Case Reports in Infectious Diseases最新文献

Angiostrongylus eosinophilic meningitis is aparasitic disease caused by Angiostrongylus cantonensis. The initial report is originated from southern China. However, the incidence rate has decreased due to improvements in sanitary conditions. Individuals who become infected are considered accidental cases. The clinical symptoms exhibit variability, with eosinophilic meningitis accompanied by elevated intracranial pressure being the most prevalent clinical presentation. The main treatment for angiostrongylus eosinophilic meningitis involves giving a combination of albendazole and corticosteroids. In this report, we present a prototypical case of eosinophilic meningitis and confirm Angiostrongylus cantonensis as the causative pathogen through next-generation sequencing (NGS). The disease progression was monitored using a range of blood and cerebrospinal fluid (CSF) assays. The patient underwent an extensive 46-day systemic treatment, resulting in a remarkable reduction of inflammatory cytokines and eosinophilic cells. The combined therapy of albendazole and corticosteroids, along with dehydration management and neuroprotective measures, resulted in positive outcomes. The timely detection and prompt initiation of anthelmintic therapy are associated with a favorable prognosis. This successful experience provides valuable insights for clinical practice.

Background: Myroides spp. are a group of Gram-negative bacteria which may cause opportunistic infections in humans. They are widely resistant to clinically relevant empiric antibiotics. Importantly, the focus of infection, regional susceptibility data, and patient's medical history dictate the choice of an empiric antibiotic treatment. Unfortunately, the empiric treatment is not always optimal. Especially immunocompromised patients are at risk of having opportunistic infections, which are not necessarily common causes of typical infections.

Case presentation: We report here a case of a patient with several comorbidities, including chronic kidney failure, heart failure, and leg ulcers, who developed fever and infection of his chronic leg ulcers. Cefuroxime was initiated as an empiric treatment of suspected sepsis with unknown origin. Two days later, the initial blood culture sample indicated Gram-negative rods which VITEK MS mass spectrometry identified as Myroides spp. The patient's antibiotics were first changed to meropenem, and the next day, ciprofloxacin was added. After susceptibility testing, ciprofloxacin was changed to levofloxacin. Fortunately, the patient recovered with the treatment and was discharged from hospital.

Conclusions: Myroides spp. are widely resistant opportunistic pathogens to acknowledge to be out of reach for first-line empiric antibiotic treatment. Myroides cases reported earlier have suggested soil exposure or pig bite as potential sources of infection. In the case described here, one possible source of Myroides might be cat scratches or cat licks.

Bacillus cereus is a Gram-positive, rod-shaped facultative anaerobe commonly associated with gastrointestinal infections. Although typically regarded as a blood culture contaminant, B. cereus can cause severe infections, including bacteremia, in high-risk patients. We report a case of a 39-year-old male with a history of intravenous drug use (IVDU) presenting with fevers and found to have B. cereus bacteremia. Cultures remained persistently positive for B. cereus despite 7 days of therapeutic vancomycin. Gentamicin was initiated for Gram-positive synergistic effect with vancomycin. This combination of gentamicin and vancomycin resulted in blood culture clearance. On discharge, he received one dose of dalbavancin and oral levofloxacin for 21 days to complete a total 4-week antibiotic course from date of blood culture clearance. This case demonstrates that dalbavancin may be a promising alternative to standard treatments for prolonged antibiotic courses of B. cereus infections, particularly when intravenous access is a challenge.

We present three patients who developed BCGosis, a rare complication following intravesical Bacillus Calmette-Guérin (BCG) treatment for bladder cancer. These cases highlight the diverse clinical manifestations, diagnostic challenges, and management strategies of this entity, emphasizing the importance of early recognition and initiation of antimycobacterial treatment.

Background: Aspergillus endocarditis (AE) is a rare but life-threatening form of infective endocarditis, accounting for only 0.2% of cases. Despite antifungal and surgical treatment, AE remains a major diagnostic and therapeutic challenge with high mortality rates. Ibrutinib, a Bruton's tyrosine kinase inhibitor used in the treatment of chronic lymphocytic leukemia (CLL), has been associated with early-onset invasive aspergillosis. However, no cases of AE have been documented in patients undergoing ibrutinib therapy to date. Case Presentation: A 71-year-old man with relapsed CLL on third-line ibrutinib therapy and a history of arrhythmic cardiomyopathy requiring an implantable cardioverter-defibrillator (ICD) presented with a six-month history of fever, cough, and fatigue. On admission, a full-body computed tomography scan revealed intestinal ischemia and multiple thrombotic occlusions involving the kidney, spleen, and iliac artery. Markedly elevated beta-D-glucan and serum galactomannan levels prompted empirical initiation of isavuconazole. Transthoracic echocardiography identified a large vegetation (2.5 × 4 cm) on the mitral valve with ICD lead involvement. Despite urgent surgical intervention-including ICD extraction and mitral valve replacement-the patient succumbed to complications. Intraoperative valve cultures grew Aspergillus fumigatus. Conclusions: This report underscores the severity of AE despite combined surgical and antifungal therapy. Given its high mortality rates, clinicians should maintain a high index of suspicion for AE, particularly in immunocompromised patients or those with a history of cardiac surgery or implanted cardiac devices. Early recognition and aggressive intervention remain essential to improving outcomes.

In United States, Q fever cases increased from < 50 to 200 from 2000-2019. Case: 31-year-old female with fever after exposure to unpasteurized milk. Investigation revealed positive Q fever IgG. Trimethoprim-sulfamethoxazole and doxycycline were started due to QTc prolongation. Evidence is limited on treatment without hydroxychloroquine, and the use constraints might prompt additional studies.

Background: Clostridium perfringens is an anaerobic, Gram-positive, spore-forming bacterium, commonly associated with gas gangrene and clostridial myonecrosis. Although bacteremia is rare, it carries a high mortality rate, particularly when complicated by massive intravascular hemolysis. Case Presentation: We report the case of a woman with poorly controlled diabetes mellitus who presented with fever, abdominal pain, systemic inflammatory response syndrome, respiratory insufficiency, and hemolytic anemia. Imaging studies revealed a hepatic abscess with gas formation, and blood cultures confirmed C. perfringens sepsis. Due to the patient's critical status, surgical intervention was deferred, and a multidisciplinary team initiated treatment involving intensive care, hematology, microbiology, immunohemotherapy, and surgery. Management and Outcome: Treatment included high-dose beta-lactam antibiotics combined with clindamycin, chosen for its antitoxin properties, alongside percutaneous drainage of the liver abscess and comprehensive intensive care support, including renal replacement therapy. The patient demonstrated progressive clinical improvement, with resolution of hyperlactatemia, successful weaning from vasopressors, and extubation. She completed a 28-day course of antibiotics and was discharged after a 75-day hospital stay. Conclusion: This case highlights the vital importance of early clinical suspicion, prompt diagnosis, and coordinated multidisciplinary management in C. perfringens sepsis. In the absence of well-established, evidence-based treatment protocols for this fulminant infection, our report illustrates a successful nonsurgical approach combining timely antimicrobial therapy, percutaneous source control through interventional radiology, and intensive organ support. Further research is essential to better define optimal management strategies and improve outcomes in this life-threatening condition.

We report a case of Epstein-Barr virus (EBV) encephalitis in a 27-year-old man from Bangkok, Thailand, presenting with fever and altered mental status. Cerebrospinal fluid analysis showed neutrophil predominance and EBV-positive PCR. The patient improved with intravenous dexamethasone, highlighting EBV as a potential encephalitis pathogen in immunocompetent individuals.

Background: Primary pulmonary cystic echinococcosis (CE) is a zoonotic disease often caused by Echinococcus granulosus sensu lato complex. Although rare in North America, it can present significant diagnostic and therapeutic challenges. Case Presentation: We report a 36-year-old male from Quebec, Canada, with locally acquired primary pulmonary CE who presented to the emergency department with a two-month history of shortness of breath, cough, and hemoptysis. Laboratory investigations showed mild leukocytosis and high eosinophil counts. A chest computed tomography (CT) scan revealed extensive multifocal consolidation in the right upper lobe (RUL) with a large 6-cm thick-walled cavity. Echinococcus serology was positive. Treatment was initiated with albendazole and praziquantel as well as antibiotics for pulmonary CE, with likely ruptured cyst and bronchoalveolar spillage complicated by a superimposed bacterial infection of the RUL. Follow-up imaging showed a decrease in the size of the cavitary lesion and regression of adjacent consolidations. Discussion: Diagnosing and managing pulmonary CE is complex, as clinical presentations vary and imaging and serological tests have limitations. Treatment depends on factors such as cyst size, rupture status, and infection, with surgery as the main approach for viable cysts and albendazole used for ruptured cysts. Conclusion: Pulmonary CE requires individualized management due to its varied presentations, with imaging and serology playing key but limited roles in the diagnosis. Medical management and monitoring were effective, while surgery was reserved for complex cases, with long-term follow-up and family screening essential for detecting recurrence and asymptomatic cases.

A 43-year-old male with newly diagnosed diabetes developed methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia following a foot injury. Despite appropriate antibiotic treatment, the patient's blood cultures remained persistently positive, and imaging revealed septic pulmonary emboli. Both transthoracic and transesophageal echocardiography showed no evidence of right-sided infective endocarditis. A gallium scan, followed by CT and MRI, identified a perinephric abscess as the source of infection. After drainage of the abscess and prolonged antibiotic therapy, the bacteremia was resolved, and pulmonary septic foci were reduced. This case highlights the importance of considering extracardiac sources, such as perinephric abscesses, in cases of persistent bacteremia and septic pulmonary emboli, especially when there is no evidence of endocarditis. And the remarkable utility of gallium scans to detect hidden infections.