Case Reports in Infectious Diseases最新文献

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.

Powassan virus (POWV) is a tick-borne flavivirus transmitted to humans by Ixodes ticks. In this report, we describe an immunocompromised patient who presented with progressive neurologic symptoms and was diagnosed with POWV encephalitis. Additionally, the patient tested positive for Jamestown Canyon virus (JCV), a mosquito-borne orthobunyavirus, creating a diagnostic dilemma. This case underscores the importance of considering vector-borne illnesses in immunocompromised individuals who present with neurologic symptoms, particularly during peak arboviral transmission seasons in the United States. It also highlights the complexities of laboratory testing for arboviral infections in these vulnerable patients.

Human T-lymphotropic virus type 1 (HTLV-1), the first oncogenic retrovirus discovered in humans, is primarily associated with two disease entities: adult T cell leukemia-lymphoma and HTLV-1-associated myelopathy-tropical spastic paresis. HTLV-1 has also been implicated in the pathogenesis of various autoimmune rheumatic diseases, and its association with the autoimmune disorders of the gastrointestinal track is less well understood. Our patient, a 26-year-old previously healthy female, presented with recurrent, progressively worsening chronic abdominal pain and persistent liver test abnormalities. Initially diagnosed with acute acalculous cholecystitis and autoimmune hepatitis (AIH), her liver tests continued to exhibit a predominantly cholestatic pattern. This prompted further advanced imaging, and magnetic resonance cholangiopancreatography ultimately confirmed a diagnosis of primary sclerosing cholangitis (PSC). Complicating her condition further, she developed lower extremity weakness, initially attributed to axonal Guillain-Barré syndrome, which unfortunately did not respond to standard treatment. After a year marked by progressive clinical decline with repeated and prolonged hospitalizations due to fever of unknown origin, an extensive diagnostic workup ultimately led to a diagnosis of HTLV-1 myelopathy, along with AIH-PSC overlap syndrome. This case highlights the diagnostic challenges associated with the multisystem involvement of HTLV-1. Notably, our patient's presentation was not consistent with classic HTLV-1 myelopathy rather a subtype with rapidly progressive symptoms and flaccid as opposed to spastic paresis. The association between HTLV-1 infection and autoimmune cholangiopathy is exceptionally rare. To the best of our knowledge, our case represents only the second reported instance of autoimmune cholangiopathy associated with HTLV-1 myelopathy and the first reported case of AIH-PSC overlap syndrome associated with HTLV-1 myelopathy. This underscores the need for heightened clinical awareness of potential hepatic immune manifestations in patients with HTLV-1 infection, even in the absence of classic neurologic symptoms at initial presentation.

Chlamydia psittaci, the causative agent of psittacosis, is an intracellular bacterium typically transmitted from birds to humans, leading to atypical pneumonia. We present a case of a 60-year-old man with no reported bird exposure but a history of working as a chief cook, potentially exposed to poultry. He presented with high fever, diffuse soreness, and left-sided pulmonary consolidation. Initial treatment with β-lactams was ineffective, but a multiplex PCR on bronchoalveolar lavage identified C. psittaci DNA. Therapy was switched to moxifloxacin, resulting in rapid clinical improvement. C. psittaci causes approximately 1% of community-acquired pneumonias, often underdiagnosed due to nonspecific symptoms and the need for advanced diagnostic tools like nucleic acid amplification tests (NAATs) or metagenomic next-generation sequencing (mNGS). The bacterium is endemic in birds and poultry, with human infections linked to occupational exposure or contact with infected animals. Diagnosis relies on NAAT and mNGS, as serology and culture are less practical. Treatment with tetracyclines, quinolones, or macrolides is effective, reducing mortality from 10%-20% to < 1%. Preventive measures, including protective equipment for high-risk individuals and treatment of infected birds, are crucial. Mandatory reporting of cases could improve understanding of the disease burden. This case highlights the importance of considering psittacosis in atypical pneumonia, even without direct bird exposure, and the role of NAAT or mNGS in accurate diagnosis.

Background: Aerococcus urinae, a rare human pathogen, mainly causes urinary tract infection, endocarditis, and bacteremia. However, it is rarely the cause of other types of infection such as spondylodiscitis. Invasive A. urinae infection chiefly occurs in older men with underlying urinary tract disorders. The real incidence may be underestimated, as Aerococci grow in a CO2-containing atmosphere, and urine cultures are usually not incubated in this environment. There have been eight case reports of spondylodiscitis due to A. urinae. Material and Methods: We report a 9^th case occurring in an 80-year-old Caucasian man with lower back pain. The patient had predisposing conditions (diabetes and a history of urological surgery). Spinal MRI showed signs of spondylodiscitis. Two computed tomography-guided biopsies targeting the intervertebral disc and psoas muscle were not diagnostic. One of 10 blood culture bottles grew A. urinae. Results: After worsening of an L2 fracture, and unsuccessful percutaneous sampling procedures, the patient underwent surgical stabilization of T12 to L4 with multiple biopsies. Biopsy cultures grew Aerococcus urinae. Amoxicillin was administered intravenously for 14 days, followed by oral levofloxacin for 3 months. Conclusion: A. urinae should be considered in spondylodiscitis with negative cultures, particularly in older men with diabetes and urological conditions.

Mycobacterium genavense was first identified in a patient with HIV. Here, we describe a 40-year-old man with prolonged fever and mediastinal and abdominal lymphadenopathy, who was initially misdiagnosed with sarcoidosis. A molecular study was conducted after mycobacterium was isolated from a lymph node biopsy, leading to the identification of M. genavense. The identification of this microbe, along with recurrent oral candidiasis and varicella skin lesions, raised suspicion of an immunodeficiency disorder, which ultimately resulted in an HIV diagnosis. Concurrently, the patient experienced polyradiculopathy caused by cytomegalovirus. This case highlights that after identifying a granuloma in tissue, a comprehensive investigation to exclude infectious causes using microbiological and molecular methods is crucial.

Despite being relatively common in endemic settings, amoebic liver abscesses are rarely diagnosed in high-resource countries, where they are usually imported by migrants or travelers to endemic areas. Between 2010 and 2024, we observed two cases of amoebic liver abscess that were successfully managed in a tertiary-care center in Italy. In both cases, the infection was contracted in Colombia. Given the high morbidity and mortality associated with nontreated amoebic liver abscesses, this report aims at underlying the importance of travel history and of considering amoebic liver abscess among the differential diagnoses for people coming from endemic countries with compatible clinical presentations. Prompt diagnosis and treatment are of paramount importance for favorable clinical outcomes.

Introduction: Paradoxical reactions during tuberculosis (TBC) therapy are characterized by clinical or radiological worsening of preexisting tuberculous lesions or the appearance of new manifestations following appropriate TBC treatment. Identifying this phenomenon is crucial, since it can be mistaken with treatment failure or relapse. Although widely described in HIV patients following immune reconstitution inflammatory syndrome, the literature on HIV-negative patients is scarce. Case Series: We present three cases of immunocompetent patients with central nervous system tuberculosis (CNS-TBC) who developed paradoxical reactions following appropriate TBC therapy. These included diverse clinical and radiological manifestations, such as persistent headaches, apparition or progression of tuberculomas, cerebral infarcts, and dorsal myelitis. Paradoxical reactions occurred within an average of 2.5 months from the start of anti-TBC treatment. Conclusion: Our findings underscore the importance of closely monitoring patients following anti-TBC treatment to identify potential complications rapidly. Paradoxical reactions due to exaggerated immune response to Mycobacterium tuberculosis complex antigens should be considered in a thorough differential diagnosis including other CNS infections, granulomatous or neoplastic disorders, treatment failure, or treatment-related toxicities. Ensuring adequate adherence to anti-TBC treatment and immunosuppressants is essential in such cases.