Case Reports in Infectious Diseases最新文献

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.

Background and objectives: Leptospirosis, a globally prevalent zoonotic disease, exhibits diverse clinical manifestations, often with severe multiorgan involvement. Gastrointestinal complications are uncommon, but their potential severity and impact on patient outcomes warrant attention. We present two cases of severe leptospirosis complicated by terminal ileal and colonic necrosis.

Patients and methods: Two patients presented with acute febrile illness, severe myalgia, oliguria, and hypotension. Both had occupational exposure to paddy fields, a known risk factor for leptospirosis. Based on clinical presentation and laboratory findings (acute kidney injury, myocarditis, and acute severe pulmonary hemorrhagic syndrome), a diagnosis of severe leptospirosis was established. Development of proximal bowel obstruction and melena in the third week of illness indicated severe gastrointestinal involvement. Both patients received intensive care support, including broad-spectrum antibiotics, inotropes, and renal replacement therapy. One patient underwent exploratory laparotomy for bowel perforation. Despite aggressive management, both patients succumbed to the disease.

Conclusions: Gastrointestinal complications, including bowel necrosis and perforation, can occur in severe leptospirosis. Early recognition and management of gastrointestinal symptoms are crucial. Further research is needed to understand the pathophysiology of this rare but fatal complication.

Nontyphoidal Salmonella (NTS) bacteremia is an uncommon but potentially fatal infection that predisposes patients to vascular complications, including infectious aortitis. The Nontyphoidal Salmonella Vascular Infection (NTSVI) Score was developed to estimate this risk, with scores ≥ 1 indicating high risk. We describe the first clinical application of the NTSVI Score in a resource-limited Malaysian tertiary care center. Five patients with confirmed NTS bacteremia were assessed using the score and subsequently underwent imaging to evaluate for vascular involvement. Four patients were classified as high risk (scores 3, 2, 1, and 1); two had radiological evidence of infectious aortitis, while two showed no vascular changes. The remaining patient, classified as low risk (score 0), also demonstrated no vascular abnormalities. In this series, the NTSVI Score showed excellent negative predictive value, supporting its potential role as a rule-out tool to avoid unnecessary imaging in low-risk patients, particularly in resource-constrained settings. Although the positive predictive value was modest, the score appeared useful in early risk stratification and guiding further investigation. While limited by small sample size and lack of contemporary validation, this report highlights the potential clinical utility of the NTSVI Score in managing NTS vascular infections in resource-limited settings. To our knowledge, this represents the first reported application of the NTSVI Score in Malaysia, underscoring the need for further evaluation in Southeast Asian populations.

Rahnella aquatilis is a Gram-negative bacterium commonly found in the environment. Previously associated with food spoilage, it has in the past been responsible for causing infection in humans, usually as an opportunistic pathogen. We report a case of a previously healthy female who was diagnosed with R. aquatilis bacteraemia. Careful history-taking confirmed she had received an intravenous infusion of presumed-contaminated vitamins immediately prior to presentation. As the global beauty-industry continues to expand, we should be vigilant of future similar cases.

Infection with Edwardsiella tarda, a Gram-negative rod found in freshwater and seawater, is typically associated with the ingestion of raw fish and commonly causes enteritis, liver abscess, cholangitis, and cholecystitis in humans. However, multiple pyogenic arthritis, which have not been previously reported, are considered exceedingly rare. Herein, we report a case of E. tarda bacteremia that resulted in multiple pyogenic arthritis and septic shock, which was successfully treated with intensive care. An 84-year-old man with a history of prostate cancer, diabetes mellitus, and chronic kidney disease was transferred to our hospital for swelling and pain in the left shoulder, following initial treatment for pyogenic arthritis of the left hip at a previous hospital. Imaging revealed the formation of abscesses in the shoulders and hips. He underwent emergent debridement of the left shoulder abscess and was admitted to the ICU. E. tarda was identified from blood cultures on Day 3 of hospitalization. The patient developed septic shock and required vasopressor support. Intensive care, including the administration of appropriate antibiotics and surgical debridement, yielded clinical improvement. The patient was discharged from the ICU on Day 8. Cases of multiple pyogenic arthritis caused by E. tarda bacteremia have the potential for rapid clinical deterioration. Our patient had multiple risk factors, including cancer, diabetes, and hypertension, which might have predisposed him to a severe disease course. Early diagnosis, appropriate antibiotic therapy, surgical debridement, and intensive care are crucial for patient survival, and early transfer to a tertiary center may improve outcomes. Even rare infections, such as E. tarda, should be considered in the differential diagnosis of immunocompromised patients.

Cabotegravir/rilpivirine (CAB/RPV) is a long-acting injectable antiretroviral therapy (ART) with limited data on safety and efficacy during pregnancy. We report a patient who maintained viral suppression on CAB/RPV every 2 months throughout pregnancy. MV was a 33-year-old G4P1021 with HIV and hypertension. She was infected perinatally and treated with multiple ART regimens due to inconsistent adherence to oral ART. Prior to this pregnancy, she switched to long-acting intramuscular CAB (600 mg)/RPV (900 mg), which allowed her to maintain an undetectable viral load. In preconception counseling, we advised her of the unknown efficacy and safety during pregnancy. She elected to continue CAB/RPV every 2 months and maintained 100% adherence with an undetectable viral load throughout pregnancy. Fetal pyelectasis was identified by ultrasound and persisted throughout pregnancy. A male infant with growth restriction (2.33 kg) was delivered via scheduled 37-week cesarean and admitted to the neonatal ICU for respiratory support for two days. Postnatal ultrasound confirmed hydronephrosis. The infant had negative HIV testing at one, two, and 10 months. There are limited reports of CAB/RPV continuation throughout pregnancy. One previous report identified fetal growth restriction and ptosis of the neonate. Another reported normal birthweight and no congenital anomalies. Most recently, an abstract presented 22 pregnancies continued on CAB/RPV. Anomalies in this series were pyelectasis, ventriculomegaly, and Trisomy 21. None of these reports observed perinatal HIV transmission. Primary concerns for the use of CAB/RPV during pregnancy are the possibility of reduced drug efficacy and adverse neonatal outcomes. The existing literature is sparse, but multiple studies have shown reduced RPV concentrations during pregnancy, raising concern for ineffective viral suppression. There is no evidence of teratogenic effects. Benefits of CAB/RPV during pregnancy include improved drug adherence and discretion. Based on our experience and review of the literature, long-acting intramuscular CAB/RPV may be of value in treatment-experienced patients experiencing difficulties with pill adherence.

Ureaplasma spp. are small and fastidious bacteria that may cause urogenital infections in healthy adults and, in rare cases, invasive disease. These bacteria have been increasingly recognized in immunocompromised patients and have been associated with hyperammonemia syndrome, particularly in lung transplant recipients. In this context, we present a unique clinical case of Ureaplasma parvum prostate abscess, a condition rarely observed in heart transplant recipients, diagnosed using next-generation sequencing (NGS).

Cholera is an acute diarrheal disease caused by Vibrio cholerae which primarily affects the gastrointestinal system. However, severe dehydration and electrolyte imbalances caused by diarrhea can precipitate systemic complications, including renal, cardiovascular, and cerebrovascular events. This case report describes a rare occurrence of cholera with concomitant myocardial infarction (MI) and ischemic stroke that has not been previously reported in the literature.

Leishmaniasis is a disease caused by Leishmania protozoa that is transmitted to the patient by sand flies. Depending on the Leishmania species, the disease can present with cutaneous, mucosal, or multiorgan involvement. Cutaneous leishmaniasis can present with diverse clinical manifestations mimicking other diseases. We present a 26-year-old pregnant woman with a painless tumoral lesion on her nose. Due to the atypical clinical presentation of our case for leishmaniasis, it is worth reporting.

We report a case of septicemia due to Streptococcus gwangjuensis in an immunocompromised 8-year-old child. The final diagnosis was febrile neutropenia associated with acute myeloid leukemia and septicemia. The patient was successfully treated with chemotherapy, granulocyte colony-stimulating factor, leukodepleted packed red cell transfusions, piperacillin/tazobactam, and meropenem. S. gwangjuensis was identified using sodA and gyrB amplicon-based next-generation sequencing. The isolate was susceptible to all β-lactam antibiotics.