Case Reports in Infectious Diseases最新文献

Staphylococcus argenteus, a recently recognized species within the Staphylococcus aureus complex, shares numerous virulence traits with S. aureus. While S. argenteus typically lacks pigmentation and exhibits greater antibiotic susceptibility compared to S. aureus, it can cause severe infections, including bacteremia. Clinicians can be misled by its name and may not give it the necessary attention. It may also be misidentified as a S. aureus by the microbiology lab. We present the case of a 56-year-old man with a complex medical history who developed a polymicrobial urosepsis involving S. argenteus. It was initially misinterpreted as a contaminant in urinary samples by an external laboratory. The patient subsequently developed septic shock and was admitted to intensive care unit. The blood cultures confirmed S. argenteus associated with E. coli and K. pneumoniae bacteremia. He was successfully treated with high-dose intravenous floxacillin and oral ciprofloxacin. Whole-genome sequencing confirmed the isolate as S. argenteus (ST2250). This case underscores the diagnostic and clinical challenges posed by S. argenteus, particularly in regions where its prevalence is low. S. argenteus harbors the majority of S. aureus virulence genes and causes a comparable spectrum of disease. Epidemiological data indicate regional differences in its prevalence and clinical impact. Some studies report lower virulence while others suggest worse outcomes. The case illustrates the importance of accurate identification using techniques like MALDI-TOF MS and whole-genome sequencing. Clinicians and microbiologists should remain vigilant and consider S. argenteus as a pathogen, warranting appropriate antimicrobial therapy and clinical attention. Differentiating it from S. aureus might be relevant for guiding therapy, surveillance, and infection control, particularly given emerging reports of methicillin-resistant S. argenteus strains.

Cryptococcal meningitis commonly presents with acute symptoms such as fever and signs of raised intracranial pressure and usually occurs in immunocompromised hosts. A 55-year-old woman presented with worsening cognitive decline, gait disturbance and recurrent falls. Magnetic resonance imaging (MRI) of the brain revealed a prior stroke and ventriculomegaly. A lumbar puncture (LP) showed normal opening pressure. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with raised protein and reduced glucose. Cryptococcal antigen in the CSF was positive; however, Cryptococcus was not cultured. The immunodeficiency screen was unremarkable. She was treated with intravenous liposomal amphotericin B and oral flucytosine induction, followed by oral fluconazole consolidation and maintenance. Her cognition and mobility improved markedly after treatment. This case illustrates an uncommon presentation of cryptococcal meningitis and highlights the need to consider this diagnosis in atypical presentations. Culture negativity complicates the determination of optimal treatment duration. This case also highlights the utility of the lateral flow assay (LFA) in diagnosing cryptococcal meningitis.

Brucellosis, an endemic zoonotic infection, often presents with musculoskeletal complications, but sternoclavicular joint (SCJ) osteomyelitis is exceptionally rare. We report a case of a 49-year-old male with SCJ osteomyelitis secondary to brucellosis, emphasizing the diagnostic challenges and management. Advanced imaging and serology were pivotal in confirming osteomyelitis, underscoring the need for clinical suspicion in endemic regions. The patient achieved full recovery with a combination of antibiotics. This case highlights the importance of differentiating osteomyelitis from arthritis in atypical presentations.

A 22-year-old man presented with headache, night sweats, intermittent fever, tremors, sleep disturbances, agitation, and hallucinations for 2 months. Thoracic computed tomography (CT) showed widespread interstitial nodular lesions, but initial cranial CT showed no significant pathology. Cerebrospinal fluid (CSF) analysis revealed 25 cells/mm³ of white blood cells (72% neutrophils), 83 mg/dL protein, and 30 mg/dL glucose (concurrent serum glucose was 103 mg/dL). Gram and Ziehl-Neelsen stains were negative for acid-fast bacilli. Tuberculosis (TB) cultures and Mycobacterium PCR tests remained negative. Biopsy of the bronchoalveolar lavage sample showed necrotizing granulomatous inflammation, and the Mycobacterium tuberculosis PCR result was positive. During the first month of first-line anti-TB treatment, the patient experienced recurrent severe headaches, persistent fever, and decreased visual acuity. Contrast-enhanced MRI revealed lesions that were consistent with tuberculous meningitis (TBM). Considering the possibility of drug-resistant TB, streptomycin 1 gr/qd (quaque die) intramuscularly and linezolid 600 mg/bid (bid in die) intravenously were added to the regimen. The patient's symptoms persisted during the second month of treatment. The patient experienced epileptic seizures. The control MRI showed an enlargement of the lesions. A paradoxical reaction was considered. Intravenous methylprednisolone 500 mg/day was initiated. The patient did not respond clinically, and his complaints continued. The patient was started on the IL-1 inhibitor anakinra. Paradoxical inflammatory reactions are common in TBM but challenging to predict. When severe, they can lead to significant neurological morbidity and death. This article aimed to share a case that did not respond to corticosteroids, a standard treatment for paradoxical reactions, but was successfully managed with the IL-1 inhibitor anakinra.

Background: Brucellosis is a globally significant zoonotic disease, but congenital brucellosis remains exceedingly rare. It is primarily transmitted transplacentally from an infected mother to the fetus, often presenting with nonspecific signs that mimic neonatal sepsis. The condition poses diagnostic and therapeutic challenges, particularly in endemic regions where early identification is crucial to improving neonatal outcomes.

Case presentation: We report the case of a 19-year-old gravida 1, para 0 female with a history of treated Brucella infection at 12 weeks of gestation. She experienced preterm premature rupture of membranes (PPROM) at 24 weeks and 2 days and delivered a female infant via spontaneous vaginal delivery. The neonate, weighing 725 g at birth, presented with cyanosis, respiratory distress, and unstable vital signs. Initial workup suggested early onset sepsis, prompting empirical antibiotic therapy. However, on Day 7, blood cultures confirmed the presence of Brucella melitensis and Brucella abortus, establishing the diagnosis of congenital brucellosis. The neonate's clinical course was complicated by intraventricular hemorrhage, necrotizing enterocolitis, multiple episodes of sepsis, and cardiac arrests. Despite intensive medical management, including antimicrobial therapy with rifampicin and gentamicin, the infant succumbed to multiple organ failure on Day 39 of life.

Conclusion: This case highlights the diagnostic challenges of congenital brucellosis and underscores the importance of considering Brucella infection in neonates presenting with unexplained sepsis, especially in endemic regions. Early recognition and targeted therapy are essential to improve neonatal outcomes. Enhanced screening protocols for pregnant women in high-risk areas, coupled with heightened clinical suspicion in neonates with maternal brucellosis exposure, could facilitate timely diagnosis and treatment.

Background: Acute bacterial sacroiliitis is a rare yet potentially debilitating infection of the sacroiliac (SI) joint. While often associated with immunocompromised states, intravenous drug use, or trauma, this condition can also manifest in, otherwise, healthy individuals. Its nonspecific clinical presentation frequently mimics common musculoskeletal disorders, such as mechanical back pain or inflammatory arthropathies, leading to underdiagnosis and treatment delays. Staphylococcus aureus is the most prevalent pathogen involved, and without timely recognition and intervention, the infection can result in irreversible joint destruction. Therefore, early diagnosis is critical to prevent long-term disability and ensure favorable patient outcomes.

Objective: This case report presents a rare instance of acute bacterial sacroiliitis in a previously healthy, immunocompetent adult female with no predisposing conditions. The report emphasizes the diagnostic challenges, the role of imaging, and the necessity for early intervention.

Case presentation: A 40-year-old woman with no significant medical history presented with a 21-day history of progressively worsening pain in the left SI joint, radiating to the left lower limb, accompanied by fever, anorexia, and chills. Initial treatment with analgesics and nonsteroidal anti-inflammatory drugs proved ineffective, and laboratory tests revealed significantly elevated inflammatory markers. Magnetic resonance imaging (MRI) demonstrated joint effusion, a multiloculated abscess within the left iliacus muscle, and adjacent myositis. Ultrasound-guided arthrocentesis confirmed Staphylococcus aureus as the causative organism. The patient was successfully treated with intravenous antibiotics, followed by oral therapy and surgical drainage.

Conclusion: This case highlights the importance of maintaining a high index of suspicion for bacterial sacroiliitis in immunocompetent adults presenting with persistent pelvic pain. Prompt diagnosis through advanced imaging and targeted therapy is essential to prevent complications and ensure favorable clinical outcomes.

Retroperitoneal hydatid cyst caused by Echinococcus granulosus is a rare clinical condition that can occur primarily or synchronously with other location. We present a 47-year-old man with a recurrent retroperitoneal echinococcal cyst, complaining of pain in the right lumbar region. The diagnosis was established by ultrasound and computed tomography; additionally a partial cystectomy was performed. Retroperitoneal echinococcal cysts are often initially interpreted as retroperitoneal tumors, except in cases with a history of echinococcosis, which always leaves a degree of doubt regarding the presence of a recurrence or the development of a new cyst. In the present case, the surgical approach was the appropriate choice, followed by antihelminthic therapy. Only the combination of these two approaches can prevent the troublesome complication of echinococcosis recurrence.

Cytomegalovirus (CMV) and tuberculosis (TB) are two distinct infectious diseases that can cause significant health complications and may share clinical manifestations, complicating diagnosis and management. Herein, we present a case report of an immunocompetent patient with concurrent pulmonary CMV and TB infections, highlighting the rare occurrence of dual infection with TB and CMV in an otherwise healthy individual. An enhanced awareness among healthcare professionals about the potential for concurrent infections can improve diagnostic accuracy and patient care in similarly challenging cases.

Bacterial and fungal infections are recognized as prevalent etiological factors contributing to the symptoms associated with urinary tract infections and vulvovaginitis, respectively. This report presents a notable instance of a nonbacterial cause, specifically involving Enterobius vermicularis (pinworm). A 7-year-old female patient from a low socioeconomic background is reported, presenting with a 14-month history of recurrent urinary symptoms and vulvovaginitis. This clinical picture persists despite multiple courses of antibiotic therapy and negative urinary cultures. The diagnosis was established following meticulous urine collection, which demonstrated the presence of motile organisms identified as Enterobius vermicularis. The patient exhibited a favorable response to the administered treatment. This case highlights the importance of considering parasitic infections in the differential diagnosis of recurrent urinary symptoms, especially in pediatric patients with inadequate hygiene and lower socioeconomic conditions.

Introduction: Tuberculosis (TB) causes substantial morbidity and mortality globally, with continued endemicity in developing populations. Most cases of primary TB present as pulmonary TB; however, between 10% and 20% include extrapulmonary manifestations. Almost 26% of extrapulmonary manifestations include musculoskeletal TB. The risk of reactivation of latent TB is approximately 10% per year and is most common in those with immunocompromising conditions. Diagnosis of extrapulmonary TB remains elusive because of atypical presentation.

Case: We present a case of a 71-year-old man with a history of renal transplantation and previously treated latent TB who presented with worsening left lower extremity pain and swelling over the previous six months. Initially, the patient was unsuccessfully treated for presumed bacterial cellulitis with several rounds of antibiotics. The patient was then seen by Dermatology, who diagnosed presumed primary erythema nodosum. He was managed with prednisone and topical steroids for several months with only partial improvement. At admission, physical exam was significant for a 4 × 3-cm erythematous, warm, and tender area on the lower left extremity. Labs showed elevated neutrophils and lymphopenia, and an MRI of the limb suggested hindfoot abscesses, talonavicular septic arthritis, and surrounding osteomyelitis. Intraoperative cultures grew acid-fast bacilli and were confirmed to be pan-sensitive M. tuberculosis complex.

Conclusion: Musculoskeletal TB diagnosis requires a high index of suspicion, thorough physical exam, imaging, and tissue for culture and biopsy. Special attention should be placed on the combined risk factors of previous TB diagnosis, immunocompromised status, and symptoms refractory to alternative management strategies such as antibiotics and corticosteroids.