diagnosed with a mitral valve endocarditis, a very rare complication of C. canimorsus infection. It was treated conservatively with antibiotics and was no longer detectable 8 weeks after the diagnosis. Surgical intervention was not needed. The case describes well that it is still difficult to distinguish between thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC), and sepsis-induced coagulopathy (SIC), especially in the early phases of acute disease, especially in C. canimorsus-induced sepsis.

Cat scratch disease (CSD) typically presents as a self-limiting lymphadenopathy associated with a cat bite or scratch and commonly affects children and young adults. Atypical manifestations, involving the eyes, nervous system, heart, liver, spleen, skin, and musculoskeletal system, could be severe and difficult to diagnose, and they could occur in 5%-20% of the cases. Herein, we report an unusual case of CSD with multifocal osteomyelitis. A 15-year-old girl presented with right axillary lymphadenopathy. Since she had a history of cat scratch, azithromycin was started for CSD. Two days later, she was readmitted to our hospital with severe back pain which required differential diagnosis. Lumbar spinal magnetic resonance imaging (MRI) revealed multifocal vertebral osteomyelitis. The patient was hospitalized, and then teicoplanin and cefotaxime were added to the azithromycin therapy. After excluding the possible other causes, the definitive diagnosis of osteomyelitis secondary to CSD was made upon the combination of the MRI scan findings of the vertebrae, histopathological investigation of excisional right axillary biopsy, positron-emission tomography/computed tomography (PET/CT), and Bartonella henselae serologies. Atypical manifestations of CSD are widely variable; therefore, it should be kept in mind in the differential diagnosis of severe musculoskeletal pain and osteomyelitis.

AZD7442 (150 mg of tixagevimab plus 150 mg of cilgavimab) has been approved for the preexposure prophylaxis of COVID-19 and for the treatment of adults and adolescents with COVID-19 who do not require supplemental oxygen and who are at increased risk of severe COVID-19. Thus, the aim of the present study is to evaluate the neutralizing capacity of tixagevimab and cilgavimab across different SARS-CoV-2 variants in two patients who received AZD7442 for immunoprophylaxis. A cohort of subjects (n = 45) who had received the BNT162b2 mRNA COVID-19 vaccine has been included to compare these two preventive strategies. Neutralizing antibody (NAb) titers against several variants were assessed against the wild-type, alpha, beta, gamma, delta, omicron BA.5, and XBB.1.5 variants. Binding antibodies have also been measured. NAbs T _1/2 for AZD7442 was 8.1 days (95% CI: 5.1-19.5 days) and was 11.8 days (95% CI: 7.9-23.7 days) for the primo-vaccination cohort. The time to reach neutralization negativity was 108.3 days (95% CI: 66.9-130.7) for AZD7442 compared to 95.4 days (95% CI: 31.0-119.7 days) for the primo-vaccination cohort. The time to reach NAbs' negativity differs between variants with the maximum value obtained for alpha (i.e., 101.1 days (95% CI: 30.0-135.4 days)) and the minimum obtained for beta (i.e., 61.2 days (95% CI: 37.8-77.1 days)). Our results reinforce the need of reviewing the use of AZD7442 in relation to variants of concern and potentially adapting its administration schedule. AZD7442 could be indicated for short-term prophylaxis in frail patients who may be acutely exposed to SARS-CoV-2.