Case Reports in Infectious Diseases最新文献

Opportunistic fungal infections (OFIs) are common among human immunodeficiency virus (HIV) -positive patients, especially in those with delayed diagnosis and treatment. Patients with severe HIV/AIDS with clusters of differentiation 4 (CD4) counts less than 100 are significantly prone to develop multiple OFIs. In the current study, we present a case of co-infection of pulmonary aspergillosis and cryptococcal meningitis in a late-diagnosed HIV patient with a low CD4 count.

Introduction: Mucormycosis is a rare but serious infection caused by fungi called mucormycetes. It is life-threatening, highly aggressive angioinvasive infection, which mainly affects immunocompromised people. Methods and Results: During 2021-early 2023, at the Clinic for Maxillofacial Surgery, Faculty of Dental Medicine, University of Belgrade, Serbia (the "Clinic"), medical team (the "Team") treated five patients, with a rhino-orbital-cerebral form of mucormycosis. All five patients had recently recovered from COVID-19 infection prior to detection of mucormycosis. All of them spent a considerable amount of time (on average 1 month of hospitalization) at COVID-19 specialized hospitals. The Team treated these patients following the guidelines for screening diagnosis and management of mucormycosis at the time of the COVID-19 pandemic (COVID-19 patient guidelines/Indian Council of Medical Research, published in May 2021 approved by WHO). Treatment included several phases, out of which the Team was responsible for and carried out early diagnosis and surgical intervention phase, while colleagues from other clinics assisted in other phases of treatment/management of mucormycosis. Conclusion: The goal of this paper is to present five patients diagnosed with mucormycosis, with a special focus on two patients who, due to their condition, received surgical intervention as part of their antifungal treatment.

Hemophagocytic lymphohistiocytosis is a fatal hyperinflammatory disorder in which CD8+ cytotoxic T-cells, natural killer cells, and macrophages destroy hematopoietic cells and vital organs. Viral infections, such as Epstein-Barr virus, are known to cause secondary hemophagocytic lymphohistiocytosis in adult patients. However, despite its rarity, dengue virus has been identified to potentially cause hemophagocytic syndrome, which is associated with significant mortality and morbidity. Herein, we present a case report of a 52-year-old male patient who presented with fevers, worsening non-bloody copious diarrhea, excessive fatigue, and nausea and vomiting. He was known to have sickle cell trait. A diagnosis of hemophagocytic lymphohistiocytosis was confirmed with a liver biopsy, accompanied by elevated ferritin levels (33,539 ng/mL), IL-2R levels (5944.2 pg/mL), thrombocytopenia (49 k/μL), anemia (hemoglobin and mean corpuscular volume of 7.3 g/dL and 77.3 fL), and elevated bilirubin (total bilirubin of 3.2 mg/dL). In addition, elevated IgG and IgM antibodies determined reinfection with dengue virus. The administration of dexamethasone, etoposide, and additional supportive medications was initiated. Despite all efforts, the patient's neurological status declined, and the patient died. In this case, dengue-induced hemophagocytic lymphohistiocytosis is a worrisome and challenging diagnostic condition, primarily due to the similarities between the symptoms of hemophagocytic lymphohistiocytosis and those of dengue hemorrhagic fever. Treatment delay may be an inevitable consequence. Differentiating between dengue hemorrhagic fever and dengue-induced hemophagocytic lymphohistiocytosis requires evaluating clinical, laboratory, and biopsy findings. The role of the sickle cell trait is unknown in the presentation.

The occurrence of sellar toxoplasmosis in the pituitary gland is exceedingly rare, and only a few reports have been published in the literature, primarily impacting immunocompromised patients. We report an intriguing case of a 54-year-old man with an initial asymptomatic panhypopituitarism diagnosed under investigation for urolithiasis. Cranial CT and MRI revealed a large sellar lesion first suspectable of a nonfunctioning pituitary macroadenoma. An endonasal transsphenoidal surgery was performed, and the histopathological diagnosis was surprisingly a pituitary Toxoplasma gondii abscess. This case highlights that these types of infections can also occur in immunocompetent patients.

Dengue fever is a disease caused by the dengue virus and it is present in many tropical countries, including Nigeria. Cases of acute abdomen have been reported in dengue fever and they include acute cholecystitis, acute pancreatitis, acute appendicitis, and nonspecific peritonitis. This case report illustrates a case of acute appendicitis in dengue fever and aims to describe the relationship between both conditions. We report a case of a 25-year-old lady who presented with symptoms of dengue fever and was confirmed to have the disease. She was on treatment for dengue but subsequently developed acute appendicitis. She later underwent appendectomy and the appendix was confirmed to be inflamed both intraoperatively and histologically. Dengue virus can cause periappendiceal inflammation (periappendiceal fluid collection and mesenteric lymphadenopathy/adenitis) or acute appendicitis (which can progress to appendiceal perforation or appendicular mass formation). Periappendiceal inflammation presents with clinical features mimicking acute appendicitis but without appendicitis on ultrasonography or laparoscopy. Periappendiceal inflammation can also progress to appendicitis. For patients with dengue fever, diagnosis of acute appendicitis should not be based on clinical findings alone. Serial ultrasonography to confirm appendicitis is recommended. Conservative treatment with antibiotics should be the first line for acute appendicitis in dengue fever or periappendiceal inflammation in dengue. Surgical treatment is required in cases of appendiceal perforation or failure of conservative management.

Haemophilus influenzae (H. influenzae) is a common organism that causes noninvasive infections in the respiratory tract. Lately, there has been an increasing incidence of invasive diseases with nontypeable strains not covered by Hib vaccines. We discuss a case of a middle-aged male with sickle cell trait and gout who presented with altered mentation and polyarthralgia. On investigations, he had H. influenzae bacteremia on two sets of blood cultures with dissemination to meninges and joints, causing acute encephalopathy and polyarthralgia. The initial results of arthrocentesis and lumbar puncture were sterile. However, PCR analysis of the fluid revealed nontypeable H. influenzae. The patient required mechanical ventilation and vasopressor support given sepsis but recovered after extended antibiotics and multiple surgical debridements. Our case highlights the importance of maintaining a high suspicion of invasive disease in decompensated patients and the role of advanced diagnostics in treatment and outcome.

Endophthalmitis is a rare, vision-threatening ocular infection. During the COVID-19 pandemic, the widespread use of immunosuppressive agents-particularly corticosteroids-and prolonged hospital stays have been associated with an increased risk of secondary bacterial infections, including ocular involvement. One such opportunistic pathogen is Streptococcus pneumoniae. Among the rare but severe complications of endogenous endophthalmitis is retinal detachment (RD), which often results in a poor visual prognosis. We present a unique case of RD secondary to endogenous endophthalmitis in a COVID-19 patient with S. pneumoniae bacteremia. This case highlights the importance of early ophthalmologic evaluation in patients with ocular symptoms during or after COVID-19 infection to ensure timely intervention and improve clinical outcomes.

Mycobacterium abscessus is a rapidly growing non-tuberculous Mycobacterium (NTM) primarily associated with pulmonary infections, particularly in individuals with underlying lung conditions. While soft tissue infections are less common, their incidence has been increasing. These infections are challenging to treat due to inherent resistance to many antibiotics obtained through spontaneous mutation as well as physical characteristics of the microbes. The case presented here describes a 61-year-old female without obvious risk factors for mycobacterial infection who developed an intramuscular abscess over a 2-year period following a mechanical fall. Surgical resection with a complex antibiotic regimen was required based on macrolide resistance and a lack of established treatment plans for such a rare presentation. This case highlights the increasing incidence of NTM and the variable clinical presentation. Early identification with a combination of surgery and antibiotics is usually indicated to successfully manage these infections. Even without obvious risk factors, NTM infection should be considered in the presence of soft tissue and intramuscular abscesses.

We report the case of a 53-year-old male with recent travel to Guatemala and Belize who was diagnosed with cutaneous leishmaniasis (CL). He was treated empirically with miltefosine with no improvement and switched to amphotericin B upon species identification of L. braziliensis, resulting in the resolution of his lesions. This case demonstrates that clinicians should recognize the importance of systemic therapy for treating complex CL, as well as the importance of identification of species type for tailoring treatments. Furthermore, while miltefosine has proven efficacious for CL in many New World locales, it has demonstrated lower cure rates for CL in Guatemala, and thus identification of the region of origin of the CL infection is imperative for further guiding treatment, which may vary according to the differences in drug potency or region-specific resistance rates.

Managing the mpox in patients with advanced HIV infection and coinfections poses significant challenges. This report discusses a young male with advanced HIV (CD4 count 28) and severe concurrent mpox and HSV-1 proctitis. Despite initial treatment with oral tecovirimat, acyclovir, and antiretrovirals, the patient's condition worsened, requiring readmission. The patient received intravenous tecovirimat, vaccinia immune globulin, and brincidofovir. Sigmoidoscopy revealed extensive rectal and sigmoid lesions that necessitated prolonged hospitalization and pain management. This case emphasizes the complexity of treating severe coinfections in immunocompromised patients, highlighting the need for a multidisciplinary approach and consideration of alternative therapies when standard treatment fails.