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Concurrent Ocular and Cerebral Toxoplasmosis in a Liver Transplant Patient Treated with Anti-CD40 Monoclonal Antibody. 抗cd40单克隆抗体治疗肝移植患者并发眼脑弓形虫病
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/5565575
Roos Van Den Noortgate, Maja Kiselinova, Céline Sys, Geraldine Accou, Guy Laureys, Hans Van Vlierberghe, Frederik Berrevoet, Elke O Kreps

Toxoplasma gondii, an obligate intracellular parasitic protozoon, usually causes a mild, acute infection followed by a latent asymptomatic phase with tissue cysts or a chronic form with recurrent retinochoroiditis. However, immunocompromised patients can cause disseminated disease due to the reactivation of the latent tissue cysts or due to a primary infection. Here, we present a rare case of bilateral ocular toxoplasmosis and concurrent subacute toxoplasma encephalitis in a 70-year-old patient on anti-CD40 treatment following his liver transplant. The diagnosis was confirmed by PCR of anterior chamber fluid and brain biopsy, and no other sites of disseminated disease were detected on PET-CT. The patient has been treated with sulfamethoxazole-trimethoprim 800/160 mg with virtually complete resolution of the neurological and ocular symptoms. Iatrogenic blockade of the CD40 pathway may elicit a particular susceptibility for CNS reactivation of T. gondii.

刚地弓形虫是一种专性细胞内寄生原虫,通常引起轻微的急性感染,随后是潜伏的无症状期,伴有组织囊肿或慢性形式,伴复发性视网膜脉络膜炎。然而,由于潜伏组织囊肿的再激活或由于原发性感染,免疫功能低下的患者可引起播散性疾病。在此,我们报告一例罕见的双侧眼弓形虫病并发亚急性弓形虫脑炎的病例,患者为70岁,肝移植后接受抗cd40治疗。经前房液PCR及脑组织活检证实诊断,PET-CT未检出其他播散性病变部位。患者已接受磺胺甲恶唑-甲氧苄啶800/160 mg治疗,神经和眼部症状几乎完全缓解。医源性阻断CD40通路可能引起弓形虫中枢神经系统再激活的特殊易感性。
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引用次数: 0
An Adult Case of Adenovirus-Associated Acute Disseminated Encephalomyelitis. 成人腺病毒相关急性播散性脑脊髓炎1例。
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/5528198
Dewayne Campbell, Gordon S Wong, Hyun Park, Gavin McLeod

Acute disseminated encephalomyelitis (ADEM) is an autoimmune neurological disease that predominately affects pediatric population. Only a single fatal adult case of adenovirus-associated ADEM has previously been published by Qamar et al. in 2021. Here, we present an adult case of adenovirus-associated ADEM, which was diagnosed early in her clinical course. The patient was treated with the prompt initiation of steroids, intravenous immune globulin (IVIG), and plasmapheresis (PLEX), and the patient recovered fully. This case highlights the importance of early accurate diagnosis for other clinicians to treat adenovirus-associated ADEM in a timely fashion to prevent a potentially fatal outcome.

急性播散性脑脊髓炎(ADEM)是一种主要影响儿童的自身免疫性神经系统疾病。Qamar等人在2021年仅发表了一例腺病毒相关ADEM致死成人病例。在这里,我们提出一个成人病例腺病毒相关的ADEM,这是诊断早期在她的临床过程。患者立即开始类固醇、静脉注射免疫球蛋白(IVIG)和血浆置换(PLEX)治疗,患者完全康复。该病例强调了早期准确诊断的重要性,以便其他临床医生及时治疗腺病毒相关的ADEM,以防止潜在的致命结果。
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引用次数: 2
Lemierre Syndrome: A Diagnosis behind the Veil. 莱米尔综合征:面纱背后的诊断。
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/2273954
Pak-Ho Au, Kelechi Nwabara, Nanuli Gvazava, Shannon Ejiofor, Ghulam Ghous

Lemierre syndrome (LS) is a rare, serious infection that is often misdiagnosed, as it frequently mimics common upper respiratory infections. It is even rarer for LS to be preceded by a viral infection. We share a case of LS in a young man who presented to the Emergency Department with COVID-19 viral infection followed by a subsequent LS diagnosis. The patient's condition initially worsened despite treatments for COVID-19 and was subsequently started on broad-spectrum antibiotics. He was then diagnosed with LS after blood cultures grew Fusobacterium necrophorum, and antibiotics were adjusted accordingly, resulting in improvement of symptoms. Even though LS is often recognized as a sequela of bacterial pharyngitis, preceding viral infections, including COVID-19, might be a risk factor that contributes to the development of LS.

Lemierre综合征(LS)是一种罕见的严重感染,经常被误诊,因为它经常模仿常见的上呼吸道感染。更罕见的是,LS之前有病毒感染。我们分享了一位年轻男性的LS病例,他因COVID-19病毒感染而到急诊室就诊,随后被诊断为LS。尽管接受了COVID-19治疗,但患者的病情最初恶化,随后开始使用广谱抗生素。血液培养培养出坏死梭杆菌后被诊断为LS,并相应调整抗生素,症状得到改善。虽然LS通常被认为是细菌性咽炎的后遗症,但之前的病毒感染(包括COVID-19)可能是导致LS发展的危险因素。
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引用次数: 1
HIV-Associated Vacuolar Myelopathy and HIV-Associated Neurocognitive Disorder as an Initial Presentation in HIV Infection. HIV相关空泡性脊髓病和HIV相关神经认知障碍是HIV感染的初始表现。
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/1542785
Md Asaduzzaman, Atonu Das, Sowmitra Das, Mahfuza Khadija Shamma, Abul Kalam Mohammed Shoab, Biplob Kumar Roy

Several neurological disorders have been described in HIV infection. Vacuolar myelopathy and neurocognitive disorders usually come at an advanced stage of the disease process. Here, we present a case where these features constitute the presenting complaints. Both of these conditions improved significantly following the start of HAART. We believe this clinical pathway can be a good learning point for the clinician.

在HIV感染中已经描述了几种神经系统疾病。空泡性脊髓病和神经认知障碍通常发生在疾病的晚期。在这里,我们提出一个案例,其中这些特征构成了目前的投诉。在开始HAART治疗后,这两种情况都有了显著改善。我们相信这一临床途径对临床医生来说是一个很好的学习点。
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引用次数: 0
Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia. 嗜肺军团菌肺炎的非外伤性脾破裂。
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/9625170
Elliott Worku, Dominic Adam Worku

A previously fit 46-year-old male handyman presented to a rural hospital with a cough, fever, and epigastric pain without peritonism. The patient was admitted medically with symptoms and radiological appearances consistent with atypical community-acquired pneumonia. During the first 48 hours of admission, he suffered a significant haemodynamic deterioration and was transferred to the intensive care unit (ICU) for vasoactive support. Following stabilisation, urgent abdominal CT imaging demonstrated splenic rupture with haematoma in the absence of historical trauma. Emergency splenectomy was performed; the histopathological examination was unremarkable. Investigations for the presenting complaint confirmed Legionella pneumophila serotype 1 pneumonia by urinary antigen testing. The patient was extubated on postoperative day 2 and stepped down from ICU to complete a 14-day course of azithromycin. Atraumatic splenic rupture is a rarely described clinical entity. The process can be subdivided into pathological and nonpathological (spontaneous) cases. Pathological atraumatic splenic rupture may occur in the context of wide-ranging aetiologies, including bacterial pneumonia; however, the association with Legionella pneumophila serotype 1 is exceptional, with this representing the eighth case in the medical literature.

46岁男性杂工,以咳嗽、发热、上腹痛无腹胀就诊于农村医院。患者入院时的症状和影像学表现与非典型社区获得性肺炎相符。入院前48小时,患者血流动力学明显恶化,转至重症监护病房(ICU)接受血管活性支持。稳定后,紧急腹部CT成像显示脾破裂伴血肿,无历史创伤。行急诊脾切除术;组织病理学检查无显著差异。对主诉的调查通过尿抗原检测证实嗜肺军团菌血清1型肺炎。患者于术后第2天拔管,退出ICU,完成14天的阿奇霉素疗程。非外伤性脾破裂是一种罕见的临床症状。该过程可细分为病理性和非病理性(自发)病例。病理性非创伤性脾破裂可能发生在广泛的病因,包括细菌性肺炎;然而,与嗜肺军团菌血清型1的关联是例外的,这是医学文献中的第8例。
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引用次数: 0
A Case of Visceral Leishmaniasis in a 4-Year-Old Child Living in Nonendemic Area Located in Suburbs of Dakar, Senegal. 生活在塞内加尔达喀尔郊区非流行区1例4岁儿童内脏利什曼病。
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/2354935
Magatte Ndiaye, Dienaba Fafa Cissé, Aicha Djigal, Aminata Sow, Souléye Lélo, Fatoumata Ly, Isaac A Manga, Mame Ami Diouf, Doudou Sow, Oumar Gaye, Boubacar Camara, Babacar Faye

Visceral leishmaniasis (VL) is an infectious disease caused by protozoa of the genus Leishmania. Sporadic cases are observed in nonendemic areas and often associated with limited foci; therefore, the disease is easily overlooked. In addition, other diseases have similar clinical symptoms, which make it difficult for clinicians to make an accurate diagnosis and to provide effective treatment. We identified visceral leishmaniasis in a 4-year-old child in Pikine, Senegal. The patient was admitted to the Pikine National Teaching Hospital for haemorrhagic, tumoral, and infectious syndromes. At admission, the patient presented with epistaxis and gingivorrhagia, a severe anaemic syndrome poorly tolerated, a systemic inflammatory response syndrome with fever at 39.5°C, a tumoral syndrome with 11 cm of hepatomegaly and 12 cm of type IV splenomegaly, and noninflammatory macropoly adenopathies. A spinal cord puncture was performed, and direct microscopy examination of the sample after GIEMSA staining revealed amastigote forms of Leishmania. The PCR amplification of extracted DNA from the bone marrow aspiration using specific primers for VL (forward and reverse) confirmed that VL was responsible for the infection. A treatment with meglumine antimoniate (Glucantime) was given and it gave a successful outcome with remission of clinical symptoms and favourable evolution with 3 months hindsight. Conclusion. This visceral leishmaniasis case diagnosis in Senegal has shown that, apart from haematological malignancies, this disease must be considered in combination with a tumor syndrome, haemorrhagic syndrome, and infectious syndrome.

内脏利什曼病(VL)是一种由利什曼属原虫引起的传染病。在非流行地区观察到散发病例,通常与有限的疫源地有关;因此,这种疾病很容易被忽视。此外,其他疾病具有类似的临床症状,这给临床医生做出准确的诊断和提供有效的治疗带来了困难。我们在塞内加尔Pikine的一名4岁儿童中发现内脏利什曼病。患者因出血、肿瘤和感染综合征被送入Pikine国立教学医院。入院时,患者表现为鼻出血和牙龈出血,耐受性差的严重贫血综合征,伴有39.5℃发热的全身炎症反应综合征,伴有11厘米肝肿大和12厘米IV型脾肿大的肿瘤综合征,以及非炎症性大多腺病。进行脊髓穿刺,GIEMSA染色后对样本进行直接显微镜检查,发现利什曼原虫的无梭体形式。用VL特异性引物(正向和反向)对骨髓抽吸提取的DNA进行PCR扩增,证实VL是引起感染的原因。给予甲氨苄胺锑酸盐(葡聚糖)治疗,临床症状缓解,3个月后进展良好,结果成功。结论。塞内加尔这一内脏利什曼病病例的诊断表明,除了血液系统恶性肿瘤外,还必须将该病与肿瘤综合征、出血性综合征和感染综合征结合起来考虑。
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引用次数: 0
Minimal Change Nephrotic Syndrome with Acute Kidney Injury after the Administration of Pfizer-BioNTech COVID-19 Vaccine. 辉瑞- biontech COVID-19疫苗接种后急性肾损伤的微小变化肾病综合征
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/5122228
Erdinc Gulumsek, Dilan Damla Ozturk, Huseyin Ali Ozturk, Tayyibe Saler, Kivilcim Eren Erdogan, Ahmed Muhammad Bashir, Hilmi Erdem Sumbul

Nephrotic syndrome progresses with various metabolic disturbances, such as proteinuria over 3.5 grams in 24 hours, hypoalbuminemia, and hypercoagulability. Patients usually complain about diffuse edema throughout the body, which is secondary to hypoalbuminemia. It has many primary and secondary causes. Patients may require a renal biopsy to confirm the diagnosis. Besides, many secondary causes of nephrotic syndrome should be examined and excluded. Although many vaccines were developed due to the COVID-19, many side effects are still reported because of the Pfizer-BioNTech COVID-19 vaccine (COVID-19 mRNA and BNT162b2), which is widely used in Turkey. This study examines a case of nephrotic syndrome with acute renal injury after Pfizer-BioNTech vaccine.

肾病综合征的进展伴随着各种代谢紊乱,如24小时内蛋白尿超过3.5克、低白蛋白血症和高凝血性。患者通常主诉为全身弥漫性水肿,继发于低白蛋白血症。它有许多主要和次要的原因。患者可能需要肾活检来确认诊断。此外,肾病综合征的许多继发原因应检查和排除。尽管针对COVID-19开发了许多疫苗,但由于在土耳其广泛使用的辉瑞- biontech COVID-19疫苗(COVID-19 mRNA和BNT162b2),仍有许多副作用的报道。本研究报告一例在辉瑞生物技术(Pfizer-BioNTech)疫苗后并发急性肾损伤的肾病综合征。
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引用次数: 0
HAV Infection Associated with Hemophagocytic Syndrome. 与噬血细胞综合征相关的甲肝感染。
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/7799252
H Aamri, R Elqadiry, H Nassih, A Bourrahouat, I Ait Sab

Hemophagocytic syndrome is a rare disease that can cause severe illness and death. This condition is caused by the presence of antibodies against the hepatitis A virus. A positive anti-IGM antibody was identified in our 7-year-old patient with severe hepatitis A. A week after the hepatitis A was diagnosed, the patient experienced pancytopenia, which was worsened by prolonged fever. He was then diagnosed with macrophage activation syndrome. The treatment with steroids improved the clinical and biological evolution of the condition.

噬血细胞综合征是一种罕见的疾病,可导致严重疾病和死亡。这种情况是由抗甲型肝炎病毒抗体的存在引起的。我们7岁的重症甲型肝炎患者抗igm抗体阳性,在确诊一周后,患者出现全血细胞减少症,并因持续发热而加重。随后,他被诊断为巨噬细胞激活综合征。类固醇治疗改善了病情的临床和生物学进展。
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引用次数: 0
Strongyloides stercoralis Dissemination and Hyperinfection Associated with Long-Term Steroid Treatment in a Neurosurgical Population. 神经外科人群长期类固醇治疗与粪圆线虫传播和过度感染相关。
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/4412935
Mariana Constante, João Domingos, Francisco Neves Coelho, Teresa Baptista Fernandes, Teresa Baptista, Marta Maio Herculano

Strongyloidiasis develops from the infection with Strongyloides stercoralis (Family: Strongylidae) and was recently considered a neglected tropical disease by the World Health Organization due to its global distribution and high burden of infection. Here, we present the cases of two patients under corticosteroid therapy after neurosurgical surgery who developed septic shock-like hyperinfection syndrome due to disseminated strongyloidiasis. The first case is a 77-year-old man from Cape Verde who was diagnosed with an extra-axial right parietal brain mass. He was given dexamethasone and was submitted to a biparietal craniotomy. His condition deteriorated and he was admitted to the intensive care unit (ICU), where he was diagnosed with disseminated strongyloidiasis with hyperinfection. Anthelmintic treatment and corticosteroid therapy were rapidly tapered and stopped. Neurological dysfunction persisted and the patient was transferred to the ward. The patient had died after complications of hospital-acquired pneumonia. The second case is a 47-year-old man from Guinea-Bissau who was diagnosed with a space-occupying lesion in the right temporal region and started treatment with dexamethasone. He underwent a craniectomy with partial excision of the lesion (high-grade glioma). Later his neurologic state worsened, and he was diagnosed with septic shock and hospital-acquired pneumonia. He was admitted to the ICU, the diagnosis of disseminated strongyloidiasis and hyperinfection syndrome was made and he initiated treatment with ivermectin and albendazole. Corticosteroid therapy was tapered. The patient's clinical status deteriorated, and multiple opportunistic infections were diagnosed during the ICU stay, which lead him to die. Clinicians should have a high index of suspicion when in the presence of corticosteroid-treated patients with sepsis. Preventive strategies and subsequent treatment should be considered in patients with a risk of acquisition or dissemination. Treating severe strongyloidiasis is still a clinical challenge and a delayed diagnosis can significantly worsen the outcomes of the patients affected, as seen in the presented cases.

圆形线虫病是由粪形圆形线虫(圆形线虫科)感染发展而来,由于其全球分布和感染负担高,最近被世界卫生组织认为是一种被忽视的热带病。在此,我们报告了两例神经外科手术后接受皮质类固醇治疗的患者,由于播散性圆线虫病而出现脓毒性休克样过度感染综合征。第一个病例是一名来自佛得角的77岁男子,他被诊断为右脑顶叶轴外肿块。他被给予地塞米松,并提交了双顶骨开颅术。他的病情恶化,被送进重症监护病房(ICU),在那里他被诊断为播散性圆线虫病伴过度感染。驱虫药治疗和皮质类固醇治疗迅速逐渐减少并停止。神经功能障碍持续存在,患者被转移到病房。患者死于医院获得性肺炎并发症。第二个病例是来自几内亚比绍的一名47岁男子,他被诊断为右侧颞区占位性病变,并开始使用地塞米松治疗。他接受了部分切除病变(高级别胶质瘤)的颅骨切除术。后来他的神经状态恶化,他被诊断为感染性休克和医院获得性肺炎。他住进ICU,诊断为播散性圆线虫病和过度感染综合征,并开始伊维菌素和阿苯达唑治疗。皮质类固醇治疗逐渐减少。患者临床状况恶化,在ICU住院期间多次出现机会性感染,导致患者死亡。临床医生应该有高度的怀疑指数时,在存在皮质类固醇治疗的患者败血症。对于有感染或传播风险的患者,应考虑预防策略和后续治疗。治疗严重的圆线虫病仍然是一项临床挑战,如所述病例所示,延迟诊断可显著恶化受影响患者的预后。
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引用次数: 0
Acute Babesiosis Causing a False-Positive HIV Result: An Unexpected Association. 急性巴贝斯虫病引起假阳性HIV结果:一个意想不到的关联。
IF 1.1 Q4 INFECTIOUS DISEASES Pub Date : 2023-01-01 DOI: 10.1155/2023/6271710
Jody Z He, Montasin Rezwan, Aneela Arif, Saada Baroud, Mohamed Elhaj, Aizaaz Khan

Babesiosis is a tick-borne condition that causes hemolytic anemia and manifests with flu-like symptoms such as fevers, chills, fatigue, and anorexia. Very few case reports have documented babesiosis infection associated with a false-positive HIV test. In this case report, we add to the current literature by describing a patient admitted for treatment of babesiosis who had a preliminary positive HIV test on admission and a negative repeat HIV test after one week of treatment for babesiosis. A 60-year-old male with a past medical history of high cholesterol presented to the Emergency Department after having abnormal laboratory tests with his primary care doctor. He reported fever, fatigue, anorexia, and worsening jaundice for three weeks. He was hypotensive and febrile on admission. A blood smear showed Babesia species with 1-2% infected red blood cells. He was admitted to the intensive care unit and received treatment with plasmapheresis, atovaquone, and antibiotics. The fourth-generation HIV 1/2 antigen/antibody test was initially positive but after treatment, HIV testing was negative. A misdiagnosis of HIV can greatly impact a patient's quality of life as antiretroviral therapy has multiple deleterious side effects. Clinicians must consider further evaluation of patients with acute babesiosis who also test positive for HIV.

巴贝斯虫病是一种蜱传疾病,可引起溶血性贫血,并表现为发烧、发冷、疲劳和厌食等流感样症状。很少有病例报告证明巴贝斯虫病感染与艾滋病毒检测假阳性有关。在这个病例报告中,我们通过描述一个入院治疗巴贝斯虫病的患者,他在入院时HIV初步检测呈阳性,在治疗巴贝斯虫病一周后HIV再次检测呈阴性,从而增加了目前的文献。一位60岁男性,既往有高胆固醇病史,在与初级保健医生进行异常实验室检查后来到急诊科。他报告发烧、疲劳、厌食和黄疸加重三周。他入院时有低血压和发热。血液涂片显示巴贝斯虫种类有1-2%的红细胞感染。他被送进重症监护室,接受血浆置换、阿托伐醌和抗生素治疗。第四代HIV 1/2抗原/抗体检测最初呈阳性,但治疗后,HIV检测呈阴性。由于抗逆转录病毒治疗有多种有害的副作用,HIV的误诊会极大地影响患者的生活质量。临床医生必须考虑对艾滋病毒检测呈阳性的急性巴贝斯虫病患者进行进一步评估。
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引用次数: 0
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Case Reports in Infectious Diseases
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