Case Reports in Infectious Diseases最新文献

Candida blankii has recently emerged as a pathogen of clinical significance, particularly in cases of candidemia. Here, we present two cases involving adult patients with complex medical histories. In one case, C. blankii was considered clinically significant, while in the other, it was regarded as a colonizer. The first case involves an 85-year-old male with multiple comorbidities, including chronic obstructive pulmonary disease and heart failure, who presented with a pleural effusion. Blood cultures revealed yeast which could not be identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), which was later identified as C. blankii after being sent to the provincial reference laboratory. The isolate showed high minimum inhibitory concentrations (MICs) to azoles. The second case involves a 60-year-old male with cirrhosis and multifocal pneumonia. C. blankii was isolated from bronchoalveolar lavage samples, though it was ultimately considered a colonizer rather than a pathogen in this instance. Initial identification via MALDI-TOF MS was inconclusive, necessitating further molecular sequencing. The pathogen exhibited high MICs to azoles and lower MICs to echinocandins and polyenes. Both cases highlight the challenges in identifying C. blankii using conventional laboratory methods. Given the increasing reports of C. blankii as a pathogen, particularly in immunocompromised patients, our findings emphasize the need for heightened awareness and improved diagnostic techniques. Accurate and timely identification is crucial for appropriate therapeutic management, given the organism's unique susceptibility profile. Further research is necessary to understand the epidemiology, pathogenesis, and optimal treatment strategies for C. blankii infections.

Background: Q fever is a globally distributed zoonotic infection caused by Coxiella burnetii, exhibiting a broad clinical spectrum in both acute and chronic forms. While pneumonia, hepatitis, and endocarditis are well-recognized manifestations, cutaneous involvement remains poorly characterized and likely underreported.

Case presentation: A 63-year-old male metalworker was admitted with a 2-week history of high-grade fever, dyspnea, anorexia, intractable hiccups, and profound asthenia. Physical examination revealed a diffuse, nonpruritic, blanchable macular rash on the back and sacral region. Extensive microbiological and autoimmune investigations were negative. Chest imaging demonstrated bilateral pneumonia, mediastinal lymphadenopathy, and a small pericardial effusion. Skin biopsy showed mild acanthosis, dermal capillary congestion, and superficial lymphohistiocytic infiltrates. Serological testing confirmed acute Q fever, with elevated Phase II C. burnetii antibody titers. Oral doxycycline led to complete resolution of fever and rash. Serial serology demonstrated a progressive decline in antibody titers, and the patient remained symptom-free after 6 months.

Discussion: This case highlights a rare parainfectious macular rash associated with acute Q fever-apparently the first reported in Italy. Cutaneous involvement in Q fever may represent a parainfectious immune-mediated reaction. Its nonspecific appearance and lack of a characteristic distribution pattern often delay diagnosis.

Conclusion: Clinicians should maintain a high index of suspicion for C. burnetii infection in patients with unexplained fever, pneumonia, and rash, even in the absence of direct animal exposure. Multidisciplinary evaluation and serial serology are pivotal for timely diagnosis, effective management, and monitoring of disease resolution.

Empyema necessitans is a rare complication of untreated/undertreated empyema characterized by the invasion and progression of empyema beyond the pleura into the chest wall. With the availability of antibiotics, empyema necessitans is now rarely seen in clinical practice. Effective treatment of empyema necessitans entails aggressive source control with surgical decortication in conjunction with prolonged culture-directed antibiotics. The most common etiologies include Mycobacterium tuberculosis, Actinomyces, Staphylococcus aureus, and Streptococcus species. Here, we report a case of refractory nontyphoidal Salmonella empyema necessitans in a patient who is virologically suppressed on HIV treatment and highlight the challenges in management when surgical decortication could not be performed.

Mucormycosis is a rare but aggressive opportunistic fungal infection, predominantly affecting immunocompromised individuals. We report a case of a 59-year-old male with newly diagnosed acute myeloid leukemia undergoing chemotherapy who developed pulmonary mucormycosis, which rapidly progressed to disseminated disease with pericardial involvement, an exceptionally rare occurrence. Initial chest CT imaging showed a subtle perihilar infiltrate, but within days, extensive spread was evident, showing widespread pulmonary consolidation, ground-glass opacities, vascular thrombosis, mediastinal invasion, and pericardial involvement. Bronchoscopy confirmed airway obstruction due to fungal invasion, and biopsy, along with pericardial fluid cultures, revealed Rhizopus microsporus. Despite early antifungal treatment, the patient's condition worsened, making surgery impossible and leading to respiratory failure and death. This case underscores the rapid progression and extensive spread of mucormycosis, highlighting the critical role of early CT imaging and clinical vigilance in high-risk patients. Timely recognition and intervention are essential to improve outcomes through both early medical and possible surgical management in this often-fatal disease.

Coccidioides is the causative organism for Coccidioidomycosis or otherwise known as "Valley fever." Valley fever usually presents as upper respiratory tract illness which can often be complicated by dissemination. Although immunosuppression increases the risk of disseminated disease, it can also be seen in immunocompetent patients. Coccidioides meningitis is the most feared outcome of disseminated coccidioides infection, rendering early diagnosis and treatment imperative. However, the diagnosis of coccidioides meningitis is challenging due to its vague presentation and its resemblance to other CNS disorders, both infectious and noninfectious. Moreover, serum and cerebrospinal fluid serologies, which are the mainstay in diagnosing coccidioides meningitis, can be inconclusive during the early phases of the disease process, potentially leading to missed diagnosis. Therefore, keeping a very high index of suspicion for coccidioides meningitis is crucial. Initiating antifungals early in suspected coccidioides meningitis even with inconclusive serologies may be appropriate as well. We present a case of coccidioides meningitis in an immunocompetent patient and the associated diagnostic challenges to guide physicians with the diagnosis and prevent fearsome complications.

Background: Moraxella catarrhalis, once considered a component of the normal human flora of the upper respiratory tract, is now recognized as a true pathogen and, rarely, a cause of infective endocarditis (IE).

Case presentation: We describe a rare case of a 36-year-old woman who presented with respiratory symptoms and was initially misdiagnosed with pneumonia and M. catarrhalis bacteremia. No vegetations were seen on transesophageal echocardiogram (TOE) imaging. However, further investigation with cardiac computed tomography (CT) revealed prosthetic pulmonary valve IE caused by M. catarrhalis, which also resulted in pulmonary abscesses.

Conclusions: This case highlights the importance of considering M. catarrhalis as a true pathogen in invasive disease, including prosthetic pulmonary valve IE. It also demonstrates the limitations of negative TOE findings in the evaluation of right-sided IE, particularly when prosthetic valves are involved. Cardiac CT is crucial when TOE results are negative but clinical suspicion for prosthetic right-sided IE remains high, as it aids in diagnosing both the infection and its perivalvular or periprosthetic complications.

Lepra reactions (LR) are acute inflammatory conditions with immune mediators that are highly morbid. Patients with the lepromatous end of the leprosy spectrum (BL-LL) are the only ones who develop Type-2 LR. 90% of the time, it happens during or right after treatment, usually within 2 years. The emergence of Erythema Nodosum Leprosum (ENL) suggests a paradoxical immune reaction and hypersensitivity to leprosy bacteria that results in painful erythematous nodules and systemic symptoms. Here, we present a case of Type 2 LR in a 41-year-old Indian man diagnosed with lepromatous leprosy 2 years ago. He was treated with MDT regime for 12 months and was compliant with treatment till 1 month before presenting with fever, cough, red eyes, and painful erythematous nodules involving his trunk and extremities. This case underscores the severe systemic inflammatory response that can be triggered by noncompliance with MDT, mimicking sepsis and requiring prompt recognition and management. Early recognition of ENL and appropriate management are essential to alleviate symptoms and prevent serious complications that may result from this serious condition.

Leclercia adecarboxylata is an emerging gram-negative pathogen. Historically, it has primarily affected immunocompromised individuals and has mainly been isolated from polymicrobial infections. Yet, advances in diagnostic techniques have led to increased recognition of its incidence and clinical relevance. In this case series, two instances of monomicrobial L. adecarboxylata infections following neurosurgical procedures in immunocompetent patients are presented. The first case occurred after spinal laminectomy, and the other case caused external ventricular drain ventriculitis. Both patients responded well to targeted antibiotic therapy, with no sequela or recurrence of infection. These cases represent the first documented neurosurgical infections caused by L. adecarboxylata, highlighting the organism's potential as a nosocomial pathogen and underscoring the need for heightened clinical awareness and further investigation into its epidemiology to prevent further infections.

Atraumatic splenic rupture is an uncommon, life-threatening abdominal emergency involving the rupture of the spleen in the absence of obvious trauma. This case report provides a summary of a 48-year-old male who presented to the Emergency Department of the University of Ghana Medical Centre with syncope and hemodynamic instability one week after receiving a yellow fever vaccine. A diagnosis of an atraumatic splenic rupture was eventually confirmed by imaging, and a splenectomy was done. This report aims to provide valuable insights into the recognition and management of atraumatic splenic rupture, a potential adverse event associated with the yellow-fever vaccine. It also highlights the importance of prompt diagnosis and timely intervention in such life-threatening cases.

Syphilis screening during pregnancy is essential to prevent congenital syphilis, yet diagnostic challenges arise when clinical presentation, serologic results, and pathologic examination are discordant. We report the case of a 39-year-old pregnant patient with a reactive enzyme immunoassay (EIA) at delivery, despite prior nonreactive syphilis serologies and a negative confirmatory test postpartum. Placental examination revealed multiple intervillous abscesses and chronic villitis, raising concern for congenital syphilis. However, immunohistochemistry (IHC) for Treponema pallidum yielded conflicting results across laboratories. Despite the lack of confirmed maternal infection, the neonate underwent a full congenital syphilis evaluation and received penicillin treatment. This case highlights the complexities of interpreting isolated positive treponemal tests, the limitations of placental pathology in syphilis diagnosis, and the need for standardized management algorithms to prevent misclassification, overtreatment, and undue emotional and healthcare burden. Interdisciplinary communication and rapid confirmatory testing are critical to optimizing maternal and neonatal outcomes.