Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. The First Evidence of Lyme Neuroborreliosis in Southern Bosnia and Herzegovina Mon, 15 Dec 2014 09:13:44 +0000 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 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 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 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 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 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 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 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 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. Aeromonas hydrophila Sepsis Associated with Consumption of Raw Oysters Wed, 19 Nov 2014 00:00:00 +0000 Introduction. Aeromonas hydrophila is a gram negative bacillus that is native to aquatic environments that is increasingly reported in humans. This case is remarkable for A. hydrophila with an initial presentation of acute pancreatitis. Case Presentation. A 61-year-old male presented to the emergency department with nausea, vomiting, and abdominal pain for two days. His past medical history was significant for alcohol abuse. Initial laboratory examination showed an elevated white blood cell count, elevated lipase, and elevated liver function tests (LFT). Computer tomography (CT) showed peripancreatic inflammatory changes and retroperitoneal free fluid, suggestive of acute pancreatitis. The patient was treated with intravenous (IV) fluids and IV meropenem. After two days, the patient developed sepsis and respiratory failure and was intubated. Blood cultures were positive for Aeromonas hydrophila sensitive to ciprofloxacin which was added to his treatment. Additionally, it was discovered that this patient had recently vacationed in Florida where he consumed raw oysters. He was discharged home on the eighth day of the hospital admission. Conclusion. This is a rare case of A. hydrophila sepsis in an elderly patient with acute pancreatitis and a history of consumption of raw oysters. This case suggests that A. hydrophila can cause disseminated infection in immunocompetent individuals. Ivan Nikiforov, John Goldman, Pramil Cheriyath, Anix Vyas, and Vinod Nookala Copyright © 2014 Ivan Nikiforov et al. All rights reserved. Chylous Ascites in a Patient with HIV/AIDS: A Late Complication of Mycobacterium avium Complex-Immune Reconstitution Inflammatory Syndrome Tue, 18 Nov 2014 07:41:09 +0000 Chylous ascites is very rare in HIV/AIDS and its association with Mycobacterium avium complex-immune reconstitution inflammatory syndrome (MAC-IRIS) has been rarely reported. Here, we report a case of a young African-American male who developed chylous ascites as a late sequela to immune reconstitution inflammatory syndrome while on treatment for MAC. Antiretroviral drug-naive patients who start HAART in close proximity to the diagnosis of an opportunistic infection and have a rapid decline in HIV RNA level should be monitored for development of IRIS. Although the long term prognosis is poor, early diagnosis and treatment help to improve quality of life. Imam H. Shaik, Fernando Gonzalez-Ibarra, Rumana Khan, Saira Shah, Amer K. Syed, and David Lintz Copyright © 2014 Imam H. Shaik et al. All rights reserved. A Rare Case of Central Nervous System Tuberculosis Sun, 16 Nov 2014 06:53:37 +0000 Intracranial abscess is an extremely rare form of central nervous system (CNS) tuberculosis (TB). We describe a case of central nervous system tuberculous abscess in absence of human immunodeficiency virus (HIV) infection. A 82-year-old Middle Eastern male from Yemen was initially brought to the emergency room due to altered mental status and acute renal failure. Cross-sectional imaging revealed multiple ring enhancing lesions located in the left cerebellum and in bilateral frontal lobe as well as in the inferior parietal lobe on the left. The patient was placed on an empiric antibiotic regimen. Preliminary testing for infectious causes was negative. Chest radiography and CT of chest showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle. Brain biopsy showed focal exudative cerebellitis and inflamed granulation tissue consistent with formation of abscesses. The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures. The patient was started on standard tuberculosis therapy but expired due to renal failure and cardiac arrest. Ravish Parekh, Alexis Haftka, and Ashleigh Porter Copyright © 2014 Ravish Parekh et al. All rights reserved. Failed Reverse Total Shoulder Arthroplasty Caused by Recurrent Candida glabrata Infection with Prior Serratia marcescens Coinfection Thu, 06 Nov 2014 11:28:19 +0000 This report describes a 58-year-old insulin-dependent diabetic male patient who initially sustained a proximal humerus fracture from a fall. The fracture fixation failed and then was converted to a humeral hemiarthroplasty, which became infected with Candida glabrata and Serratia marcescens. After these infections were believed to be cured with antibacterial and antifungal treatments and two-stage irrigation and debridement, he underwent conversion to a reverse total shoulder arthroplasty. Unfortunately, the C. glabrata infection recurred and, nearly 1.5 years after implantation of the reverse total shoulder, he had a resection arthroplasty (removal of all implants and cement). His surgical and pharmacologic treatment concluded with (1) placement of a tobramycin-impregnated cement spacer also loaded with amphotericin B, with no plan for revision arthroplasty (i.e., the spacer was chronically retained), and (2) chronic use of daily oral fluconazole. We located only three reported cases of Candida species causing infection in shoulder arthroplasties (two C. albicans, one C. parapsilosis). To our knowledge, a total shoulder arthroplasty infected with C. glabrata has not been reported, nor has a case of a C. glabrata and S. marcescens periprosthetic coinfection in any joint. In addition, it is well known that S. marcescens infections are uncommon in periprosthetic joint infections. John G. Skedros, Kendra E. Keenan, Wanda S. Updike, and Marquam R. Oliver Copyright © 2014 John G. Skedros et al. All rights reserved. First Description of KPC-2-Producing Klebsiella oxytoca Isolated from a Pediatric Patient with Nosocomial Pneumonia in Venezuela Wed, 22 Oct 2014 12:06:06 +0000 During the last decade, carbapenem resistance has emerged among clinical isolates of the Enterobacteriaceae family. This has been increasingly attributed to the production of β-lactamases capable of hydrolyzing carbapenems. Among these enzymes, Klebsiella pneumoniae carbapenemases (KPCs) are the most frequently and clinically significant class-A carbapenemases. In this report, we describe the first nosocomial KPC-2-producing K. oxytoca isolated from a pediatric patient with pneumonia admitted to the intensive care unit at The Andes University Hospital, Mérida, Venezuela. This strain was resistant to several antibiotics including imipenem, ertapenem, and meropenem but remained susceptible to ciprofloxacin, colistin, and tigecycline. Conjugation assays demonstrated the transferability of all resistance determinants, except aminoglycosides. The isolate LMM-SA26 carried a ~21 kb conjugative plasmid that harbored the , , and genes. Although carbapenem resistance in the Enterobacteriaceae is still unusual in Venezuela, KPCs have a great potential to spread due to their localization on mobile genetic elements. Therefore, rapid detection of KPC-carrying bacteria with phenotypic and confirmatory molecular tests is essential to establish therapeutic options and effective control measures. Indira Labrador and María Araque Copyright © 2014 Indira Labrador and María Araque. All rights reserved. Community Acquired Chronic Arthritis due to Pseudomonas aeruginosa in a Previously Healthy Pregnant Woman Sun, 12 Oct 2014 00:00:00 +0000 Septic arthritis caused by Pseudomonas aeruginosa is uncommon in the immunocompetent population, despite its occurrence in younger patients with open injuries and in intravenous drug abusers. Here we report a case of septic arthritis caused by P. aeruginosa. This case is unique for several reasons. First, it is a case of septic arthritis in a pregnant woman with no traditional risk factors reported in the literature including history of prior traumatic events, hospitalisation, or chronic underlying disease. She was suspected of having transient osteoporosis associated with pregnancy to involve both hip joints. Second, this is the first reported case of a community acquired chronic septic arthritis due to P. aeruginosa involving large joints of both upper and lower extremities. The patient was treated successfully with a combination of ceftazidime and amikacin for 4 weeks followed by oral ciprofloxacin 750 mg twice daily for 8 weeks. Mesut Yilmaz, Ferhat Arslan, and Ali Mert Copyright © 2014 Mesut Yilmaz et al. All rights reserved. A Fatal Case of Multidrug Resistant Acinetobacter Necrotizing Fasciitis: The Changing Scary Face of Nosocomial Infection Thu, 02 Oct 2014 11:31:04 +0000 Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR) A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis. Nupur Sinha, Masooma Niazi, and Dmitry Lvovsky Copyright © 2014 Nupur Sinha et al. All rights reserved. On a Boat: A Case in Australia of Endophthalmitis and Pyogenic Liver, Prostatic, and Lung Abscesses in a Previously Well Patient due to Klebsiella pneumoniae Wed, 17 Sep 2014 06:17:42 +0000 This is a case report about a patient who arrived in our emergency department in Western Australia to the care of the urologists having just gotten off a ship with a bacterial infection that would result in a 44-day stay in hospital and have quite devastating lasting effects for the young male. His story was in fact reflective of an emerging global phenomenon. Once thought to generally be a bacterium of threat only to the elderly and alcoholics, causing pneumonia and urinary tract infections, this case report describes the potentially devastating consequences of what is now becoming recognized as a hypervirulent form of Klebsiella pneumoniae with the potential to spread throughout the system rapidly seeding abscesses and causing significant morbidity in nonimmunocompromised patients. Initially noticed in Asia increasingly case reports are emerging in Western countries suggesting a global spread. Alecia Vandevelde and Bojana Stepanovic Copyright © 2014 Alecia Vandevelde and Bojana Stepanovic. All rights reserved. Pediatric HIV Long-Term Nonprogressors Tue, 26 Aug 2014 12:59:55 +0000 Patients infected with HIV are best categorized along a continuum from rapid progressors to HIV long-term nonprogressors. Long-term nonprogressors (LTNPs) are those in which AIDS develop many years after being infected with HIV, often beyond the 10-year mark, and represent 15–20% of the HIV infected patients. Many of these patients are able to control their infection and maintain undetectable viral loads for long periods of time without antiretroviral therapy. After a comprehensive literature search, we found extensive data related to HIV LTNPs in the adult population; however, very limited data was available related to LTNPs within the pediatric population. We present a case of pediatric HIV LTNPs, perinatally infected patient with undetectable viral loads, despite never receiving ART. Although there are not many instances of LTNPs among children, this child may be one, though she had intermittent viremia. She has continued to manifest serologic evidence of infection, with yearly ELISA and western blot positive tests. Based on the viral fitness studies that were performed, this case exemplifies an adolescent LTNP. B. H. Rimawi, R. H. Rimawi, M. Micallef, L. Pinckney, S. L. Fowler, and T. C. Dixon Copyright © 2014 B. H. Rimawi et al. All rights reserved. Atypical Presentation of PKDL due to Leishmania infantum in an HIV-Infected Patient with Relapsing Visceral Leishmaniasis Thu, 14 Aug 2014 09:19:52 +0000 We describe the case of an Italian patient with HIV infection who developed an atypical rash resembling post-kala-azar dermal leishmaniasis (PKDL) when receiving liposomal Amphotericin B (L-AMB) for secondary prophylaxis of visceral leishmaniasis (VL). At the time of PKDL appearance, the patient was virologically suppressed but had failed to restore an adequate CD4+ T-cell count. Histology of skin lesions revealed the presence of a granulomatous infiltrate, with lymphocytes, plasma cells, and macrophages, most of which contained Leishmania amastigotes. Restriction fragment length polymorphism-polymerase chain reaction was positive for Leishmania infantum. Paradoxically, cutaneous lesions markedly improved when a new relapse of VL occurred. The patient received meglumine antimoniate, with a rapid clinical response and complete disappearance of cutaneous rash. Unfortunately, the patient had several relapses of VL over the following years, though the interval between them has become wider after restarting maintenance therapy with L-AMB 4 mg/kg/day once a month. Even if rare, PKDL due to Leishmania infantum may occur in Western countries and represents a diagnostic and therapeutic challenge for physicians. The therapeutic management of both PKDL and VL in HIV infection is challenging, because relapses are frequent and evidence is often limited to small case series and case reports. Benedetto Maurizio Celesia, Bruno Cacopardo, Daniela Massimino, Maria Gussio, Salvatore Tosto, Giuseppe Nunnari, and Marilia Rita Pinzone Copyright © 2014 Benedetto Maurizio Celesia et al. All rights reserved. Streptococcus intermedius Bacteremia and Liver Abscess following a Routine Dental Cleaning Wed, 13 Aug 2014 12:24:24 +0000 Streptococcus intermedius is a member of the Streptococcus anginosus group of bacteria. This group is part of the normal flora of the oropharynx, genitourinary, and gastrointestinal tracts; however, they have been known to cause a variety of purulent infections including meningitis, endocarditis, and abscesses, even in immunocompetent hosts. In particular, S. intermedius has been associated with the development of liver and brain abscesses. There have been several case reports of S. intermedius liver abscesses with active periodontal infection. To our knowledge, however, there has not been a case following a routine dental procedure. In fact, the development of liver abscesses secondary to dental procedures is very rare in general, and there are only a few case reports in the literature describing this in relation to any pathogen. We present a rare case of S. intermedius bacteremia and liver abscess following a dental cleaning. This case serves to further emphasize that even routine dental procedures can place a patient at risk of the development of bacteremia and liver abscesses. For this reason, the clinician must be sure to perform a detailed history and careful examination. Timely diagnosis of pyogenic liver abscesses is vital, as they are typically fatal if left untreated. Lachara V. Livingston and Elimarys Perez-Colon Copyright © 2014 Lachara V. Livingston and Elimarys Perez-Colon. All rights reserved. A Case of Ocular Syphilis in a 36-Year-Old HIV-Positive Male Mon, 11 Aug 2014 11:36:43 +0000 The incidence of syphilis in the United States has increased markedly over the last decade, particularly among men who have sex with men (MSM). Although uncommon, ocular involvement is a potentially devastating clinical manifestation of syphilis. Human immunodeficiency virus (HIV) infection appears to increase the risk of ocular syphilis. Because of the lack of pathognomonic features for ocular syphilis and its ability to occur in both immunocompetent and immunosuppressed individuals, prompt diagnosis requires a high index of suspicion. Ocular syphilis should therefore be considered in MSM and HIV-infected patients presenting with unexplained visual complaints. Herein, we present a case of ocular syphilis in a patient with newly diagnosed HIV. Amy Nguyen, Samuel Clark Berngard, Jay Patrick Lopez, and Timothy C. Jenkins Copyright © 2014 Amy Nguyen et al. All rights reserved. Visceral Leishmaniasis in a UK Toddler following a Short Trip to a Popular Holiday Destination in Spain Sun, 10 Aug 2014 13:19:05 +0000 We herein present the case of a 15-month-old with visceral leishmaniasis diagnosed in the UK following a short trip to a popular holiday destination in Spain. Four months after the initial symptoms, the diagnosis was made incidentally on microscopy of a bone marrow biopsy taken for suspected haematological malignancy after the child developed hepatosplenomegaly, pancytopaenia, and Klebsiella pneumoniae septicaemia. Neda Minakaran, Talha Soorma, and Shamez N. Ladhani Copyright © 2014 Neda Minakaran et al. All rights reserved. Elizabethkingia meningosepticum in a Patient with Six-Year Bilateral Perma-Catheters Tue, 05 Aug 2014 12:40:54 +0000 Elizabethkingia meningosepticum (EM) is a saprophyte which is ubiquitous in nature, but not normally present in the human flora. Instances of infection are rare in the USA, but EM may be an emerging pathogen among immune-compromised patients. EM can cause a variety of infections, but nosocomial pneumonia and bacteremia have been the most commonly reported among immune-compromised adults. EM has proven difficult to treat with a mortality rate of 23%–41% in adult bacteremia. This is likely due to its resistance to commonly used empiric antibiotics for Gram-negative infections. A review of the literature suggests that there has been a shift EM’s susceptibility profile over time along with a great variability in antibiotic susceptibilities reported. This signifies the importance of close monitoring of these changes. In this report we present a case of a 64-year-old male with end stage renal disease and bilateral subclavian perma-catheters, who was admitted with systemic inflammatory response syndrome. While initial peripheral blood cultures were negative, cultures later drawn from his perma-catheters revealed Corneybacterium species and EM. The patient was initially treated with empiric vancomycin and piperacillin-tazobactam. After antibiotics susceptibilities became available, he was treated with levofloxacin and ceftazidime. The patient improved, was culture negative, and later had perma-catheter removal. Konstantin Boroda and Li Li Copyright © 2014 Konstantin Boroda and Li Li. All rights reserved. A Case of Recurrent Cryptococcal Meningoencephalitis in an Immunocompetent Female Tue, 15 Jul 2014 09:34:06 +0000 Cryptococcus neoformans is commonly associated with meningoencephalitis in immunocompromised patients and occasionally in apparently healthy individuals. Duration and regimen of antifungal treatment vary depending on the nature of the host and extent of disease and CNS shunts are placed in persistently elevated intracranial pressures. Recurrence of infection after initial treatment is not uncommon in HIV positive patients, Kaya et al. (2012) and Illnait-zaragozí et al. (2010). We describe a 39-year-old immunocompetent female that presented with neurologic deficits and increased intracranial pressure (ICP) due to cryptococcal meningoencephalitis that had a complicated course with drug induced hepatitis and persistently increased ICP that ultimately required shunt placement and presented again with relapse of cryptococcal meningoencephalitis after completion of antifungal treatment. Our case shows that recurrent cryptococcal meningitis can be seen in immunocompetent patients due to prolonged placement of CNS shunt and suggests that shunts should be removed after resolution of meningitis. Negin Niknam, Negar Niknam, Kola Dushaj, and Erfidia Restrepo Copyright © 2014 Negin Niknam et al. All rights reserved. Chryseobacterium indologenes Septicemia in an Infant Thu, 10 Jul 2014 08:31:25 +0000 Chryseobacterium indologenes is a rare cause of infection in children. The organism causes infections mostly in hospitalised patients with severe underlying diseases. The choice of an effective drug for the treatment of infections due to C. indologenes is difficult as the organism has a limited spectrum of antimicrobial sensitivity. We present a case of nosocomial septicemia caused by C. indologenes in an infant with congenital heart disease who was successfully treated with trimethoprim sulfamethoxazole and also reviewed fourteen additional cases of C. indologenes infections reported in the English literature in this report. Turkan Aydin Teke, Fatma Nur Oz, Ozge Metin, Gulsum Iclal Bayhan, Zeynep Gökce Gayretli Aydin, Melek Oguz, and Gonul Tanir Copyright © 2014 Turkan Aydin Teke et al. All rights reserved. Disseminated Abdominal Hydatidosis: A Rare Presentation of Common Infectious Disease Tue, 08 Jul 2014 13:06:27 +0000 Hydatid disease is one of the most geographically widespread zoonoses with substantial disease burden. In this report we are discussing an unusual case of intra-abdominal HD that was ongoing for 22 years despite two surgical interventions. Significant symptomatic relief was achieved within the first two months of combination therapy with albendazole and praziquantel. HD is still of public health concern in the Middle East that needs optimized care. Abdulrahman Almalik, Aynaa Alsharidi, Mohammed Al-Sheef, and Mushirah Enani Copyright © 2014 Abdulrahman Almalik et al. All rights reserved. A Case Report of Typhoidal Acute Acalculous Cholecystitis Thu, 26 Jun 2014 09:19:37 +0000 Introduction. Acalculous cholecystitis in the setting of typhoid fever in adults is an infrequent clinical encounter, reported sparsely in the literature. In this case report we review the presentation and management of enteric fever involving the biliary system and consider the literature surrounding this topic. The aim of this case report is to alert clinicians to the potential diagnosis of extraintestinal complications in the setting of typhoid fever in the returned traveller, requiring surgical intervention. Presentation of Case. We report the case of a 23-year-old woman with acalculous cholecystitis secondary to Salmonella Typhi. Discussion. There is scarce evidence surrounding the optimal treatment and prognosis of typhoidal acalculous cholecystitis. In the current case, surgical invention was favoured due to failure of medical management. Conclusion. Clinical judgement dictated surgical intervention in this case of typhoidal acute acalculous cholecystitis, and cholecystectomy was safely performed. Neeha Rajan, Imeldah Motoroko, Dilshan Udayasiri, Jo-Lyn McKenzie, Jason S. C. Tan, and Adrian R. Tramontana Copyright © 2014 Neeha Rajan et al. All rights reserved. A Novel Case of Symptomatic BK Viraemia in a Patient Undergoing Treatment for Hodgkin Lymphoma Tue, 24 Jun 2014 12:12:01 +0000 Symptomatic BK viral infection in the immunocompromised host is well described, most commonly seen in renal transplant recipients, bone marrow transplant recipients, and HIV positive patients. The present case describes a novel clinical scenario of symptomatic urological BK virus infection in a patient receiving treatment for Hodgkin lymphoma. This case highlights the importance of casting a wide diagnostic net for adverse events encountered with novel therapeutic agents or regimens. Jacinta Perram and Jane Estell Copyright © 2014 Jacinta Perram and Jane Estell. All rights reserved. A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis Sun, 15 Jun 2014 06:19:02 +0000 Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy. Brijesh Patel, Anas Souqiyyeh, and Ammar Ali Copyright © 2014 Brijesh Patel et al. All rights reserved. Atypical Pyoderma Gangrenosum Mimicking an Infectious Process Thu, 12 Jun 2014 09:31:34 +0000 We present a patient with atypical pyoderma gangrenosum (APG), which involved the patient’s arm and hand. Hemorrhagic bullae and progressive ulcerations were initially thought to be secondary to an infectious process, but a biopsy revealed PG. Awareness of APG by infectious disease services may prevent unnecessary use of broad-spectrum antibiotics. Derek To, Aaron Wong, and Valentina Montessori Copyright © 2014 Derek To et al. All rights reserved.