Case Reports in Infectious Diseases最新文献

Amebiasis is a significant public health issue in tropical regions, with liver abscess as its most common extraintestinal complication. Budd-Chiari syndrome secondary to amoebic liver abscess is rare and seldom reported. We present a 37-year-old man with poorly controlled Type 1 diabetes who developed fever, abdominal pain and distension. Imaging identified a left lobe liver abscess with hepatic vein and inferior vena cava thrombosis, consistent with Budd-Chiari syndrome. The patient received image-guided drainage, broad-spectrum antimicrobials, and anticoagulation, leading to clinical improvement and vascular recanalization. We intend to bring to notice, the need to consider hepatic venous outflow obstruction in patients with amoebic liver abscess and ascites or lower extremity edema. Early diagnosis and combined medical and interventional management can help prevent irreversible liver damage.

Leclercia adecarboxylata is a gram-negative, rod-shaped bacterium commonly found in nature. Its pathogenicity is mild and often results in asymptomatic carriage. However, it can cause sepsis and other life-threatening illnesses in immunocompromised individuals. Based on previous literature, the common practice of applying many unsafe substances, such as shea butter, to the umbilical cord of newborns for healing remains a significant risk factor for omphalitis and neonatal sepsis in developing countries. This case report describes a neonate showing signs of omphalitis and bacteremia, following the use of shea butter on the umbilical cord. A 10-day-old male neonate presented with irritability, refusal to breastfeed, and an erythematous, tender umbilical stump. The blood culture result yielded a gram-negative rod, Leclercia adecarboxylata, sensitive to cephalosporin, chloramphenicol, and gentamicin. The newborn was treated with empirical first-line antibiotics according to national guidelines: intravenous (IV) ampicillin and gentamicin for 6 days. The child fully recovered. Therefore, we emphasize the ongoing need for community-level awareness of proper umbilical cord care at the grassroots in developing countries. Additionally, early bacterial detection and antimicrobial management based on local antibiogram data are vital for successful patient outcomes.

A 44-year-old unhoused male with a history of alcohol dependence was admitted to the emergency department with symptoms of tremors, agitation, and generalized pain. His condition rapidly deteriorated, revealing a subdural hematoma that necessitated an urgent craniotomy. Following surgery, he was diagnosed with multisite myiasis, with maggots present in his ears, nose, eye, and toenail bed. The treatment included surgical removal of the larvae, administration of ivermectin, and broad-spectrum antibiotics to prevent secondary infections. ENT evaluations confirmed further infestations, identifying the larvae as Lucilia sericata. Despite the initial severity, the patient showed significant improvement, regaining full consciousness within a week. This case highlights the critical need for early recognition and comprehensive management of myiasis, especially in vulnerable populations. Effective treatment involves a multidisciplinary approach, including stabilization, surgical intervention, and infection prevention. It underscores the importance of coordinated medical care and preventive strategies to manage myiasis effectively in at-risk groups.

Background: Coronavirus disease 2019 (COVID-19) has been associated with invasive fungal infection. Several COVID-19 cases were complicated due to coinfection with Aspergillus, Rhizopus, and Mucor species. We present COVID-19 with Aspergillus tubingensis coinfection.

Case presentation: A male patient presented with fever, cough, severe shortness of breath, and abdominal pain that persisted for a week. The patient was admitted to the ICU. The patient was diabetic and hypertensive, and COVID-19 pneumonia was confirmed. The patient became septic, and his blood culture was positive for Candida albicans. His sputum culture was positive for Acinetobacter spp. The patient was treated with a broad range of antibiotics and antifungal treatment. His case was complicated by hospital-acquired pneumonia; sputum culture was positive for Aspergillus species. Immediately, he developed septic shock, acute kidney injury, and disseminated intravascular coagulation (DIC). Postmortem molecular identification via ITS sequencing confirmed the presence of Aspergillus tubingensis.

Conclusions: Invasive fungal infections are characterized by high mortality. Early diagnosis to the species level is essential for successful treatment.

Background: Warfarin, a vitamin K antagonist, is commonly used for atrial fibrillation (AF), venous thromboembolism (VTE), and mechanical heart valves. Linezolid, an oxazolidinone antibiotic, is used to treat severe infections caused by Gram-positive bacteria. A fatal drug interaction of linezolid and warfarin was reported in this case, highlighting the close monitoring of international normalized ratio (INR) when co-administering these drugs.

Case presentation: A 62-year-old female with severe mitral stenosis (MS) and moderate mitral regurgitation (MR) was diagnosed with mitral valve vancomycin-resistant Enterococcus (VRE) infective endocarditis (IE) (the diagnosis was made based on clinical presentation, positive blood cultures, and echocardiographic evidence fulfilling the modified Duke criteria) AF, and acute kidney injury (AKI). The AKI was resolved during the hospital stay. The patient was on the valvular surgery list and was discharged on oral linezolid and warfarin. The patient was on follow-up compliance with restricted diet through INR online services, and INR was also monitored through the well-established INR clinic. Ten days postdischarge, she presented with worsening dyspnea, bruising, hematuria, abdominal distension, and bilateral leg swelling. On admission, she was on rapid AF, severe metabolic acidosis, hyperkalemia, and coagulopathy (INR 12). Given her adherence to warfarin and the absence of other interacting factors, the coagulopathy was suspected to be due to a warfarin-linezolid interaction. Despite management with IV vitamin K and fresh frozen plasma (FFP), she developed refractory AKI, hyperkalemia, and multiorgan failure, leading to death.

Conclusion: This case highlights the potential for severe coagulopathy when warfarin and linezolid are co-administered and underscores the importance of close and frequent INR monitoring.

An independent 69-year-old diagnosed with community-acquired pneumonia presented with Anaerobiospirillum succiniciproducens bacteraemia, initially identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. A rarely reported cause of pneumonia and bacteraemia, it is considered a zoonotic bacterium from cats and dogs. She was treated successfully with piperacillin/tazobactam and amoxicillin/clavulanic acid.

Mycobacterium xenopi (M. xenopi) is a less common nontuberculous mycobacterium (NTM) responsible for pulmonary and other infections and can be a diagnostic and therapeutic challenge requiring prolonged courses of triple-drug therapy. We managed a case of isolated M. xenopi laryngitis in an immunocompetent patient after they presented with dysphonia and a nonspecific unilateral vocal fold lesion. This patient was treated with complete surgical excision alone, and negative cultures and symptom resolution were achieved in the absence of antimicrobials. Laryngeal infection by M. xenopi is a rare diagnosis, so it is important to keep NTM infections on the differential, and once confirmed by pathology and culture, to be aware of the option for surgical excision for definitive treatment.

Background: Isolated liver and spleen involvement of tuberculosis (TB) is a rare presentation.

Case presentation: A 60-year-old male patient from Bahir Dar City in the Amhara Region of Ethiopia presented with a 4-month history of low-grade fever, significant weight loss, drenching night sweats, poor appetite, exertional shortness of breath, and easy fatigability. Two weeks before his presentation, all symptoms worsened, and the patient started to experience left upper quadrant (LUQ) abdominal pain with a dragging sensation. Abdominal ultrasound showed hepatosplenomegaly with a linear hypoechoic area seen at the upper pole of the spleen, likely infarctions, and periportal lymphadenomegaly was visible. An abdominal CT scan showed a subcapsular hematoma on the upper pole of the spleen. After carefully ruling out both infectious and noninfectious differential diagnoses, we considered extrapulmonary tuberculosis and decided to initiate an antituberculosis trial. Extrapulmonary TB (hepatosplenic TB) was considered, and anti-TB medications were started. On his 6-month follow-up and evaluation, his symptoms were improved with normal physical findings and normal investigation findings.

Conclusion: Even though isolated hepatosplenic TB is a rare condition, it has to be considered especially in low socioeconomic communities after excluding other alternative diagnoses.

Transplant recipients have a high risk of infection with opportunistic pathogens. The type, dose, and duration of immunosuppression and use of prior broad-spectrum antimicrobials contribute to overall risk of infections. Aspergillosis is a known opportunistic infection that can occur as mid or late infection after visceral transplant. Aspergillus fumigatus is the commonly isolated species, but with the use of prophylactic broad-spectrum antifungals, other species such as Aspergillus calidoustus are emerging. We report a case of invasive sinusitis and brain mass due to this species of Aspergillus that was identified using next-generation sequencing (NGS). Use of NGS early in clinical presentation may help in effective management of opportunistic infections in immunocompromised hosts.

Spinal epidural abscess (SEA) is a serious but rare condition that is often challenging to diagnose early due to atypical presentations, especially in patients without common risk factors such as immunosuppression or sickle cell disease. This case report describes a 49-year-old woman with a history of alcohol use disorder who presented with flank pain and other nonspecific symptoms, initially misdiagnosed as musculoskeletal pain. MRI eventually revealed a SEA caused by nontyphoidal Salmonella (NTS), requiring surgical intervention and antibiotics. The discussion highlights the difficulty of diagnosing SEA, especially in patients without classic risk factors, emphasizing the need for high clinical suspicion, thorough history-taking, and timely use of MRI. Prompt imaging, neurosurgical consultation, and antibiotic administration are critical for effective management and favorable outcomes. Strategies for improving early diagnosis include using decision guides for emergent MRI and repeat imaging if initial results are nondiagnostic. This article aims to provide clinicians with an overview of SEA caused by NTS, emphasizing the importance of maintaining a high index of suspicion, critically examining reported risk factors, and exploring potential approaches for earlier diagnosis.