Case Reports in Infectious Diseases最新文献

The city of Philadelphia has seen an increase in homelessness and substance use disorders, often associated with xylazine-contaminated opiates. Here, we report the first two cases of wound infection and bacteremia associated with the Gram-negative rod Ignatzschineria species. Both cases were associated with maggot colonization in chronic lower extremity wounds from fentanyl/xylazine injections. Poor living conditions and lack of wound care are central to both case presentations. We believe this organism to be an emerging medical threat associated with injection drug use, xylazine-associated wounds, and homelessness which may impact future treatment options in this patient population. This report underscores the emergence of Ignatzschineria bacteremia in individuals with a history of xylazine-associated wounds and substance use disorder. Successful management should prioritize wound care and adherence to antibiotic regimens to prevent complications in these challenging cases.

Cardiovascular complications of Brucellosis are not common and affecting less than 2% of cases. In clinical practice, endocarditis is the most frequent cardiovascular complication and is responsible for most of the brucellosis-related mortality cases and usually diagnosed lately in the course of the disease with mostly aorta valve involvement. In this case report, we present the case of a 27-year-old woman who was admitted to the hospital with fever, sudden onset right side hemiparesis, and horizontal gaze palsy. During the stroke work up, she underwent cardiac evaluation, including echocardiography with susceptibility to septic emboli with cardiac origin, and the result indicates presence of vegetations on prosthetic aortic valve suggestive of infective endocarditis. Hopefully our patient responded well to combination of heart surgery and antibrucellosis regimen and was finally discharged with stable general condition. It is important to raise awareness of this rare but potentially serious complication of brucellosis, especially in the endemic area, and to emphasize the value of early diagnosis and treatment.

Babesiosis is a parasitic tick-borne infectious disease that is well elucidated in medical literature and known to be endemic to the Midwest and northeast United States. However, like other infectious diseases, its epidemiology is subject to change. This case report documents two cases with clinical presentations that deviate from what is expected in typical cases of Babesiosis. Two patients presented to a safety-net hospital in Newark, NJ, during the summer of 2022 with nonspecific symptoms. The first patient had a history of polysubstance use disorder and presented with bilateral leg pain, drowsiness, exertional dyspnea, back pain, and chest pain. The second patient had recently returned from a trip to Guatemala and presented with subjective fevers, generalized myalgias, malaise, headaches, and chills. Both patients underwent similar workups yielding a diagnosis of Babesiosis. Of note, neither patient had recently spent time in wooded areas. Ultimately, both patients were treated for Babesiosis with resolution of their presenting symptoms. These two cases suggest that the epidemiology of Babesiosis is changing and provide a clinical workflow for diagnosing and managing this disease in a modern healthcare setting.

Background: Aspergillus tracheobronchitis (AT) is an uncommon yet severe form of invasive pulmonary aspergillosis, with a notably low incidence among individuals living with HIV infection-accounting for merely 4.5% (7 out of 156 cases) in recent reviews. The advent of modern antiretroviral therapy (ART) has significantly altered the landscape of opportunistic infections in HIV, rendering conditions like AT rare in well-controlled cases. Case Presentation: We present the case of a woman in her mid-20s with well-managed HIV infection who experienced a 4-week history of fever and dyspnea. Diagnostic procedures, including bronchoscopy, revealed granulation tissue obstructing her right main bronchus. Cultures confirmed infection with Aspergillus fumigatus, leading to a diagnosis of AT. Despite initial positive response to voriconazole treatment, the patient developed severe hemoptysis and unfortunately succumbed to the complication. Conclusion: This case underscores the critical need for healthcare providers to consider AT in the differential diagnosis of respiratory symptoms in HIV-positive patients, even when HIV is well-controlled with ART. Early recognition and prompt antifungal therapy are essential for improving outcomes. Clinicians should remain vigilant for severe complications like hemoptysis, which can occur despite appropriate therapy. This report highlights the ongoing necessity for vigilance and proactive intervention in the care of individuals living with HIV.

Postacute Sequelae of COVID-19 Cardiovascular Syndrome (PASC-CVS) refers to a broad spectrum of cardiovascular symptoms that manifest four weeks or more after infection with COVID-19, which cannot be diagnosed as cardiovascular disease through standard examinations. Common symptoms include exercise intolerance and tachycardia, alongside persistent issues such as chest pain, chest tightness, and difficulty breathing. PASC-CVS significantly affects patients' quality of life; however, effective treatments for this condition are currently lacking. In this report, we present two cases of PASC-CVS patients who experienced well-controlled cardiovascular symptoms following treatment with Suxiao Jiuxin Pills. Our findings may offer a novel approach to the clinical management of PASC-CVS.

We report a case of a 15-year-old with refractory and relapsed AML and profound prolonged neutropenia who developed a Saprochaete capitata disseminated invasive infection while on echinocandin prophylaxis for invasive fungal disease. Azole antifungal therapies, which are often used as prophylaxis, were initially avoided due to concerns for CYP drug interactions. Treatment with a combination of liposomal amphotericin B, voriconazole, and adjuvant granulocyte transfusions was successful as he awaited neutrophil recovery.

Pathogenic Leptospira species are the source of leptospirosis, a common zoonotic infection that can cause a wide range of clinical manifestations, from minor flu-like symptoms to severe multiorgan failure. We present two peculiar cases of leptospirosis; they highlight the need for clinical awareness to improve patient outcomes and further knowledge of leptospirosis epidemiology and therapy by illuminating the difficulties in diagnosis and treatment. The first case involved a 30-year-old male presented with jaundice. Although he had no history of chronic illnesses, an exhaustive investigation was warranted due to his recent travel history and occupational contact. Laboratory tests revealed significantly increased levels of AST and ALT and positive Leptospira IgM serology. Remarkably, the patient refuted the traditional theory of leptospirosis transmission by denying direct animal interaction. After starting therapy with dexamethasone initially and adding doxycycline later, the patient's condition significantly improved; his jaundice resolved and his liver enzyme levels returned to normal. An outpatient follow-up after discharge was advised to assess liver and kidney function. The second case involved an 87-year-old woman with a fever, weakness and hypertension. Investigations revealed hepatosplenomegaly, raising the possibility of hypersplenism. She reported exposure to animals, particularly her dogs in her urban house. Surprisingly, her AST and ALT levels were normal. Lab tests also revealed thrombocytopoenia with normal APTT and prolonged PT. Serological tests indicated positive Leptospira IgM. Along with intravenous infusions, the patient's treatment plan comprised dexamethasone, enalapril and ceftriaxone to treat inflammation, hypertension and bacterial infection, respectively. Following a 20-day hospital stay, the patient's laboratory results and symptoms improved, leading to her discharge. Continuous follow-up recommended to monitor her recovery and prevent recurrence. These case studies emphasise the significance of taking leptospirosis into account when treating patients who do not have normal exposure histories yet present with unusual symptoms.

Guillain-Barré Syndrome (GBS) is an acute polyneuropathy commonly preceded by infection, with growing recognition of the human immunodeficiency virus (HIV) as a trigger. We present a case of a 44-year-old male with HIV-associated GBS refractory to intravenous immunoglobulin (IVIG) therapy, who achieved remission upon starting highly active antireroviral therapy (HAART). There remains a lack of consensus on the management of this condition across the spectrum of disease, and the interplay between the therapeutic options is poorly understood. This report aims to add to the current body of knowledge on this rare condition and highlight the need for retrospective analysis of the currently available literature.

Background: Staphylococcal infection is a common bacterial disease with common clinical features. Untreated infection, especially in immunosenescence cases, can affect other organs. This can lead to multiorgan dysfunction and cause increased morbidity and mortality. Unlike commonly presented features of pneumonia, dissemination of infection can pose diagnostic and therapeutic enigma. Therefore, any such presentation in common clinical practice can yield a conundrum of diagnoses. Case Report: A 69-year-old elderly male presented to the Emergency Department with acute onset encephalopathy. Historically, cues were limited, and evaluation was negated for acute cerebrovascular event or seizure. Laboratory findings were suggestive of a severe sepsis. While clinical medicine workup and diagnostic dilemma were ongoing, possible sources of the sepsis were thoroughly sought including range of infectious causes. This patient's presentation was one of its kind: staphylococcal bacteremia seeding to cause pneumonia and unusual epidural abscess in due course of illness. Conclusion: The health outcome of the critically ill especially elderly patients depends mostly on the importance of clinical medicine to address the diagnostic enigma and virtue of supportive care delivered. Staphylococcus aureus infections are capable of developing distant infectious foci, as highlighted in this case, and that the clinician should be alert to this possibility. This particular case firmly posits an admonition for clinicians and the importance of clinical medicine for critical reasoning to improve the patient outcome.

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.