Infectious Diseases

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• First case of meningoencephalitis and bacteraemia with Flavobacterium lindanitolerans Rebecca Zurbuchen, Mirjam de Roche, Aikaterini Galimanis, Kerstin Narr, Olivier Dubuis, Christiane Resch, Mairi Ziaka Views: 547 HTML: 124 PDF: 396

  Purpose: Flavobacterium lindanitolerans is an environmental Gram-negative, non-spore-forming rod which is usually not considered to be a human pathogen. Isolation from human clinical samples has been described only once. We report the first case of meningoencephalitis and bacteraemia with Flavobacterium lindanitolerans.
  Case description: A 76-year-old female presented with fever, headache, alteration of mental status, marked meningism and dysarthria. A lumbar puncture demonstrated cerebrospinal fluid findings consistent with bacterial meningitis, and a broad-spectrum antibiotic therapy was initiated. Blood and cerebrospinal fluid cultures revealed a growth of Flavobacterium lindanitolerans. Based on antimicrobial susceptibilities testing, antibiotic treatment was changed to levofloxacin, resulting in a remission of the clinical symptoms after 21 days of treatment.
  Conclusion: Flavobacterium species are extremely rare human pathogens. However, some of them have been reported to cause opportunistic infections. We describe the first case of meningoencephalitis and bacteraemia caused by Flavobacterium lindanitolerans which was effectively treated with levofloxacin for 21 days.

• Legionnaires' disease complicated with rhabdomyolysis and acute kidney injury Xin Ya See, Omer Ahmed, Nikita Nand, Waleed Quwatli Views: 415 HTML: 82 PDF: 371

  Legionnaire's disease can cause rare and severe complications such as rhabdomyolysis and acute kidney injury. This case report details a 45-year-old male patient who presented with features of Legionnaire's disease. Laboratory results showed a significantly elevated serum creatinine kinase level and an increased creatinine level. Imaging showed right lower lobe consolidation, and a positive urine antigen test confirmed Legionnaire's disease. The patient was administered azithromycin and underwent fluid repletion to manage the rhabdomyolysis and acute kidney injury, resulting in improved creatinine kinase levels and kidney function. He was discharged and continued on azithromycin for 10 days. His outpatient follow-up showed that creatinine kinase levels had further decreased. This case report emphasises the importance of early recognition and management of Legionnaire's disease and its rare but severe complications.

• Are patients with HHV-8 associated Castleman disease successfully treated with rituximab at risk of subsequently developing HHV-8 negative (idiopathic) Castleman disease? Gavin Ha, Kelsey Kwong, Bryce Tanaka, Yoshito Nishimura, Christina Chong Views: 314 HTML: 73 PDF: 327

  Introduction: Multicentric Castleman disease (MCD) is a lymphoproliferative disorder characterized by lymph node histopathology and systemic symptoms. To our knowledge, there are no descriptions in the literature of long-term outcomes of human herpesvirus-8 (HHV-8)-associated MCD.
  Case Description: We report a case of a 70-year-old male living with human immunodeficiency virus and a history of human herpesvirus-8 (HHV-8)-associated MCD. The patient reported having had low-grade fever for two weeks. Extensive workup revealed systemic lymphadenopathy without evidence of autoimmune disease or malignancy. Lymph node biopsy was consistent with HHV-8-negative idiopathic MCD (iMCD). The patient was subsequently scheduled for anti-interleukin-6 therapy.
  Discussion: The present case is the first report of probable development of iMCD after long-term follow-up for HHV-8-associated MCD. The case illustrates the possible long-term consequences of MCD, suggesting the necessity of further research on the pathogenesis of CD.
  Conclusion: Given the uncertainty in the long-term outcomes of HHV-8-associated MCD, periodic surveillance of patients with a history of HHV-8-associated MCD is warranted. Prospective nationwide cohort studies comparing characteristics of HHV-8-associated MCD and iMCD would bring further insights.

• Alpha-gal syndrome – A case report of tick-borne anaphylactic shock Jiri Muller, Jaroslav Radej, Miroslav Kriz, Eliska Hunkova, Jan Kasparek, Martin Matejovic Views: 518 HTML: 187 PDF: 448

  The most common cause of vasoplegic shock in critical care is sepsis. However, although rarely and only in specifically sensitised individuals previously bitten by a tick, red meat may provoke a delayed allergic reaction called an alpha-gal syndrome. We present a case of a protracted life-threatening manifestation of alpha-gal syndrome, which, due to an unusual absence of typical features of anaphylaxis can masquerade as septic shock and calls attention to the premature diagnostic closure as a contributor to diagnostic error. Alpha-gal syndrome is a relatively new, but increasingly recognised health issue. We propose that alpha-gal syndrome should be considered in the differential diagnosis of vasoplegic shock of unclear aetiology even in the absence of typical allergic symptomatology and typical allergen exposure since alpha-gal is present in a wide variety of carriers.

• Facial cellulitis caused by Candida guilliermondi in an immunocompetent patient: a rare case report Ilir Tolaj, Visar Gashi, Gramoz Bunjaku, Murat Mehmeti, Hajrullah Fejza Views: 505 PDF: 379 HTML: 390

  Background: Candida cellulitis is a rare disease, primarily reported in immunocompromised patients. Atypical Candida spp. infections are increasing, largely due to the growing number of immunocompromised patients. This case report describes a 52-year-old immunocompetent patient with facial cellulitis caused by Candida guilliermondi. Candida guilliermondi has not previously been reported as a cause of facial cellulitis in either immunocompromised or immunocompetent patients.
  Case presentation: A 52-year-old, otherwise healthy, male patient presented with facial cellulitis that did not respond to intravenous antibiotics. Culture of the drained pus revealed Candida guilliermondi. The patient was successfully treated with intravenous fluconazole.
  Conclusion: This case highlights the possibility of atypical Candida spp. causing deep facial infections in immunocompetent patients. Candida guilliermondi has not been previously reported as a cause of facial cellulitis in either immunocompromised or immunocompetent patients. Healthcare providers should consider atypical Candida spp. infections in the differential diagnosis of deep facial infections in both immunocompromised and immunocompetent patients.

• Monkeypox in a renal transplant recipient: is it a hazard for immunocompromised patients? Farah Heis, Mohamed Heis, Mahrukh Khan, Manjula Ashok Views: 408 HTML: 56 PDF: 380

  There has been a recent outbreak of monkeypox in the United States, mostly among men who have sex with men (MSM). It seems to be a self-limiting disease but can be potentially serious in immunocompromised patients. Monkeypox infection is transmitted mainly through skin-to-skin contact and possibly seminal and vaginal fluids. Very few cases of monkeypox infection in immunocompromised patients have been published in the literature. We report a case of infection in a renal transplant recipient, and describe the clinical course and outcome.

• Cardiac hydatid disease with palpitations as the only presenting complaint: the egg in the nest Ali Azari, Leila Bigdelu, Ossama Maadarani, Zouheir Bitar Views: 379 HTML: 30 PDF: 303

  Hydatid disease, also known as cystic echinococcosis, is a parasitic infection caused by the larval stage of Echinococcus granulosus. It usually invades organs such as the liver and the lungs but can affect any organ. Isolated cardiac involvement is a rare manifestation. We present a case of isolated left ventricle hydatid cyst with negative serological tests, which was treated with surgical removal and confirmed by histopathological examination.

• The Leaking Ear: A Billiard Ball Sized Otogenic Acute Brain Abscess Thomas Matthews, Cathy Keegan, David McDonnell, Peter Loughman, Mohammad Amin Mirbalouchzehi, Kevin Veerasamy, Niall Colwell Views: 398 HTML: 74 PDF: 371

  An otogenic origin is identified in over half of cases pertaining to brain abscess.  They are typically associated with either mastoiditis, cholesteatoma or otitis media and carry a risk of mortality in the region of twenty per cent.  We describe the case of a 71-year-old gentleman presenting with acute confusion and unilateral neurology in the absence of systemic signs of sepsis or associated laboratory biomarkers who was diagnosed with a particularly large spherical temporal lobe brain abscess of 5cm diameter on neuroimaging.  This abscess was treated successfully with craniotomy, evacuation and a prolonged course of anti-microbials enabling him to return to his pre-morbid level of functioning.  His prolonged course of anti-microbials was complicated by a candidaemia and colonisation of an indwelling central venous catheter that was treated successfully with antifungals.

• Cryptic presentation of cryptococcal osteomyelitis in an apparently immunocompetent individual Hariharan Subramony, Balagurunathan Raghavan, Eswer Subbaiyan, Manjunatha Gajanana Hegde, Kartik Ramanathan Views: 332 HTML: 46 PDF: 323

  Cryptococcosis is an opportunistic fungal infection seen in immunocompromised individuals. It is caused by the yeast-like fungus Cryptococcus and predominantly affects the lungs and central nervous system. Immunocompetent individuals very rarely develop bone involvement and only a few cases of cryptococcal osteomyelitis in patients without other comorbid conditions have been described. Only one other case of pelvic involvement, which was accompanied by lymphopaenia, has been reported. We describe the case of a 42-year-old immunocompetent man with cryptococcal hip osteomyelitis.

• Japanese encephalitis virus triggered overlapping Miller Fischer syndrome with Bickerstaff encephalitis in a young Filipino cruise line worker Hussain Hussain, Efrain Garcia, Sohair Angly, Jesus Aviles-Caraballo, Hirania Pages-Vega, Joseph Martinez, Zahraa Saadoon, Luis Mendez, Aya Fadel Views: 460 HTML: 90 PDF: 375

  Japanese encephalitis virus is an RNA flavivirus and one of the rare pathogens that can cause encephalitis. The main vector is the Culex tritaeniorhynchus mosquito. The virus is very close in pathophysiology and structure to the West Nile and St. Louis encephalitis viruses. It is endemic in Asia and Western Pacific areas, mostly during the summer; only a few cases have been reported outside those regions. We present the case of a young Filipino cruise line male worker with signs and symptoms of Japanese encephalitis concomitantly with Miller Fisher syndrome and Bickerstaff brainstem encephalitis. The patient developed obtundation, ataxia, areflexia, flaccid paralysis, and ophthalmoplegia, which were preceded by a few days of constitutional symptoms (fever, malaise, fatigue and anorexia). Physical examination showed various stages of erythema nodosum on the lower extremities. Analysis of cerebrospinal fluid was positive for anti-GQ1b, West Nile IgG and Japanese encephalitis IgM. Despite the neurological complications and bradyarrhythmia occurring during hospitalization, the patient recovered completely under our regimen.