Pub Date : 2024-10-24eCollection Date: 2024-01-01DOI: 10.1155/2024/1093820
Małgorzata Wilawer, Waldemar Elikowski, Natalia Fertała, Arkadiusz Włodarski, Patryk Szczęśniewski, Paulina Anna Ratajska, Paweł Bugajski
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.
{"title":"Broviac Catheter-Related Aortic Valve Infective Endocarditis Complicated With Massive Aortic Regurgitation Requiring Emergency Surgery: A Case Report.","authors":"Małgorzata Wilawer, Waldemar Elikowski, Natalia Fertała, Arkadiusz Włodarski, Patryk Szczęśniewski, Paulina Anna Ratajska, Paweł Bugajski","doi":"10.1155/2024/1093820","DOIUrl":"10.1155/2024/1093820","url":null,"abstract":"<p><p><b>Introduction:</b> 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. <i>Staphylococcus epidermidis</i> 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. <b>Presentation of Case:</b> 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 (<i>S. epidermidis</i>) 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. <b>Conclusion:</b> 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.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21eCollection Date: 2024-01-01DOI: 10.1155/2024/6571155
Nadia Solomon, Tom Heller, Tommaso Manciulli, Paola Del Giacomo, Katleen de Gaetano Donati, Enrico Brunetti, Francesco Taccari
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.
{"title":"An Uncommon Manifestation of a Great Imitator: Gummatous Syphilis of the Liver in an HIV-Positive Patient.","authors":"Nadia Solomon, Tom Heller, Tommaso Manciulli, Paola Del Giacomo, Katleen de Gaetano Donati, Enrico Brunetti, Francesco Taccari","doi":"10.1155/2024/6571155","DOIUrl":"https://doi.org/10.1155/2024/6571155","url":null,"abstract":"<p><p>Syphilis is a sexually transmitted infection caused by <i>Treponema pallidum</i>. 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.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21eCollection Date: 2024-01-01DOI: 10.1155/2024/4114954
Hayato Chikamatsu, Mana Taki, Sachiko Kitamura, Masumi Sunada, Koji Yamanoi, Ryusuke Murakami, Ken Yamaguchi, Akihito Horie, Yasuhiro Tsuchido, Junzo Hamanishi, Masaki Mandai
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.
{"title":"Vaginal Cuff Infection Caused by <i>Ureaplasma parvum</i> After Hysterectomy for Uterine Cervical Cancer: A Case Report.","authors":"Hayato Chikamatsu, Mana Taki, Sachiko Kitamura, Masumi Sunada, Koji Yamanoi, Ryusuke Murakami, Ken Yamaguchi, Akihito Horie, Yasuhiro Tsuchido, Junzo Hamanishi, Masaki Mandai","doi":"10.1155/2024/4114954","DOIUrl":"https://doi.org/10.1155/2024/4114954","url":null,"abstract":"<p><p><i>Ureaplasma parvum</i> 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 <i>Ureaplasma parvum</i> 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 <i>Ureaplasma parvum</i>, 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. <i>Ureaplasma</i> spp. can be difficult to culture. PCR testing for <i>Ureaplasma</i> infection should be considered when urogenital infection is suspected in patients prone to opportunistic infections, such as those with malignant tumors.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17eCollection Date: 2024-01-01DOI: 10.1155/2024/7510447
Saúl Flores-Medina, Ricardo Figueroa Damian, Gabriela Arreola-Ramírez, Noemi Plazola-Camacho, Graciela Villeda-Gabriel, Sara A Ochoa, Ariadnna Cruz-Córdova, Juan Xicohtencatl-Cortes, José Arellano-Galindo
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.
{"title":"Severe Cytomegalovirus Congenital Infection With Neurological Compromise a Case Series Study in Mexico: Severe CMV and Neurological Compromise.","authors":"Saúl Flores-Medina, Ricardo Figueroa Damian, Gabriela Arreola-Ramírez, Noemi Plazola-Camacho, Graciela Villeda-Gabriel, Sara A Ochoa, Ariadnna Cruz-Córdova, Juan Xicohtencatl-Cortes, José Arellano-Galindo","doi":"10.1155/2024/7510447","DOIUrl":"https://doi.org/10.1155/2024/7510447","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04eCollection Date: 2024-01-01DOI: 10.1155/2024/3905985
Anatoli Pinchuk, Gernot Geginat, Volker Rickerts, Belal Neyazi, Klaus Peter Stein, Christian Mawrin, I Erol Sandalcioglu, Ali Rashidi
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.
{"title":"Late Relapse of Previous Pulmonary Cryptococcosis With Symptoms Resembling Cerebral Infarction: A Case Report.","authors":"Anatoli Pinchuk, Gernot Geginat, Volker Rickerts, Belal Neyazi, Klaus Peter Stein, Christian Mawrin, I Erol Sandalcioglu, Ali Rashidi","doi":"10.1155/2024/3905985","DOIUrl":"https://doi.org/10.1155/2024/3905985","url":null,"abstract":"<p><p>Cryptococcosis, an infection caused by <i>Cryptococcus neoformans and Cryptococcus gattii</i>, 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 <i>C. neoformans</i> 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.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18eCollection Date: 2024-01-01DOI: 10.1155/2024/4010115
Jeannine L Kühnle, Maximilian Leitner, Vitalie Mazuru, Kai Borchardt, Sören L Becker, Franziska Roth, Robert Bals, Philipp M Lepper, Hans-Joachim Schäfers, Isabella T Jaumann
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.
{"title":"<i>Capnocytophaga canimorsus</i> Septicemia With Sepsis-Induced Coagulopathy and Endocarditis.","authors":"Jeannine L Kühnle, Maximilian Leitner, Vitalie Mazuru, Kai Borchardt, Sören L Becker, Franziska Roth, Robert Bals, Philipp M Lepper, Hans-Joachim Schäfers, Isabella T Jaumann","doi":"10.1155/2024/4010115","DOIUrl":"https://doi.org/10.1155/2024/4010115","url":null,"abstract":"<p><p><i>Capnocytophaga canimorsus</i> 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 <i>C. canimorsus</i> 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 <i>C. canimorsus</i> 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 <i>C. canimorsus-</i>induced sepsis.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07eCollection Date: 2024-01-01DOI: 10.1155/2024/9562634
Burcu Topçu, Hale Usluer Gönüllü, Osman Yeşilbaş, Pınar Polat Suma, Ahmet Soysal
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.
{"title":"Multifocal Osteomyelitis in an Adolescent Patient With Cat Scratch Disease.","authors":"Burcu Topçu, Hale Usluer Gönüllü, Osman Yeşilbaş, Pınar Polat Suma, Ahmet Soysal","doi":"10.1155/2024/9562634","DOIUrl":"https://doi.org/10.1155/2024/9562634","url":null,"abstract":"<p><p>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 <i>Bartonella henselae</i> 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.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11401736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31eCollection Date: 2024-01-01DOI: 10.1155/2024/9163490
Constant Gillot, Jean-Louis Bayart, Vincent Maloteau, Jean-Michel Dogné, Jonathan Douxfils, Julien Favresse
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 T1/2 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.
{"title":"Evaluation of Neutralizing Capacity of Tixagevimab plus Cilgavimab (AZD7442) against Different SARS-CoV-2 Variants: A Case Report Study with Comparison to a Vaccinated Population.","authors":"Constant Gillot, Jean-Louis Bayart, Vincent Maloteau, Jean-Michel Dogné, Jonathan Douxfils, Julien Favresse","doi":"10.1155/2024/9163490","DOIUrl":"10.1155/2024/9163490","url":null,"abstract":"<p><p>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 (<i>n</i> = 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 <i>T</i> <sub>1/2</sub> 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.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The occurrence of sporadic rickettsial infections has been consistently undervalued and overlooked, primarily owing to a limited emphasis on routine examinations for rickettsioses in clinical practice. At present, the immunofluorescence assay is the prevailing diagnostic method for suspected rickettsioses that enables the detection of specific antibodies against rickettsia in human serum. Herein, we present an exceptional instance of rickettsial infection that was characterized by a rare manifestation of extensive pericardial effusion leading to dyspnea and cardiac tamponade. A diagnosis of chronic fibrosing pericarditis was established based on pericardium tissue obtained through pericardiotomy, and a conclusive metagenomic next-generation sequencing test confirmed the presence of Rickettsia felis infection. The cat flea, scientifically known as Ctenocephalides felis, is the predominant carrier of R. felis. An escalating incidence of human R. felis infections has raised concerns, particularly in light of the burgeoning population of domesticated animals in many contemporary societies.
{"title":"Diagnosis of a Rare <i>Rickettsia felis</i> Infection Complicated with Unusual Pericardial Effusion and Cardiac Tamponade Using an mNGS Test.","authors":"Tien-Lung Po, Chien-Hsien Huang, Chia-Hsun Lin, Huei-Fong Hung","doi":"10.1155/2024/8877876","DOIUrl":"10.1155/2024/8877876","url":null,"abstract":"<p><p>The occurrence of sporadic rickettsial infections has been consistently undervalued and overlooked, primarily owing to a limited emphasis on routine examinations for rickettsioses in clinical practice. At present, the immunofluorescence assay is the prevailing diagnostic method for suspected rickettsioses that enables the detection of specific antibodies against rickettsia in human serum. Herein, we present an exceptional instance of rickettsial infection that was characterized by a rare manifestation of extensive pericardial effusion leading to dyspnea and cardiac tamponade. A diagnosis of chronic fibrosing pericarditis was established based on pericardium tissue obtained through pericardiotomy, and a conclusive metagenomic next-generation sequencing test confirmed the presence of <i>Rickettsia felis</i> infection. The cat flea, scientifically known as <i>Ctenocephalides felis</i>, is the predominant carrier of <i>R. felis</i>. An escalating incidence of human <i>R. felis</i> infections has raised concerns, particularly in light of the burgeoning population of domesticated animals in many contemporary societies.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12eCollection Date: 2024-01-01DOI: 10.1155/2024/4942739
Andres Rios, Colby Wood, Ricardo Isaiah Garcia, Emily C Mitchell, Jacob Nichols
This case report highlights the unusual presentation and management of nonrheumatic myocarditis in a 24-year-old male, an age demographic not commonly associated with myocardial complications following Group A streptococcal pharyngitis. The patient, devoid of any prior medical history, manifested symptoms one day after being diagnosed with Group A streptococcal pharyngitis, a stark contrast to the typical progression of myocardial complications. The swift onset of symptoms and the patient's subsequent clinical presentation necessitated a comprehensive diagnostic approach. The patient's symptoms were successfully alleviated with amoxicillin and anti-inflammatory therapy, underscoring its potential efficacy in managing nonrheumatic myocarditis. This case serves as a poignant reminder of the importance of maintaining a broad differential diagnosis, especially in atypical presentations, and the pivotal role of timely clinical intervention. The insights from this report contribute to the broader understanding of nonrheumatic myocarditis, emphasizing the significance of tailored diagnostic and therapeutic strategies to ensure optimal patient outcomes.
本病例报告重点介绍了一名 24 岁男性非风湿性心肌炎的不寻常表现和治疗方法,该年龄段的患者在甲型链球菌咽炎后出现心肌并发症的情况并不常见。该患者既往无任何病史,在被确诊为 A 组链球菌咽炎一天后就出现了症状,这与典型的心肌并发症进展形成了鲜明对比。由于患者发病迅速,随后的临床表现也很明显,因此有必要采取综合诊断方法。阿莫西林和抗炎治疗成功地缓解了患者的症状,凸显了阿莫西林在治疗非风湿性心肌炎方面的潜在疗效。本病例有力地提醒人们,保持广泛的鉴别诊断非常重要,尤其是在非典型病例中,以及时临床干预的关键作用。本报告的见解有助于人们更广泛地了解非风湿性心肌炎,强调了量身定制的诊断和治疗策略对于确保患者获得最佳治疗效果的重要性。
{"title":"Swift Onset, Swift Recovery: Unusual Nonrheumatic Myocarditis in a Young Adult Post Group A Streptococcal Pharyngitis.","authors":"Andres Rios, Colby Wood, Ricardo Isaiah Garcia, Emily C Mitchell, Jacob Nichols","doi":"10.1155/2024/4942739","DOIUrl":"10.1155/2024/4942739","url":null,"abstract":"<p><p>This case report highlights the unusual presentation and management of nonrheumatic myocarditis in a 24-year-old male, an age demographic not commonly associated with myocardial complications following Group A streptococcal pharyngitis. The patient, devoid of any prior medical history, manifested symptoms one day after being diagnosed with Group A streptococcal pharyngitis, a stark contrast to the typical progression of myocardial complications. The swift onset of symptoms and the patient's subsequent clinical presentation necessitated a comprehensive diagnostic approach. The patient's symptoms were successfully alleviated with amoxicillin and anti-inflammatory therapy, underscoring its potential efficacy in managing nonrheumatic myocarditis. This case serves as a poignant reminder of the importance of maintaining a broad differential diagnosis, especially in atypical presentations, and the pivotal role of timely clinical intervention. The insights from this report contribute to the broader understanding of nonrheumatic myocarditis, emphasizing the significance of tailored diagnostic and therapeutic strategies to ensure optimal patient outcomes.</p>","PeriodicalId":9608,"journal":{"name":"Case Reports in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}