Catheter-Related ESBL-Producing Leclercia adecarboxylata Septicemia in Hemodialysis Patient: An Emerging Pathogen?Read the full article
Case Reports in Infectious Diseases publishes case reports and case series in all areas of hematology, including general hematology, pathology, and oncology, with a specific focus on lymphomas and leukemias.
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Secondary Syphilis with Eosinophilia Complicated by Severe Jarisch–Herxheimer Reaction
It has long been acknowledged that syphilis is a disease with a diverse range of presentations. We herein describe a case of a young man who presented with fever, rash, and eosinophilia following the commencement of allopurinol, only to be diagnosed with secondary syphilis on histopathology. His treatment was complicated by a severe exacerbation of his cutaneous eruption following the commencement of penicillin, likely secondary to a Jarisch–Herxheimer reaction, an entity often overlooked by clinicians managing syphilis.
Fusobacterium necrophorum subsp. necrophorum Liver Abscess with Pylephlebitis: An Abdominal Variant of Lemierre’s Syndrome
Liver abscess associated with suppurative portal vein thrombosis (pylephlebitis) secondary to Fusobacterium necrophorum has been rarely reported. It is considered to be an abdominal variant of Lemierre’s syndrome associated with significant morbidity and mortality. We report a case of 69-year-old man who developed liver abscess and pylephlebitis due to F. necrophorum with an unclear source of infection. We discuss the pathogenesis, diagnosis, and treatment strategy for this entity, with a review of previously published cases of pyelephlebitis due to F. necrophorum in regard to their clinical presentation and outcome.
Herpes Zoster Infection Presenting as Aseptic Meningitis and Dermatomal Rash in Immunocompetent Adult
Herpes zoster is a localized, painful, and vesicular rash involving one or adjacent dermatomes caused by varicella-zoster virus reactivation. Herpes zoster presenting as aseptic meningitis is prevalent among elderly population and people with immunocompromised status. However, it is a rare phenomenon in the young immunocompetent adult; hence, we are reporting a case of a herpes zoster infection presenting as aseptic meningitis and dermatological manifestation in a 19-year-old immunocompetent male.
Use of Procalcitonin to Guide Discontinuation of Antimicrobial Therapy in Patients with Persistent Intra-Abdominal Collections: A Case Series
Objective. Limited evidence exists for the use of procalcitonin (PCT) to guide the duration of antimicrobial therapy in patients with intra-abdominal abscesses (IAA). In this case series, we describe clinical presentations and outcomes using PCT to guide cessation of antimicrobial therapy in patients with persistent IAA who exhibited clinical improvement. Methods. A retrospective analysis of patients with IAA who had PCT levels available to review was performed in a tertiary academic teaching institution in the United States between 2017 and 2018. Demographics, clinical characteristics, and outcomes were obtained from the medical records. Patients were followed up for a minimum of 180 days after completion of antimicrobial therapy to determine if evidence of recurrence or mortality was present. Results. We identified four patients with IAA. They underwent early drainage of the source of infection and received empiric antimicrobial therapy according to individual risk factors and clinical scenarios. Antimicrobials were discontinued after clinical and radiographic improvement and evidence of normal PCT levels, regardless of the persistence of fluid collections. No evidence of recurrence or mortality was observed during the follow-up period. Conclusions. We found PCT to be a useful aid in the medical decision-making process to safely discontinue antimicrobial therapy in a series of patients with persistent intra-abdominal collections despite early drainage and appropriate course of antimicrobial therapy.
Successful Treatment of Adenovirus Infection with Brincidofovir in an Immunocompromised Patient after Hematological Stem Cell Transplantation
Immunocompromised patients, including hematopoietic stem cell transplantation (HSCT), HIV, and malnourished patients, are at increased risk for viral infections with high incidences of morbidity and mortality. In HSCT patients, the infection risk is increased until immune reconstitution is re-established. Therapy with standard of care antiviral drugs, for example Cidofovir, is expensive, requires prolonged administration, and has unfavorable toxicity profiles. Our case describes the successful use of Brincidofovir (CMX001), a lipid-conjugate of the nucleotide analog Cidofovir, in a 9-year-old post-HSCT girl with disseminated adenovirus infection. The increased efficacy of Brincidofovir (BCV) against multiple viral infections, limited toxicity, and oral-administered schedule opens options in different resource settings.
Tuberculosis and Melioidosis at Distinct Sites Occurring Simultaneously
Rationale. Both tuberculosis and melioidosis are commonly encountered infectious diseases in South East Asia. However, these conditions occur commonly in isolation, cases of coinfection of Mycobacterium tuberculosis and Burkholderia pseudomallei are rare. These cases report of the isolation of both organisms concomitantly in a single disease site. We report the first case of concomitant infection at distinct noncontiguous sites. Patient Concerns. A 64-year-old man, with chronic alcohol consumption, presented with a month long history of left-sided abdominal pain, as well as significant weight loss and fever prior to the onset of abdominal pain. Diagnosis. Disseminated tuberculosis with pulmonary and gastrointestinal involvement and a splenic abscess due to melioidosis. Interventions. The patient was treated concomitantly for pulmonary and gastrointestinal tuberculosis, as well as a splenic abscess due to melioidosis. Outcomes. The patient is reported to be well, with resolution of symptoms, as well as radiological resolution of the splenic abscess. Lessons. Both melioidosis and tuberculosis can present with a similar clinical picture, and coinfections are rare. Hence, increased awareness among clinicians and microbiologists can help in diagnosing both diseases even when it is not clinically apparent.