Case Reports in Infectious Diseases http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Fulminant Shigellosis in a HIV Patient Wed, 04 Mar 2015 14:01:56 +0000 http://www.hindawi.com/journals/criid/2015/128104/ Infectious enterocolitis caused by shigella is usually self-limiting and seldom requires antibiotics treatment. It is uncommon to develop fulminant shigellosis requiring surgery. We report a rare case of fulminant shigellosis in a HIV patient with recurring infection which could not be managed with intravenous antibiotics. CT reviewed extensive colonic wall thickening and stranding with evidence of pneumatosis coli. The patient eventually required a Hartmann procedure. Although fulminant shigellosis is uncommon, thorough assessment and vigilant management are warranted in immunosuppressed patient. Siang Mei Sally Ooi Copyright © 2015 Siang Mei Sally Ooi. All rights reserved. Brain Abscess after Percutaneous Therapy for Trigeminal Neuralgia Tue, 03 Mar 2015 11:37:19 +0000 http://www.hindawi.com/journals/criid/2015/162793/ We report a case of brain abscess following the percutaneous treatment for trigeminal neuralgia. This procedure envisages the access with a needle into the middle cranial fossa through the oral cavity. Thus, in this case, the bacterial infection can be more likely ascribed to the possible contamination of the needle inside the oral cavity rather than to other frequent and more controllable causes of infection like an imperfect sterilization of surgical instruments or an inadequate antiseptic preparation of both operator’s hands and patient’s skin. The subsequent brain abscess was treated with antibiotic therapy (Vancomycin 2 gr a day and Meropenem 8 g a day for 22 days before the surgical procedure and 30 days after, until complete normalization of laboratory parameters, clinical parameters, and neurological symptoms) and surgical drainage, although the culture of the abscess capsule and the purulent material resulted sterile. In conclusion, the percutaneous therapy for trigeminal neuralgia can be objectively related to risks, even if performed by expert hands. Therefore, it is important that the patient should be advised regarding risks/benefits and/or septic complications of such procedures, even if they occur very seldom. An association of surgery and antibiotic therapy results as effective treatment for this pathologic condition. Michele Acqui, Pietro Familiari, Alessandro Pesce, Giada Toccaceli, and Antonino Raco Copyright © 2015 Michele Acqui et al. All rights reserved. Lichen Planus Induced by Pegylated Interferon Alfa-2a Therapy in a Patient Monitored for Delta Hepatitis Tue, 03 Mar 2015 07:49:37 +0000 http://www.hindawi.com/journals/criid/2015/389131/ Interferons are used for treatment of chronic hepatitis B. They can induce or exacerbate some skin disorders, such as lichen planus. In this study, as we know, we presented the first case developing lichen planus while receiving interferon treatment due to delta hepatitis. A 31-year-old male patient presented to our outpatient clinic with HBsAg positivity. With his analyses, HBV DNA was negative, anti-delta total was positive, ALT was 72 U/L (upper limit 41 U/L), and platelet was 119 000/mm3. He was therefore started on subcutaneous pegylated interferon alfa-2a therapy at 180 mcg/week for delta hepatitis. At month 4 of therapy, the patient developed diffuse eroded lace-like lesions in oral mucosa, white plaques on lips, and itchy papular lesions in the hands and feet. Lichen planus was considered by the dermatology clinic and topical treatment (mometasone furoate) was given. The lesions persisted at month 5 of therapy and biopsy samples were obtained from oral mucosal lesions and interferon dose was reduced to 135 mcg/week. Biopsy demonstrated nonkeratinized stratified squamous epithelium; epithelial acanthosis, spongiosis, and apoptotic bodies were observed in the epidermis and therefore lichen planus was considered. At month 6 of therapy, lesions did not improve and even progressed and interferon treatment was therefore discontinued. Safak Kaya, Eyup Arslan, Birol Baysal, Sule Nergiz Baykara, Ozlem Ceren Uzun, and Sehmuz Kaya Copyright © 2015 Safak Kaya et al. All rights reserved. Family Outbreaks of Nontyphoidal Salmonellosis following a Meal of Guinea Pigs Mon, 02 Mar 2015 13:37:20 +0000 http://www.hindawi.com/journals/criid/2015/864640/ Salmonella outbreaks have been linked to a wide variety of foods, including recent nationwide outbreaks. Guinea pig (Cavia porcellus), also known as cuy or cobayo, has long been a popular delicacy and ceremonial food in the Andean region in South America. This case report describes three family outbreaks of nontyphoidal salmonellosis, each occurring after a meal of guinea pigs. We believe this case report is the first to describe a probable association between the consumption of guinea pig meat and human salmonellosis. Physicians should be aware of the association of Salmonella and the consumption of guinea pigs, given the increasing immigration of people from the Andean region of South America and the increasing travel to this region. John B. Fournier, Kimberly Knox, Maureen Harris, and Michael Newstein Copyright © 2015 John B. Fournier et al. All rights reserved. Disseminated Nocardiosis: A Successful Blind Strategy of Treatment in an HIV Infected Patient Mon, 02 Mar 2015 10:42:52 +0000 http://www.hindawi.com/journals/criid/2015/260640/ Background. Nocardiosis is a rare disease that mainly affects severely immunocompromised patients. Symptoms are nonspecific and microbiological isolation is difficult, hiding the diagnosis. Treatment should be guided by species and susceptibility testing. Findings. We report a clinical case of a disseminated nocardiosis in a patient with HIV and HVB infections. Interpretation. Diagnosis should be presumed early and microbiological conditions should be optimized, in order to identify the species and achieve antibiotic susceptibility testing. This is a very important step to choose an effective therapeutic regimen or alternative options. Ana C. Guerra, Dário Batista, Maria J. Aleixo, Paulo Saraiva, and Maria J. Aguas Copyright © 2015 Ana C. Guerra et al. All rights reserved. Bone Marrow Granuloma in Typhoid Fever: A Morphological Approach and Literature Review Thu, 19 Feb 2015 11:40:16 +0000 http://www.hindawi.com/journals/criid/2015/628028/ Typhoid fever is one of the few bacterial infections in humans where bone marrow evaluation is routinely recommended. However, the morphological aspect of typhoid fever in bone marrow has been rarely described in the literature. We describe a 25-year-old male patient who presented with prolonged fever suspected to be of tubercular etiology. Bone marrow examination showed well-formed histiocytic and epithelioid granulomas and erythrophagocytosis; and the bone marrow aspirate culture grew Salmonella typhi A. In view of potential clinical implications, typhoid fever should be considered as a differential diagnosis to tuberculosis in the evaluation of prolonged fever; especially in high prevalent areas. We suggest that erythrophagocytosis may serve as a morphological marker in typhoid granulomas in the bone marrow; and bone marrow culture should be submitted in every suspected case for appropriate patient management. Kavitha Muniraj, Somanath Padhi, Manjiri Phansalkar, Periyasami Sivakumar, Renu G’Boy Varghese, and Reba Kanungo Copyright © 2015 Kavitha Muniraj et al. All rights reserved. Meningitis, Clinical Presentation of Tetanus Wed, 18 Feb 2015 07:54:11 +0000 http://www.hindawi.com/journals/criid/2015/372375/ Background. Tetanus is an acute disease caused by a neurotoxin produced by Clostridium tetani. Tetanus immunization has been available since the late 1930s but sporadic cases still occur, usually in incompletely vaccinated or unvaccinated individuals. Case Report. An elderly previously vaccinated female contracted tetanus following foot injury. Clinically she presented with meningitis causing diagnostic and therapeutic delays. Why Should Physician Be Aware of This? Even in developed countries the differential diagnosis of meningitis, especially in the elderly, should include tetanus. Treatment in intensive care unit is required. General population might benefit from vaccine boosters and education on this potentially fatal disease. Anna Moniuszko, Agata Zajkowska, Ewa Tumiel, Krzysztof Rutkowski, Piotr Czupryna, Sławomir Pancewicz, Ryszard Rutkowski, Agnieszka Zdrodowska, and Joanna Zajkowska Copyright © 2015 Anna Moniuszko et al. All rights reserved. Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection Mon, 16 Feb 2015 06:47:35 +0000 http://www.hindawi.com/journals/criid/2015/723962/ Cytomegalovirus (CMV) infection rarely manifests with skin ulcerations. We describe a case report of a 64-year-old woman with chronic immunosuppression for treatment of mixed connective tissue disease, presenting with new onset leg ulcerations after a recent change in immunosuppressive regimen. She subsequently developed fulminant hepatitis, encephalopathy, and pancytopenia and was found to have severe systemic CMV viremia. Skin ulcer biopsy was positive by immunohistochemical staining for CMV infected endothelial cells. Both systemic disease and skin ulcer rapidly improved after stopping immunosuppression and administering intravenous ganciclovir. New onset skin ulcers in an immunosuppressed individual, especially with recent changes in immunosuppressive regimen, should raise the suspicion of reactivation of CMV. Richard F. Guo, Frew H. Gebreab, Emily Hsiang-Ho Tang, Zhe Piao, Steve S. Lee, and Mario L. Perez Copyright © 2015 Richard F. Guo et al. All rights reserved. Primary Cutaneous Cryptococcosis Treated with Debridement and Fluconazole Monotherapy in an Immunosuppressed Patient: A Case Report and Review of the Literature Mon, 02 Feb 2015 14:34:14 +0000 http://www.hindawi.com/journals/criid/2015/131356/ Cryptococcus neoformans is an opportunistic yeast present in the environment. Practitioners are familiar with the presentation and management of the most common manifestation of cryptococcal infection, meningoencephalitis, in patients with AIDS or other conditions of immunocompromise. There is less awareness, however, of uncommon presentations where experience rather than evidence guides therapy. We report a case of primary cutaneous cryptococcosis (PCC) in a patient who had been immunosuppressed by chronic high-dose corticosteroid for the treatment of severe asthma. This case highlights the importance of early recognition of aggressive cellulitis that fails standard empiric antibiotic treatment in an immunocompromised patient. It also demonstrates successful treatment of PCC with a multispecialty approach including local debridement and fluconazole monotherapy. Jennifer Wang, Luther Bartelt, Deborah Yu, Anjali Joshi, Bradley Weinbaum, Tiffany Pierson, Michael Patrizio, Cirle A. Warren, Molly A. Hughes, and Gerald Donowitz Copyright © 2015 Jennifer Wang et al. All rights reserved. Brucella Endocarditis as a Late Onset Complication of Brucellosis Mon, 02 Feb 2015 08:43:51 +0000 http://www.hindawi.com/journals/criid/2015/836826/ Brucella endocarditis (BE) is a rare but life threatening complication of brucellosis. We present a case report of a patient with relapsing brucellosis complicated with aortic valve endocarditis. The patient underwent valve replacement and required prolonged antibiotic treatment because of rupture of the noncoronary leaflet and development of congestive heart failure. Since the onset of endocarditis in patients with brucellosis is not known, proper follow-up is required in order to identify any late onset complications, especially in endemic areas. Panagiotis Andriopoulos, Christos Antoniou, Panagiota Manolakou, Athanassios Vasilopoulos, George Assimakopoulos, and Maria Tsironi Copyright © 2015 Panagiotis Andriopoulos et al. All rights reserved. Pneumonia by Listeria monocytogenes: A Common Infection by an Uncommon Pathogen Sat, 31 Jan 2015 16:52:41 +0000 http://www.hindawi.com/journals/criid/2015/627073/ Infections by Listeria monocytogenes typically occur in infants, the elderly, pregnant women, and immunosuppressed subjects. Pulmonary infections in adults are extremely uncommon and only few reports can be found in the literature. We here report a case of Listeria pneumonia in an 85-year-old female patient and we discuss our diagnostic and therapeutic approach. Despite being rare and in most cases difficult to be identified, Listeria pneumonia should always be considered in immunosuppressed patients, presenting with fever and symptoms from the lower respiratory system. Theocharis Koufakis, Marianneta Chatzopoulou, Anastasios Margaritis, Maria Tsiakalou, and Ioannis Gabranis Copyright © 2015 Theocharis Koufakis et al. All rights reserved. Lemierre’s Syndrome: Recognising a Typical Presentation of a Rare Condition Tue, 27 Jan 2015 10:31:37 +0000 http://www.hindawi.com/journals/criid/2015/797415/ Lemierre’s syndrome is a rare complication following an acute oropharyngeal infection. The aetiological agent is typically anaerobic bacteria of the genus Fusobacterium. The syndrome is characterised by a primary oropharyngeal infection followed by metastatic spread and suppurative thrombophlebitis of the internal jugular vein. If left untreated, Lemierre’s syndrome carries a mortality rate of over 90%. Whilst relatively common in the preantibiotic era, the number of cases of Lemierre’s syndrome subsequently declined with the introduction of antibiotics. With the increase of antibiotic resistance and a greater reluctance to prescribe antibiotics for minor conditions such as tonsillitis, there are now concerns developing about the reemergence of the condition. This increasing prevalence in the face of an unfamiliarity of clinicians with the classical features of this “forgotten disease” may result in the misdiagnosis or delay in diagnosis of this potentially fatal illness. This case report illustrates the delay in diagnosis of probable Lemierre’s syndrome in a 17-year-old female, its diagnosis, and successful treatment which included the use of anticoagulation therapy. Whilst there was a positive outcome, the case highlights the need for a suspicion of this rare condition when presented with distinctive signs and symptoms. James A. Coultas, Neena Bodasing, Paul Horrocks, and Anthony Cadwgan Copyright © 2015 James A. Coultas et al. All rights reserved. Clostridium paraputrificum Bacteremia Associated with Colonic Necrosis in a Patient with AIDS Tue, 27 Jan 2015 07:05:49 +0000 http://www.hindawi.com/journals/criid/2015/312919/ Clostridium species are anaerobic Gram-positive rods that can cause a broad range of invasive infections in humans, including myonecrosis and bacteremia. Importantly, clostridial bacteremia is frequently associated with underlying medical conditions, such as colonic malignancy. Characterizing Clostridium spp. and understanding their associated clinical disease spectrum are paramount to provide optimal treatment, thereby decreasing morbidity and mortality especially in those with underlying debilitating comorbidities. Clostridium paraputrificum is an infrequently isolated Clostridium species and its clinical significance has not been well described. We herein report a case of bacteremia due to C. paraputrificum in a 65-year-old man with AIDS who developed acute colonic necrosis complicated by septic shock. We then review other cases of bacteremia associated with C. paraputrificum in the literature in addition to discussing the clinical significance of anaerobic bacteremia in general. To our knowledge, our report is the second case of C. paraputrificum bacteremia in a patient with AIDS. Takashi Shinha and Christiane Hadi Copyright © 2015 Takashi Shinha and Christiane Hadi. All rights reserved. Pasteurella multocida Septicemia in a Patient with Cirrhosis: An Autopsy Report Tue, 27 Jan 2015 06:35:18 +0000 http://www.hindawi.com/journals/criid/2015/597806/ More people are keeping pets in their homes but may not be sufficiently aware of the potential danger from infections. We report an autopsy case of a 57-year-old man affected by cirrhosis. Septic shock with Pasteurella multocida pneumonia was the cause of his death. P. multocida was the source of infection via the respiratory tract and caused pneumonia. Cirrhosis is one of the risk factors for P. multocida infection. A detailed patient history about animal exposure should be obtained and a differential diagnosis of P. multocida infection must be kept in mind. Takuma Yamamoto, Takahiro Umehara, Takehiko Murase, and Kazuya Ikematsu Copyright © 2015 Takuma Yamamoto et al. All rights reserved. Diagnostic Challenges of Tuberculous Lymphadenitis Using Polymerase Chain Reaction Analysis: A Case Study Thu, 22 Jan 2015 09:47:06 +0000 http://www.hindawi.com/journals/criid/2015/723726/ This report presents a case of tuberculous lymphadenitis that was difficult to diagnose using polymerase chain reaction analysis. An 80-year-old Japanese female was hospitalized due to swollen cervical lymph nodes. Her lymph node tests revealed paradoxical polymerase chain reaction results. Polymerase chain reaction analysis of two biopsy tissues using the Cobas TaqMan revealed a positive result for Mycobacterium avium and a negative result for Mycobacterium tuberculosis. However, polymerase chain reaction analysis of a cultured colony of acid-fast bacteria from biopsy tissue using the Cobas TaqMan and an alternative polymerase chain reaction analysis of biopsy tissue yielded discordant results. The patient was diagnosed as having tuberculous lymphadenitis. She was treated with antitubercular drugs and subsequently had a reduction in cervical lymph node swelling. Polymerase chain reaction analysis is not 100% accurate; hence, its use as a diagnostic tool for mycobacterial infection requires increased attention. Hirokazu Taniguchi, Masahiko Nakamura, Kazuki Shimokawa, Fumi Kamiseki, Shin Ishizawa, Hitoshi Abo, Hideaki Furuse, Takeshi Tsuda, Yasuaki Masaki, and Kensuke Suzuki Copyright © 2015 Hirokazu Taniguchi et al. All rights reserved. Severe Congenital Toxoplasmosis: A Case Report and Strain Characterization Sun, 18 Jan 2015 13:49:34 +0000 http://www.hindawi.com/journals/criid/2015/851085/ We report a fatal congenital toxoplasmosis case in an Iranian woman in the south of Iran. A pregnant mother had been admitted at the 15th week of her pregnancy on account of a febrile illness, symptoms of common cold, and enlargement of submandibular lymph nodes. Serological testing of the mother’s serum revealed positive IgG and IgM anti-Toxoplasma antibodies. Amniotic fluid was taken and evaluated by polymerase chain reaction (PCR) assay with a direct amplification of the Toxoplasma URPT gene which was found to be positive. Sequencing and analysis of PCR product revealed that the isolate has the most similarity with type I of Toxoplasma gondii. Fetal scan showed anomaly in fetus including mild hydrocephaly. Termination of the pregnancy was suggested by the physician and pregnancy was terminated 178 days after conception. Bahador Sarkari and Samaneh Abdolahi Khabisi Copyright © 2015 Bahador Sarkari and Samaneh Abdolahi Khabisi. All rights reserved. Osteomyelitis Infection of Mycobacterium marinum: A Case Report and Literature Review Sun, 18 Jan 2015 09:54:47 +0000 http://www.hindawi.com/journals/criid/2015/905920/ Mycobacterium marinum (M. marinum) is a ubiquitous waterborne organism that grows optimally at temperatures around 30°C. It is a nontuberculous Mycobacterium found in nonchlorinated water with worldwide prevalence. It is the most common atypical Mycobacterium that causes opportunistic infection in humans. M. marinum can cause superficial infections and localized invasive infections in humans, with the hands being the sites most frequently affected. It can cause skin lesions, which are either single, papulonodular lesions, confined to an extremity, or may resemble cutaneous sporotrichosis. This infection can also cause deeper infections including tenosynovitis, bursitis, arthritis, and osteomyelitis. Disseminated infections and visceral involvements have been reported in immunocompromised patients. We here report a case of severe deep soft tissue infection with necrotizing fasciitis and osteomyelitis of the left upper extremity (LUE) caused by M. marinum in an immunocompromised patient. Hao H. Nguyen, Nada Fadul, Muhammad S. Ashraf, and Dawd S. Siraj Copyright © 2015 Hao H. Nguyen et al. All rights reserved. Native Valve Endocarditis due to Ralstonia pickettii: A Case Report and Literature Review Sun, 11 Jan 2015 07:12:03 +0000 http://www.hindawi.com/journals/criid/2015/324675/ Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals. Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block. To our knowledge this is the first case report of Ralstonia species causing infective endocarditis with perivalvular abscess. Joseph Orme, Tomas Rivera-Bonilla, Akil Loli, and Negin N. Blattman Copyright © 2015 Joseph Orme et al. All rights reserved. A Case of Liver Abscess with Desulfovibrio desulfuricans Bacteremia Thu, 08 Jan 2015 06:56:58 +0000 http://www.hindawi.com/journals/criid/2015/354168/ Desulfovibrio spp. are gram-negative, sulfate-reducing, and anaerobic bacteria found in the digestive tract of humans. Because Desulfovibrio spp. are infrequent causative agents of infectious diseases and are difficult to isolate and to identify from clinical specimens, the appropriate antibiotic therapy to infection with Desulfovibrio spp. has not been determined. We report the first case of liver abscess with bacteremia due to Desulfovibrio desulfuricans to show the clinical presentation and treatment. The patient was successfully treated with intravenous piperacillin-tazobactam and oral amoxicillin-clavulanic acid. Saho Koyano, Keita Tatsuno, Mitsuhiro Okazaki, Kiyofumi Ohkusu, Takashi Sasaki, Ryoichi Saito, Shu Okugawa, and Kyoji Moriya Copyright © 2015 Saho Koyano et al. All rights reserved. A Case of Healthcare Associated Pneumonia Caused by Chryseobacterium indologenes in an Immunocompetent Patient Tue, 06 Jan 2015 06:50:34 +0000 http://www.hindawi.com/journals/criid/2015/483923/ Chryseobacterium indologenes is nonmotile, oxidase, and indole positive Gram-negative aerobic bacilli which is widely found in plants, soil, foodstuffs, and water. It can colonize hospital environment due to ability to survive in chlorine-treated water supplies. Chryseobacteria can also colonize patients via contaminated medical devices such as respirators, intubation tubes, humidifiers, intravascular catheters, and prosthetic valves. Immune suppression, comorbidities, use of broad-spectrum antibiotics, and extreme age are other important risk factors for Chryseobacterium infections. We report a case of an 82-year-old male admitted to our hospital with the complaint of altered mental status with history of trauma, and recent orthopedic and neurosurgery operations. He was transferred to neurosurgery intensive care unit due to respiratory failure. Urine culture yielded extended spectrum beta lactamase (ESBL) (+). E. coli and C. indologenes were isolated from transtracheal aspirate. He was treated with ertapenem, and levofloxacin and discharged with full recovery. Salih Atakan Nemli, Tuna Demirdal, and Serap Ural Copyright © 2015 Salih Atakan Nemli et al. All rights reserved. Delusions of Disseminated Fungosis Thu, 25 Dec 2014 13:39:23 +0000 http://www.hindawi.com/journals/criid/2014/458028/ Introduction. Delusional infestation is a rare monosymptomatic hypochondriacal psychosis according to The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). It can be a primary disorder or associated with an underlying psychological or physical disorder. It commonly presents as delusional parasitosis, and less than 1% may be fungi related. We present this case as it is a rare presentation of a rare condition. Case Presentation. Our patient is a 60-year-old Caucasian man who presented with a 7-year history of delusional infestation manifested as a disseminated fungal infection. He had previously been reviewed by multiple physicians for the same with no systemic illness diagnosed. After multiple reviews and thorough investigation we diagnosed him with a likely delusional disorder. As is common with this patient cohort he refused psychiatric review or antipsychotic medication. Conclusion. A delusion of a disseminated fungal infestation is a rare condition. It is exceedingly difficult to treat as these patients often refuse to believe the investigation results and diagnosis. Furthermore, they either refuse or are noncompliant with treatment. Multidisciplinary outpatient evaluation may be the best way to allay patient fears and improve treatment compliance. Ian Gassiep and Paul Matthew Griffin Copyright © 2014 Ian Gassiep and Paul Matthew Griffin. All rights reserved. The First Evidence of Lyme Neuroborreliosis in Southern Bosnia and Herzegovina Mon, 15 Dec 2014 09:13:44 +0000 http://www.hindawi.com/journals/criid/2014/231969/ Lyme borreliosis (LB) is caused by the spirochete Borrelia burgdorferi, which is transmitted to humans by ticks of the Ixodes ricinus complex. It is manifested by a variety of clinical symptoms and affects skin, joints, heart, and nervous system. Neurological manifestations are predictable and usually include meningoencephalitis, facial palsy, or radiculopathy. Recently, a dramatic rise in the number of diagnosed cases of LB has been observed on the global level. Here we show the first case of Lyme neuroborreliosis in southern Bosnia and Herzegovina, which was first presented by erythema chronicum migrans. Unfortunately, it was not recognized or well treated at the primary care medicine. After eight weeks, the patient experienced headache, right facial palsy, and lumbar radiculopathy. After the clinical examination, the neurologist suspected meningoencephalitis and the patient was directed to the Clinic for Infectious Disease of the University Hospital Mostar, where he was admitted. The successful antimicrobial treatment with the 21-day course of ceftriaxone was followed by normalization of neurological status, and then he was discharged from the hospital. This case report represents an alert to all physicians to be aware that LB is present in all parts of Bosnia and Herzegovina, as well as in the neighboring regions. Jurica Arapovic, Sinisa Skocibusic, Svjetlana Grgic, and Jadranka Nikolic Copyright © 2014 Jurica Arapovic et al. All rights reserved. Fever of Unknown Origin in a Patient with Confirmed West Nile Virus Meningoencephalitis Sun, 14 Dec 2014 09:02:41 +0000 http://www.hindawi.com/journals/criid/2014/120709/ West Nile Virus (WNV), an RNA arbovirus and member of the Japanese encephalitis virus antigenic complex, causes a wide range of clinical symptoms, from asymptomatic to encephalitis and meningitis. Nearly all human infections of WNV are due to mosquito bites with birds being the primary amplifying hosts. Advanced age is the most important risk factor for neurological disease leading most often to poor prognosis in those afflicted. We report a case of WNV meningoencephalitis in a 93-year-old Caucasian male who presented with fever of unknown origin (FUO) and nuchal rigidity that rapidly decompensated within 24 h to a persistent altered mental state during inpatient stay. The patient’s ELISA antibody titers confirmed pathogenesis of disease by WNV; he given supportive measures and advanced to an excellent recovery. In regard to the approach of FUO, it is important to remain impartial yet insightful to all elements when determining pathogenesis in atypical presentation. Alexander Sabre and Laurie Farricielli Copyright © 2014 Alexander Sabre and Laurie Farricielli. All rights reserved. Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash Mon, 08 Dec 2014 11:25:11 +0000 http://www.hindawi.com/journals/criid/2014/293761/ Leishmaniasis is an infectious disease that is endemic in tropical areas and in the Mediterranean. This condition spreads to 98 countries in four continents, surpassing 12 million infected individuals, with 350 million people at risk of infection. This disease is characterized by a wide spectrum of clinical syndromes, caused by protozoa of the genus Leishmania, with various animal reservoirs, such as rodents, dogs, wolves, foxes, and even humans. Transmission occurs through a vector, a sandfly of the genus Lutzomyia. There are three main clinical forms of leishmaniasis: visceral leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. The wide spectrum of nonvisceral forms includes: localized cutaneous leishmaniasis, a papular lesion that progresses to ulceration with granular base and a large framed board; diffuse cutaneous leishmaniasis; mucocutaneous leishmaniasis, which can cause disfiguring and mutilating injuries of the nasal cavity, pharynx, and larynx. Leishmaniasis/HIV coinfection is considered an emerging problem in several countries, including Brazil, where, despite the growing number of cases, a problem of late diagnosis occurs. Clinically, the cases of leishmaniasis associated with HIV infection may demonstrate unusual aspects, such as extensive and destructive lesions. This study aims to report a case of mucocutaneous leishmaniasis/HIV coinfection with atypical presentation of diffuse desquamative eruption and nasopharyngeal involvement. Guilherme Almeida Rosa da Silva, Daniel Sugui, Rafael Fernandes Nunes, Karime de Azevedo, Marcelo de Azevedo, Alexandre Marques, Carlos Martins, and Fernando Raphael de Almeida Ferry Copyright © 2014 Guilherme Almeida Rosa da Silva et al. All rights reserved. Gemella morbillorum Endocarditis Sun, 07 Dec 2014 13:42:03 +0000 http://www.hindawi.com/journals/criid/2014/456471/ Infective endocarditis caused by Gemella morbillorum is a rare disease. In this report 67-year-old male patient with G. morbillorum endocarditis was presented. The patient was hospitalized as he had a fever of unknown origin and in the two of the three sets of blood cultures taken at the first day of hospitalization G. morbillorum was identified. The transthoracic echogram revealed 14 × 10 mm vegetation on the aortic noncoronary cuspis. After 4 weeks of antibiotic therapy, the case was referred to the clinic of cardiovascular surgery for valve surgery. Serap Ural, Sureyya Gul Yurtsever, Bahar Ormen, Nesrin Turker, Figen Kaptan, Sibel El, Zehra Ilke Akyildiz, and Nejat Ali Coskun Copyright © 2014 Serap Ural et al. All rights reserved. Cotreatment of Congenital Measles with Vitamin A and Intravenous Immunoglobulin Sun, 07 Dec 2014 08:31:23 +0000 http://www.hindawi.com/journals/criid/2014/234545/ Although the measles vaccine has been part of routine national childhood vaccination programs throughout Europe, measles remains a public health concern. High numbers of cases and outbreaks have occurred throughout the European continent since 2011, and an increasing number of cases have been reported in Turkey since 2012. During a recent measles outbreak in Turkey, 2 pregnant women contracted measles prior to delivering preterm infants at Hacettepe University Hospital. Measles virus genomic RNA and IgM antibodies against measles were detected in the cord blood of infants and mothers in both cases. The infants were treated with intravenous immunoglobulin (IVIG) and vitamin A. Transient thrombocytopenia was present in 1 infant and treated with an additional dose of IVIG and vitamin A. The infants were discharged, without complications, within 10 days of birth. The successful treatment of these cases suggests that infants who have been exposed to, or infected with, measles may benefit from cotreatment of vitamin A and IVIG. Yasemin Ozsurekci, Ates Kara, Cihangul Bayhan, Eda Karadag Oncel, Sahin Takci, Sultan Yolbakan, Ayse Korkmaz, and Gulay Korukluoglu Copyright © 2014 Yasemin Ozsurekci et al. All rights reserved. Mild Clinical Course of Severe Fever with Thrombocytopenia Syndrome Virus Infection in an Elderly Japanese Patient Thu, 04 Dec 2014 13:47:44 +0000 http://www.hindawi.com/journals/criid/2014/918135/ Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious and hemorrhagic disease recently described in China and western Japan. A 71-year-old healthy Japanese woman noticed a tick biting her after harvesting in an orchard and removed it herself. She developed diarrhea, anorexia, and chills eight days later. Because these symptoms continued, she visited a primary care physician 6 days after the onset. Laboratory data revealed thrombocytopenia, leukocytopenia, and elevated liver enzymes. She was then referred to our hospital. Although not completely fulfilling the diagnostic criteria used in a retrospective study in Japan, SFTS was suspected, and we detected SFTS virus in the patient’s blood using RT-PCR. However, she recovered without intensive treatment and severe complications 13 days after the onset. In this report, we present a mild clinical course of SFTS virus infection in Japan in detail. Yuko Ohagi, Shinobu Tamura, Chiaki Nakamoto, Hiromichi Nakamoto, Masayuki Saijo, Masayuki Shimojima, Yoshio Nakano, and Tokuzo Fujimoto Copyright © 2014 Yuko Ohagi et al. All rights reserved. Mycobacterium avium Complex Infection in a Patient with Sickle Cell Disease and Severe Iron Overload Thu, 04 Dec 2014 00:10:07 +0000 http://www.hindawi.com/journals/criid/2014/405323/ A 34-year-old female with sickle cell anemia (hemoglobin SS disease) and severe iron overload presented to our institution with the subacute presentation of recurrent pain crisis, fever of unknown origin, pancytopenia, and weight loss. A CT scan demonstrated both lung and liver nodules concerning for granulomatous disease. Subsequent biopsies of the liver and bone marrow confirmed the presence of noncaseating granulomas and blood cultures isolated Mycobacterium avium complex MAC. Disseminated MAC is considered an opportunistic infection typically diagnosed in the immunocompromised and rarely in immunocompetent patients. An appreciable number of mycobacterial infection cases have been reported in sickle cell disease patients without immune dysfunction. It has been reported that iron overload is known to increase the risk for mycobacterial infection in vitro and in vivo studies. While iron overload is primarily known to cause end organ dysfunction, the clinical relationship with sickle cell disease and disseminated MAC infection has not been reported. Clinical iron overload is a common condition diagnosed in the sub-Saharan African population. High dietary iron, genetic defects in iron trafficking, as well as hemoglobinopathy are believed to be the etiologies for iron overload in this region. Patients with iron overload in this region were 17-fold more likely to die from Mycobacterium tuberculosis. Both experimental and clinical evidence suggest a possible link to iron overload and mycobacterial infections; however larger observational studies are necessary to determine true causality. Kamal Shemisa, Nasima Jafferjee, David Thomas, Gretta Jacobs, and Howard J. Meyerson Copyright © 2014 Kamal Shemisa et al. All rights reserved. Kerstersia gyiorum Isolated from a Bronchoalveolar Lavage in a Patient with a Chronic Tracheostomy Sun, 23 Nov 2014 08:30:08 +0000 http://www.hindawi.com/journals/criid/2014/479581/ The use of the matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) generates rapid microbial identification. We are presenting a case of a 63-year-old woman with a medical history of chronic tracheostomy admitted for hypotension and fevers to illustrate the clinical implication of MALDI-TOF MS on bacterial identification. Kerstersia gyiorum was identified from the bronchoalveolar lavage isolate. Kerstersia gyiorum has been isolated from human sputum samples, and may be a previously unrecognized colonizer of the upper respiratory tract. Thus, patients with long-term tracheotomies or who are chronically aspirating may be at risk of lower respiratory infection with this organism. Increased use of MALDI-TOF MS in the clinical setting may increase reporting of this atypical isolate. Meredith Deutscher, Jennifer Severing, and Joan-Miquel Balada-Llasat Copyright © 2014 Meredith Deutscher et al. All rights reserved. Necrotizing Soft Tissue Infection Occurring after Exposure to Mycobacterium marinum Wed, 19 Nov 2014 09:56:13 +0000 http://www.hindawi.com/journals/criid/2014/702613/ Cutaneous infections caused by Mycobacterium marinum have been attributed to aquarium or fish exposure after a break in the skin barrier. In most instances, the upper limbs and fingers account for a majority of the infection sites. While previous cases of necrotizing soft tissue infections related to M. marinum have been documented, the importance of our presenting case is to illustrate the aggressive nature of M. marinum resulting in a persistent necrotizing soft tissue infection of a finger that required multiple aggressive wound debridements, followed by an amputation of the affected extremity, in order to hasten recovery. Shivani S. Patel, M. Lance Tavana, M. Sean Boger, Soe Soe Win, and Bassam H. Rimawi Copyright © 2014 Shivani S. Patel et al. All rights reserved.