Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. First Case Report of Sinusitis with Lophomonas blattarum from Iran Thu, 04 Feb 2016 07:15:20 +0000 Introduction. Lophomonas blattarum is a rare cause of bronchopulmonary and sinus infection. This paper presents a rare case of Lophomonas sinusitis. Case Presentation. The patient was a 31-year-old woman who was admitted because of a history of upper respiratory infection and sinusitis. Direct microscopic examination of the sputum and nasal discharge showed large numbers of living Lophomonas blattarum with irregular movement of flagella. The patient was successfully treated by Metronidazole 750 mg t.i.d. for 30 days. Conclusions. This is the first case report of Lophomonas blattarum sinusitis from Iran. Fariba Berenji, Mahmoud Parian, Abdolmajid Fata, Mahdi Bakhshaee, and Fereshte Fattahi Copyright © 2016 Fariba Berenji et al. All rights reserved. Infective Exacerbation of Pasteurella multocida Sun, 31 Jan 2016 13:56:58 +0000 An 89-year-old lady presented with a one-day history of shortness of breath as well as a cough productive of brown sputum. Her medical history was significant for chronic obstructive pulmonary disease (COPD). She was in severe type one respiratory failure and blood tests revealed markedly raised inflammatory markers; however her chest X-ray was clear. On examination there was bronchial breathing with widespread crepitations and wheeze. She was treated as per an infective exacerbation of COPD. Subsequent blood cultures grew Pasteurella multocida, a common commensal in the oropharynx of domesticated animals. The patient was then asked about any contact with animals, after which she revealed she had a dog and was bitten on her left hand the day before admission. We should not forget to enquire about recent history of injuries or animal bites when patients present acutely unwell. She made a complete recovery after treatment with penicillin. Mayumi Hamada, Noha Elshimy, and Hatem Abusriwil Copyright © 2016 Mayumi Hamada et al. All rights reserved. Risk Factors and Epidemiology of Coccidioidomycosis Demonstrated by a Case of Spontaneous Pulmonary Rupture of Cavitary Coccidioidomycosis Sun, 24 Jan 2016 13:58:38 +0000 A 31-year-old Hispanic male with no medical history was admitted for fevers, pleurisy, and cough after recent oral surgery and completing demolition and construction work in Juarez, Mexico. Imaging showed a 4.4 cm cavitary lesion and bilateral tree-in-bud opacities. Initial suspicion of bacterial infection confirmed with clinical improvement on culture specific antibiotics, but after discharge he returned with progression of symptoms and new dyspnea. Radiograph showed a pyopneumothorax. Chest computed tomography after thoracostomy showed worsening infiltrates and another cavitary lesion. Symptoms persisted despite addition of broad spectrum antibiotics. Surgical repair for persistent air leak was required. Weeks after discharge, cultures and serologies returned positive for Coccidioidomycosis immitis. Coccidioides species cause up to 30% of community-acquired pneumonia and incidental cavitary lesions in endemic regions. Symptoms are nonspecific yet usually involve fatigue, cough, and pleurisy. Most hosts have spontaneous resolution; however, certain demographics such as Hispanics and diabetics, later diagnosed in our patient, have higher morbidity. As seen with our patient, cavitary rupture and bronchopleural fistulas are rare occurring in 2.6% of cavitary lesions. High suspicion based on symptoms and host demographics is important to assist in early diagnosis and treatment to avoid and treat this common pathogen’s presentations. Amy A. Yau Copyright © 2016 Amy A. Yau. All rights reserved. Streptococcus agalactiae Meningitis in Adult Patient: A Case Report and Literature Review Thu, 21 Jan 2016 13:48:00 +0000 We report a case of group B streptococcus meningitis in a 72-year-old female patient who was admitted in our hospital with a 21-day history of bilateral lower thigh pain and swelling associated with fever, headache, and vomiting. Her past medical history was remarkable for DM type 2, hypertension, and hypothyroidism. Upon admission, examination showed bilateral warmth and tender soft tissue swelling around the knees and MRI showed cellulitis of distal thirds of both thighs. The next day, the patient became drowsy. Neurologic examination showed neck rigidity and right sided hemiparesis. Cerebrospinal fluid and blood cultures yielded group B streptococcus sensitive to ceftriaxone, penicillin G, and vancomycin. The patient received ceftriaxone for a total of 14 days after which she improved and was discharged from the hospital with right sided weakness. Fahmi Yousef Khan Copyright © 2016 Fahmi Yousef Khan. All rights reserved. Edwardsiella tarda Endocarditis Confirmed by Indium-111 White Blood Cell Scan: An Unusual Pathogen and Diagnostic Modality Sun, 17 Jan 2016 16:12:48 +0000 Edwardsiella tarda is a freshwater marine member of the family Enterobacteriaceae which often colonizes fish, lizards, snakes, and turtles but is an infrequent human pathogen. Indium-111- (111In-) labeled white blood cell (WBC) scintigraphy is an imaging modality which has a wide range of reported sensitivity and specificity (from 60 to 100% and from 68 to 92%, resp.) for diagnosing acute and chronic infection. We describe a case of suspected E. tarda prosthetic aortic valve and mitral valve endocarditis with probable vegetations and new mitral regurgitation on transthoracic and transesophageal echocardiograms which was supported with the use of 111In-labeled WBC scintigraphy. Kayleigh M. Litton and Bret A. Rogers Copyright © 2016 Kayleigh M. Litton and Bret A. Rogers. All rights reserved. First Pediatric Case of Tularemia after a Coyote Bite Wed, 13 Jan 2016 11:46:23 +0000 Bite-transmitted tularemia is a rare event in humans and most of the cases have been associated with cat bites. We report the first pediatric case of tularemia caused by a coyote (Canis latrans) bite. Coyotes can be healthy carriers of Francisella tularensis and transmit this infectious agent through a bite. Pediatricians should be aware of this risk after a carnivore bite and implement appropriate antibiotic therapy, as amoxicillin/clavulanate potassium (Augmentin) may have prolonged the typical two to three days’ incubation period commonly observed for tularemia after an animal bite and was not effective in preventing clinical signs in this child. Finally, it emphasizes again the importance of early and late serum samples for appropriate serodiagnostic. Bruno B. Chomel, Jane A. Morton, Rickie W. Kasten, and Chao-chin Chang Copyright © 2016 Bruno B. Chomel et al. All rights reserved. Native Valve Streptococcus bovis Endocarditis and Refractory Transfusion Dependent Iron Deficiency Anaemia Associated with Concomitant Carcinoma of the Colon: A Case Report and Review of the Literature Tue, 05 Jan 2016 07:03:16 +0000 Streptococcus bovis is found as a commensal organism in human gut and may become opportunistically pathogenic. Infective endocarditis is one of the commonest modes of presentation of this infection. The association between Streptococcus bovis endocarditis and colorectal cancer is well recognized. We report a case of Streptococcus bovis endocarditis along with a refractory iron deficiency anaemia associated with concomitant carcinoma of ascending colon in a 63-year-old male. Cooccurrence of these two conditions may cause a challenge in the management. Considering the strong association of colon cancer with Streptococcus bovis endocarditis, a detailed screening colonoscopy is mandatory following the diagnosis of the latter. Abdul Azeez Ahamed Riyaaz, Randula Samarasinghe, Kolitha Sellahewa, Sabaratnam Sivakumaran, and Manjula Sri Tampoe Copyright © 2016 Abdul Azeez Ahamed Riyaaz et al. All rights reserved. An Adverse Drug Reaction to Trimethoprim-Sulfamethoxazole Revealing Primary HIV: A Case Report and Literature Review Mon, 21 Dec 2015 12:54:35 +0000 Adverse drug reactions (ADRs) to antibiotics complicate the management of any infection, particularly opportunistic infections in advanced HIV as some ADRs are potentiated by HIV. Trimethoprim-sulfamethoxazole (TMP-SMX) causes ADRs in 40–80% of HIV infected individuals, compared to 3–5% in the general population. The incidence and severity of ADRs among HIV infected individuals appear to increase as they progress from latent infection to AIDS. We present a single case report of a 55-year-old African American male found to have an otherwise asymptomatic acute HIV infection who developed an ADR to TMP-SMX, despite having previously tolerating the medication. The proposed mechanisms for the increased incidence of sulfa hypersensitivity reactions among HIV infected individuals focus on either (1) HIV-induced changes in the immune function driven by falling levels of CD4 cells or (2) other HIV-specific factors correlated with rising viral load. To our knowledge this is the first reported case of new sulfa hypersensitivity in primary HIV and may provide clinical evidence to support the correlation between viral load and ADRs to TMP-SMX without a severely diminished CD4 count, though further research is necessary. This case also demonstrates a rare and easily overlooked presentation of HIV that may aid in early diagnosis. Charles Meyer, Nicole Behm, Emily Brown, Nathanial K. Copeland, and Marvin J. Sklar Copyright © 2015 Charles Meyer et al. All rights reserved. Sometimes There Is More Than One Puzzle on the Table: Pneumococcal Bacteremia as a New Systemic Lupus Erythematosus Presentation Sun, 20 Dec 2015 08:55:57 +0000 Infection is common and a leading cause of death in patients with systemic lupus erythematosus (SLE). SLE is associated with a diverse spectrum of immune impairments including humoral defects and hypocomplementemia that contribute to a lupus patient’s increased susceptibility to infection with encapsulated bacteria. Nonetheless, there are only few reports of severe invasive bacterial infection as the initial presentation of SLE in the literature. Here, we report a rare case of SLE presenting with pneumococcal bacteremia. Based on the high resolution chest computed tomography and the result of blood cultures, the bacteremia was assumed to be secondary to pneumococcal pneumonia. Fereshte Sheybani, Hamidreza Naderi, Zahra Mirfeizi, and Sedigheh Erfani Copyright © 2015 Fereshte Sheybani et al. All rights reserved. Clostridium septicum Gas Gangrene in Colon Cancer: Importance of Early Diagnosis Thu, 17 Dec 2015 12:28:15 +0000 The Clostridia species are responsible for some of the deadliest diseases including gas gangrene, tetanus, and botulism. Clostridium septicum is a rare subgroup known to cause atraumatic myonecrosis and is associated with colonic malignancy or immunosuppression. It is a Gram-positive, anaerobic, spore-forming bacillus found in the gastrointestinal tract and can lead to direct, spontaneous infections of the bowel and peritoneal cavity. The anaerobic glycolysis of the tumor produces an acidic, hypoxic environment favoring germination of clostridial spores. Tumor-induced mucosal ulceration allows for translocation of sporulated bacteria from the bowel into the bloodstream, leading to fulminant sepsis. C. septicum bacteremia can have a variable presentation and is associated with greater than 60% mortality rate. The majority of deaths occur within the first 24 hours if diagnosis and appropriate treatment measures are not promptly started. We report a case of abdominal myonecrosis in a patient with newly diagnosed colon cancer. The aim of this study is to stress the importance of maintaining a high suspicion of C. septicum infection in patients with underlying colonic malignancy. Sowmya Nanjappa, Sweta Shah, and Smitha Pabbathi Copyright © 2015 Sowmya Nanjappa et al. All rights reserved. A Case Report on Oral Subcutaneous Dirofilariasis Thu, 17 Dec 2015 09:24:51 +0000 Dirofilariasis is an uncommon zoonotic parasitic infection affecting human. The natural hosts for this nematode are animals such as dogs, cats, foxes, jackals, and raccoons. This disease is endemic in South Eastern United States, Australia, Europe, and Central and Southern Asia. Dirofilaria immitis and D. repens are the common mosquito borne filarial nematodes that cause infection. Several species of mosquitos including Mansonia uniformis, M. annulifera, and Aedes aegypti are the potential vectors for this disease in Sri Lanka. Two rare cases of dirofilariasis presenting as facial and intraoral lumps are presented. R. D. Jayasinghe, S. R. Gunawardane, M. A. M. Sitheeque, and S. Wickramasinghe Copyright © 2015 R. D. Jayasinghe et al. All rights reserved. Chromobacterium violaceum Isolated from a Wound Sepsis: A Case Study from Nepal Wed, 16 Dec 2015 06:32:45 +0000 Chromobacterium violaceum is a facultative anaerobic, Gram-negative rod, prevalent in tropical and subtropical regions. It enters through the skin injury and is capable of causing severe systemic infections leading to septic shock and multiorgan failure. It has been reported by few authors across the world but this is probably the first case of Chromobacterium violaceum isolated from wound sepsis from Nepal. In this study, a pus sample from the infection of a prick injury in the left middle finger was collected from the patient admitted to the intensive care unit. Bacteriological investigations of the pus sample revealed the causative organism to be Chromobacterium violaceum. This case study indicates that Chromobacterium violaceum can act as a potential cause of wound sepsis that may lead to the septic shock and if not treated timely, the mortality rate can be high as was in this study. Although this organism is very rare, the infection caused requires prompt treatment to minimize the mortality rate. Therefore, we recommend the timely diagnosis and antimicrobial therapy of this infection to combat the consequences led. Shamshul Ansari, Pramod Paudel, Kishor Gautam, Sony Shrestha, Sangita Thapa, and Rajendra Gautam Copyright © 2015 Shamshul Ansari et al. All rights reserved. Ruxolitinib Associated Tuberculosis Presenting as a Neck Lump Tue, 15 Dec 2015 11:06:00 +0000 Tuberculosis is an opportunistic infection with protean clinical manifestations. We describe a case of Ruxolitinib induced miliary tuberculosis presenting as a neck lump. A 78-year-old female presented with a two-month history of right-sided neck lump associated with fever, night sweats, and significant weight loss. She had a past medical history that included myelofibrosis, being treated with Ruxolitinib. Examination demonstrated 4 × 4 cm right-sided cervical lymphadenopathy. A chest radiograph showed extensive shadowing in both lungs. CT scan demonstrated perilymphatic nodes in addition to the cervical mass. An ultrasound-guided biopsy of a cervical lymph node demonstrated confirmed Mycobacterium tuberculosis infection. It was hypothesized that use of Ruxolitinib through its selective inhibition of Janus-activated kinases 1 and 2 resulted in immunosuppression and miliary tuberculosis in this patient. The medication was stopped and a 12-month regime of antituberculosis therapy commenced. She remained well at one-year follow-up with resolution of lung involvement. Clinicians should consider tuberculosis as a differential diagnosis for patients presenting with a neck lump, particularly in those taking immunosuppressant medication such as Ruxolitinib. A multidisciplinary approach is needed to promptly treat the tuberculosis and consider discontinuation of Ruxolitinib. Eamon Shamil, David Cunningham, Billy L. K. Wong, and Piyush Jani Copyright © 2015 Eamon Shamil et al. All rights reserved. Respiratory Failure due to Possible Donor-Derived Sporothrix schenckii Infection in a Lung Transplant Recipient Mon, 30 Nov 2015 14:10:22 +0000 Background. De novo and donor-derived invasive fungal infections (IFIs) contribute to morbidity and mortality in solid organ transplant (SOT) recipients. Reporting of donor-derived IFIs (DDIFIs) to the Organ Procurement Transplant Network has been mandated since 2005. Prior to that time no systematic monitoring of DDIFIs occurred in the United States. Case Presentation. We report a case of primary graft dysfunction in a 49-year-old male lung transplant recipient with diffuse patchy bilateral infiltrates likely related to pulmonary Sporothrix schenckii infection. The organism was isolated from a bronchoalveolar lavage on the second day after transplantation. Clinical and radiographic responses occurred after initiation of amphotericin B lipid formulation. Conclusion. We believe that this was likely a donor-derived infection given the early timing of the Sporothrix isolation after transplant in a bilateral single lung transplant recipient. This is the first case report of sporotrichosis in a lung transplant recipient. Our patient responded well to amphotericin induction therapy followed by maintenance therapy with itraconazole. The implications of donor-derived fungal infections and Sporothrix in transplant recipients are reviewed. Early recognition and management of these fungi are essential in improving outcomes. Nathan C. Bahr, Katherine Janssen, Joanne Billings, Gabriel Loor, and Jaime S. Green Copyright © 2015 Nathan C. Bahr et al. All rights reserved. Actinomyces naeslundii: An Uncommon Cause of Endocarditis Mon, 30 Nov 2015 09:18:45 +0000 Actinomyces rarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE) caused by Actinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused by Actinomyces. Christopher D. Cortes, Carl Urban, and Glenn Turett Copyright © 2015 Christopher D. Cortes et al. All rights reserved. Deep Neck Infection and Descending Mediastinitis as a Complication of Propionibacterium acnes Odontogenic Infection Sun, 29 Nov 2015 12:28:30 +0000 Propionibacterium acnes is an anaerobic, Gram-positive bacterium which causes numerous types of infections. Isolated Propionibacterium acnes deep neck infections are very rare. We present an interesting case of deep neck infection complicated by descending mediastinitis of isolated Propionibacterium acnes infection. Evgeni Brotfain, Leonid Koyfman, Lisa Saidel-Odes, Abraham Borer, Yael Refaely, and Moti Klein Copyright © 2015 Evgeni Brotfain et al. All rights reserved. Babesia in a Nonsplenectomized Patient Requiring Exchange Transfusion Sun, 29 Nov 2015 11:48:11 +0000 Babesiosis is a tick born zoonosis caused by red blood cell parasites of the genus Babesia. It is caused predominantly by B. microti and B. divergens, microti being more common in the US. The parasites are transmitted by Ixodes tick to their host but infection can also spread by blood transfusion and perinatally. Clinical manifestations vary from subclinical infection to fulminating disease depending upon the immune status of the patient. About half of patients, hospitalized with babesiosis, develop complication with fatality rates of 6 to 9% which increase up to 21% among those with immunosuppression. A case of 58-year-old previously healthy man, infected by B. microti, was reported on 2000 who presented with severe disease characterized by severe anemia, DIC, and renal and respiratory failure. First case of overwhelming septic shock without respiratory involvement due to babesiosis in a healthy patient with an intact spleen was published in a case report on 2011. Since our patient here is an immunocompetent healthy male with intact spleen presenting with severe babesiosis requiring exchange transfusion, this presentation of Babesia is rare and warrants further study. Dikshya Sharma, Bindu Mudduluru, Elias Moussaly, Neville Mobarakai, and Matthew Hurford Copyright © 2015 Dikshya Sharma et al. All rights reserved. Right Gaze Palsy and Hoarseness: A Rare Presentation of Mediastinal Tuberculosis with an Isolated Prepontine Cistern Tuberculoma Sun, 29 Nov 2015 07:29:36 +0000 We describe a previously healthy young man who presented with headaches, diplopia with right lateral gaze palsy, dysphagia, and hoarseness over a 2-month period. Magnetic resonance imaging of the brain revealed a small enhancing mass at the prepontine cistern and chest CT showed a left mediastinal mass. Mediastinoscopy and lymph node biopsy were performed. DNA probe and culture of the biopsy specimen were confirmed to be Mycobacterium tuberculosis complex. Resolution of neurologic symptoms was noted after 6 weeks, in addition to regression of brain stem and mediastinal lesions after 12 weeks of antituberculous therapy. Chidozie Charles Agu, Olufemi Aina, Md Basunia, Bikash Bhattarai, Vikram Oke, Marie Frances Schmidt, Joseph Quist, Danilo Enriquez, and Vijay Gayam Copyright © 2015 Chidozie Charles Agu et al. All rights reserved. Enterococcus faecalis Septicemia and Vertebral Osteomyelitis after Transrectal Ultrasound Guided Biopsy of the Prostate Sun, 22 Nov 2015 08:59:24 +0000 Transrectal ultrasound guided prostate biopsy (TRUS) has rarely been associated with disseminated infection, yet the occurrence appears to be increasing. Resistance to fluoroquinolones, the most commonly used prophylaxis, is one of the likely causes, with Escherichia coli being the most commonly reported cause of these infections. Herein we present what is, to our knowledge, the first case of Enterococcus faecalis septicemia and vertebral osteomyelitis after TRUS. Previously reported cases of this condition are referenced also. Ayaz Virji, Lucio R. Minces, and Zargham Abbass Copyright © 2015 Ayaz Virji et al. All rights reserved. Severe Legionnaires’ Disease Complicated by Rhabdomyolysis and Clinically Resistant to Moxifloxacin in a Splenectomised Patient: Too Much of a Coincidence? Sun, 22 Nov 2015 07:09:16 +0000 We here report a case of Legionnaires’ disease in a splenectomised patient, complicated by rhabdomyolysis and acute renal failure and characterized by a poor clinical response to moxifloxacin. Splenectomy is not included among the factors, typically associated with higher risk or mortality in patients with Legionellosis. However, our report is consistent with previous case reports describing severe Legionella infections in asplenic subjects. The possibility that functional or anatomic asplenia may be a factor predisposing to severe clinical course or poor response to therapy in patients with Legionella infection cannot be excluded, deserving further investigation in the future. More studies are required in order to clarify the underlying pathophysiological mechanisms that connect asplenia, immunological response to Legionella, and pathogen’s resistance to antibiotics. Theocharis Koufakis, Ioannis Gabranis, Marianneta Chatzopoulou, Anastasios Margaritis, and Maria Tsiakalou Copyright © 2015 Theocharis Koufakis et al. All rights reserved. Atypical Kaposi Sarcoma of the Tongue in HIV Positive Tanzanian Female Tue, 17 Nov 2015 11:24:01 +0000 We report atypical case of Kaposi Sarcoma (KS) in a 32-year-old human immunodeficiency virus- (HIV-) infected female, involving only the tongue. Viral loads and CD4 T cells were measured and were 65,000 cps/mL and 10 cells/mL, respectively. This patient was newly diagnosed and had no history of antiretroviral therapy (ART), radiotherapy, or immunosuppressive drugs prior to this admission. Clinically, there were no dermatological features of KS lesions which are purple, red, or brown and which may be flat, raised (plaques), or bumpy (nodules) except for fungating and protruding enlarged tongue which was necrotic. Histologically, it was proven to be the most common type of KS “epidemic” or AIDS-related KS. Elichilia Shao, Flora Ruhangisa, Neema Minja, Kanankira Nnko, Denis Katundu, George Semango, Eva Mbwilo, Amos Mwasamwaja, Kajiru Kilonzo, and Isaack Lyaruu Copyright © 2015 Elichilia Shao et al. All rights reserved. Onychomycosis due to Cunninghamella bertholletiae in an Immunocompetent Male from Central India Thu, 12 Nov 2015 11:34:41 +0000 Onychomycosis is a fungal infection of nails seen frequently in immune competent and immune compromised patients due to dermatophytes, Candida spp., Fusarium spp., Scopulariopsis brevicaulis, Penicillium spp., and Aspergillus spp. We report a case of onychomycosis in a young immunocompetent male who presented onycholysis of a solitary nail without inflammation. The etiological agent was diagnosed to be Cunninghamella bertholletiae, a fungus pertaining to the order Mucorales (subdivision Mucoromycotina) and known for some of the invasive lesions among immunocompromised patients. This case demonstrates the association of onychomycosis with Cunninghamella bertholletiae in an immune competent individual, not reported so far. Karuna Tadepalli, Pradeep Kumar Gupta, Dinesh P. Asati, and Debasis Biswas Copyright © 2015 Karuna Tadepalli et al. All rights reserved. First Report of Ventriculoperitoneal Shunt Infection due to Cyberlindnera fabianii Wed, 04 Nov 2015 07:21:47 +0000 Fungal infections in the central nervous system (CNS) are associated with significant morbidity and death. Transient fungemia in immunocompetent patients without any other risk factors for fungemia has been suggested as a possible mechanism that may lead to serious fungal ventriculoperitoneal (VP) shunt infections, but evidence is lacking. The clinical spectrum, diagnosis, and optimal therapy of Cyberlindnera fabianii infections remain to be determined. We describe the first case of CNS infection due to C. fabianii that occurred in an immunocompetent adult with a VP shunt. Spontaneous translocation with yeast that is not part of the normal gastrointestinal flora in the setting of ingestion of multiple servings of a fermentation product was the likely source from which Cyberlindnera fabianii gained entrance into the VP shunt system, causing meningitis in this patient. The authors conclude that, in view of the high morbidity associated with yeast infection of the CNS, long-term antifungal therapy should be strongly considered in cases where the VP shunt cannot be completely removed. Transient fungemia may lead to invasive disease in an immunocompetent host with VP shunt, even in the absence of any other risk factors for fungemia and even after remote placement of the VP shunt. Jonathan Baghdadi, Peera Hemarajata, Romney Humphries, and Theodoros Kelesidis Copyright © 2015 Jonathan Baghdadi et al. All rights reserved. Case Report of Granulicatella adiacens as a Cause of Bacterascites Wed, 04 Nov 2015 07:15:31 +0000 Granulicatella adiacens is a Gram-positive coccus, formerly grouped with nutritionally variant Streptococcus, often found as commensal bacteria of the human oral cavity, urogenital tract, and gastrointestinal tract. Prior case reports have demonstrated Granulicatella spp. as a pathogen that can cause bacteremia and infective endocarditis particularly of prosthetic valves and pacemaker leads. Here, we report on a unique case of Granulicatella adiacens bacterascites in a 50-year-old male. Molly C. Cincotta, K. C. Coffey, Shannon N. Moonah, Dushant Uppal, and Molly A. Hughes Copyright © 2015 Molly C. Cincotta et al. All rights reserved. Vibrio alginolyticus Associated Chronic Myringitis Acquired in Mediterranean Waters of Turkey Thu, 29 Oct 2015 08:04:02 +0000 Vibrio alginolyticus was originally classified as biotype 2 of Vibrio parahaemolyticus. Most clinical isolates are recovered from superficial wounds or the external ear infections. V. alginolyticus is acknowledged to be nearly nonpathogenic in humans. The reason for presence of V. alginolyticus’s virulence is uncertain. We describe a chronic myringitis case in a 47-year-old female due to V. alginolyticus. According to her anamnesis, it was detected that she had sea bathing history in Mugla Coast in Turkey. Pure isolation of V. alginolyticus was obtained from external auditory canal’s culture. Investigation and antimicrobial susceptibility of the isolate were performed by the automatized BD Phoenix system and Kirby-Bauer disk diffusion method, respectively. The bacteria were sensitive to all antibiotics. This case was presented to pay attention to Vibrio alginolyticus infections. Burak Ekrem Citil, Serhan Derin, Funda Sankur, Murat Sahan, and Mahmut Ugur Citil Copyright © 2015 Burak Ekrem Citil et al. All rights reserved. Enterococcus faecium Mediastinitis Complicated by Disseminated Candida parapsilosis Infection after Congenital Heart Surgery in a 4-Week-Old Baby Wed, 28 Oct 2015 13:57:25 +0000 Background. Cardiac surgery offers multiple treatment options for children with congenital heart defects. However, infectious complications still remain a major cause of morbidity and mortality in these patients. Mediastinitis is a detrimental complication in children undergoing cardiac surgery. The risk of mediastinitis after delayed sternal closure is up to 10%. Case Presentation. We report a case of Enterococcus faecium mediastinitis in a 4-week-old female baby on extracorporeal membrane oxygenation after Norwood procedure. Although repeated antibiotic irrigation, debridement, and aggressive antibiotic treatment were started early, the pulmonary situation deteriorated. Candida parapsilosis was isolated from bronchoalveolar lavage after pulmonary hemorrhage. Disseminated C. parapsilosis infection with pulmonary involvement was treated with liposomal amphotericin B. Subsequently, inflammatory markers increased again and eventually C. parapsilosis was isolated from the central venous catheter. Conclusion. Children undergoing delayed sternal closure have a higher risk of mediastinitis. Therefore, antibiotic prophylaxis, for example, for soft tissue infection seems justified. However, long-term antibiotic treatment is a risk factor for fungal superinfection. Antifungal treatment of disseminated C. parapsilosis infection may fail in PICU patients with nonbiological material in place due to capacity of this species to form biofilms on medical devices. Immediate removal of central venous catheters and other nonbiological material is life-saving in these patients. Hanna Renk, Felix Neunhoeffer, Florian Hölzl, Michael Hofbeck, and Matthias Kumpf Copyright © 2015 Hanna Renk et al. All rights reserved. Hepatosplenic Abscesses and Osteomyelitis of the Spine in an Immunocompetent Adult with Cat Scratch Disease Wed, 21 Oct 2015 12:35:15 +0000 We present an 18-year-old, immunocompetent Austrian military conscript with cervical lymphadenopathy, fever, back-pain, and persistent inflammation markers despite two weeks of antimicrobial therapy with ampicillin/sulbactam. All specific laboratory investigations for identification of a specific etiology, including blood cultures and autoantibodies, were inconspicuous. Abdominal computed tomography showed multiple hypodense hepatosplenic lesions and osteomyelitis of the thoracic and lumbar spine with base plate fracture. Based on the patient’s history, clinical presentation, and radiological findings, serology for cat scratch disease (CSD) was performed and high B. henselae specific IgM and IgG antibodies were detected. Due to its variety of clinical presentations, diagnosis of CSD is challenging, especially in the absence of a history of specific exposure. This case report shall remind the physician that cat scratch disease is a common disease, mainly presenting with fever and lymphadenopathy in young patients. Nevertheless CSD has many different and rare forms of presentations, including hepatosplenic lesions and bone involvement as shown in this case. D. Knafl, F. Lötsch, H. Burgmann, G. Goliasch, W. Poeppl, M. Ramharter, F. Thalhammer, and C. Schuster Copyright © 2015 D. Knafl et al. All rights reserved. Listeria monocytogenes Meningitis in an Immunosuppressed Patient with Autoimmune Hepatitis and IgG4 Subclass Deficiency Mon, 19 Oct 2015 06:08:40 +0000 A 51-year-old Caucasian woman with Listeria monocytogenes meningitis was treated and discharged after an uncomplicated course. Her medical history included immunosuppressive treatment with prednisolone and azathioprine for autoimmune hepatitis. A diagnostic work-up after the meningitis episode revealed that she had low levels of the IgG4 subclass. To our knowledge, this is the first case report describing a possible association between autoimmune hepatitis and the occurrence of Listeria monocytogenes meningitis, describing a possible association between Listeria monocytogenes meningitis and deficiency of the IgG4 subclass and finally describing a possible association between Listeria monocytogenes meningitis and immunosuppressive therapy with prednisolone and azathioprine. Shahin Gaini Copyright © 2015 Shahin Gaini. All rights reserved. Mycobacterium sherrisii Lung Infection in a Brazilian Patient with Silicosis and a History of Pulmonary Tuberculosis Sun, 18 Oct 2015 17:01:40 +0000 Nontuberculous mycobacteria (NTM) diseases became relevant with the emergence and spread of HIV and are also related to lung infection in non-HIV individuals with structural lung diseases. Mycobacterium sherrisii is a NTM first characterized in 2004. Only a few cases have been reported. The aim of this case report is to describe the first detailed case of infection with M. sherrisii in a patient with silicosis and history of pulmonary tuberculosis. A 50-year-old HIV-negative white male, previous smoker, with silicosis and a history of treated pulmonary tuberculosis developed a worsening of cough and expectoration pattern, and two sputum samples were positive for acid-fast bacilli. Presumptive treatment for pulmonary tuberculosis was initiated with rifampin, isoniazid, pyrazinamide, and ethambutol, but, at month 5 of treatment, despite correct medication intake and slight improvement of symptoms, sputum bacilloscopy remained positive. Sputum cultures were positive Mycobacterium sherrisii. Treatment regimen was altered to streptomycin (for 2 months), ethambutol, clarithromycin, rifabutin, and trimethoprim-sulfamethoxazole. M. sherrisii should be considered a possible etiological agent of lung infections in patients with pneumoconiosis and history of tuberculosis. Carolina de Oliveira Abrão and João Alves de Araújo Filho Copyright © 2015 Carolina de Oliveira Abrão and João Alves de Araújo Filho. All rights reserved. Empedobacter brevis Bacteremia in a Patient Infected with HIV: Case Report and Review of Literature Thu, 15 Oct 2015 13:19:43 +0000 Clinical disease caused by Empedobacter brevis (E. brevis) is very rare. We report the first case of E. brevis bacteremia in a patient with HIV and review the current literature. A 69-year-old man with human immunodeficiency virus (HIV) and CD4 count of 319 presented with chief complaints of black tarry stools, nausea and vomiting for 2 days. Physical exam was significant for abdominal pain on palpation with no rebound or guarding. His total leukocyte count was 32,000 cells/μL with 82% neutrophils and 9% bands. Emergent colonoscopy and endoscopic esophagogastroduodenoscopy showed esophageal candidiasis, a nonbleeding gastric ulcer, and diverticulosis. Blood cultures drawn on days 1, 2, and 3 of hospitalization grew E. brevis. Patient improved with intravenous antibiotics. This case is unusual, raising the possibility of gastrointestinal colonization as a source of the patient’s bacteremia. In conclusion, E. brevis is an emerging pathogen that can cause serious health care associated infections. Syed Bokhari, Naeem Abbas, Manisha Singh, Richard B. Cindrich, and Cosmina Zeana Copyright © 2015 Syed Bokhari et al. All rights reserved.