Case Reports in Infectious Diseases https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Intracranial Hemorrhage Complicating Herpes Simplex Encephalitis on Antiviral Therapy: A Case Report and Review of the Literature Tue, 19 Sep 2017 08:12:28 +0000 http://www.hindawi.com/journals/criid/2017/6038146/ Herpes simplex virus (HSV) encephalitis is the most common cause of nonendemic sporadic encephalitis in the USA. Decreased mortality with early treatment with acyclovir has been documented. Although common complications include cortical petechial hemorrhages, frank intracerebral hematomas are considered very rare. Only few cases have been reported in the literature. We report a case of HSV encephalitis complicated by intracerebral hemorrhage 12 days after initiation of acyclovir therapy. Ghada ElShimy, Christina Mariyam Joy, Fred Berlin, and Waleed Lashin Copyright © 2017 Ghada ElShimy et al. All rights reserved. Immune Reconstitution Inflammatory Syndrome and Cytomegalovirus Pneumonia Case Report: Highlights and Missing Links in Classification Criteria and Standardized Treatment Mon, 18 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/9314580/ Background. Cytomegalovirus (CMV) pulmonary involvement is rarely associated with IRIS; therefore, limited information is available. Case Presentation. Here, we describe the case of a 43-year-old HIV-infected male who developed an unusual case of IRIS after cytomegalovirus (CMV) pneumonia. Clinically there was a progressive and paradoxical worsening of respiratory distress, despite being treated for CMV after initiation with antiretroviral therapy. Chest X-ray revealed disseminated infiltrates in both lungs; chest CT-scan showed generalized lung involvement and mediastinal adenopathy. Pulmonary biopsy confirmed CMV pneumonia with the observation of typical viral inclusions on pneumocytes. Conclusions. CMV pneumonia can be associated with the development of IRIS requiring treatment with immunosuppressant’s and immunomodulatory drugs. Stefania Petarra-Del Río, Adrian Rodriguez-Hernandez, Luis Anguiano-Landa, Georgina Aguilar-Portillo, Isidro Zavala-Trujillo, Arnulfo Hernan Nava-Zavala, and Maria G. Zavala-Cerna Copyright © 2017 Stefania Petarra-Del Río et al. All rights reserved. Successful Treatment of Klebsiella pneumoniae Harboring a Klebsiella pneumoniae Carbapenemase Isolated from Lumbar Wound Infection and Blood in a Patient with Hardware Retention Sun, 17 Sep 2017 08:36:42 +0000 http://www.hindawi.com/journals/criid/2017/9028543/ Infections caused by carbapenem-resistant Enterobacteriaceae, especially carbapenemase producing Klebsiella pneumoniae, represent an urgent threat as outlined by the Centers for Disease Control and Prevention (CDC). We present a 66-year-old male with spinal stenosis who underwent elective L2-pelvis posterior spinal fusion at an outside institution and rapidly developed a complicated infection with Klebsiella pneumoniae harboring Klebsiella pneumoniae carbapenemase. This is the first described case of a patient with Klebsiella pneumoniae harboring Klebsiella pneumoniae carbapenemase causing postoperative lumbar wound infection and bacteremia, successfully treated with ceftazidime-avibactam in combination with additional synergistic antibacterials and without hardware removal. Alan Bulbin, Carol Bono, Tena Philp, Noriel Mariano, and Carl Urban Copyright © 2017 Alan Bulbin et al. All rights reserved. A Case of Infective Endocarditis and Spinal Epidural Abscess Caused by Streptococcus mitis Bacteremia Tue, 05 Sep 2017 09:27:29 +0000 http://www.hindawi.com/journals/criid/2017/7289032/ A 57-year-old man presented with abdominal pain, hematemesis, and melena. He reported taking high-dose ibuprofen for back pain and drinking several 24-ounce beers daily. Examination was remarkable for icteric sclera, poor dentition, tachycardia, and crescendo-decrescendo murmur at right upper sternal border, radiating to the carotids. Labs revealed leukocytosis, anemia, thrombocytopenia, and elevated liver function tests and INR. Endoscopy demonstrated antral ulcers, duodenitis, and esophagitis. Blood cultures were obtained and broad-spectrum antibiotics started; cultures later grew Streptococcus mitis, and antibiotic coverage was narrowed. Transthoracic echocardiogram (TTE) demonstrated aortic stenosis and regurgitation, but no vegetation. Repeat blood cultures were negative; however, the patient developed neurological symptoms concerning for cauda equina syndrome, and MRI revealed epidural abscess. Emergent decompression could not be performed as the patient developed hematemesis and required intubation. Transesophageal echocardiogram (TEE), initially deferred due to friable esophageal mucosa, was performed and revealed small aortic valve vegetation. Poor oral hygiene was felt to be the probable source of the patient’s S. mitis bacteremia, epidural abscess, and infective endocarditis. The patient’s neurological symptoms resolved without intervention and remaining teeth were extracted. This case demonstrates that Streptococcus mitis can result in clinically significant bacteremia, particularly in immunocompromised patients, including chronic heavy alcohol users. Victoria S. Byrd and Attila S. Nemeth Copyright © 2017 Victoria S. Byrd and Attila S. Nemeth. All rights reserved. The First Reported Case of Majocchi’s Granuloma with Malbranchea sp. in an Immunocompetent Patient Wed, 30 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/9196528/ Majocchi’s granuloma is a rare condition in which a dermatophyte invades the deeper layers of the dermis and subcutaneous tissue and can often be misidentified and treated as eczema. It has a variable presentation ranging from cutaneous lesions to deeper infections in immunocompromised patients. No prior cases have described the formation of Majocchi’s granuloma with the deuteromycetes, Malabranchea. Anusha Govind, Nathan L’Etoile, and Gustavo Vasquez Copyright © 2017 Anusha Govind et al. All rights reserved. First Confirmed Case of Middle East Respiratory Syndrome Coronavirus Infection in the Kingdom of Bahrain: In a Saudi Gentleman after Cardiac Bypass Surgery Mon, 28 Aug 2017 07:03:47 +0000 http://www.hindawi.com/journals/criid/2017/1262838/ Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is well known to cause severe respiratory infection and was first reported in the Kingdom of Saudi Arabia in 2012. We report here the first confirmed MERS-CoV infection in the Kingdom of Bahrain in a Saudi gentleman who was admitted electively for coronary bypass surgery, postoperatively developed an acute respiratory illness, and tested positive for MERS-CoV. 40 close contacts, all healthcare workers, were traced and followed with no documented secondary cases. Nahed Seddiq, Manaf Al-Qahtani, Jaffar A. Al-Tawfiq, and Nazar Bukamal Copyright © 2017 Nahed Seddiq et al. All rights reserved. Streptococcus intermedius: An Unusual Case of Purulent Pericarditis Mon, 28 Aug 2017 06:34:32 +0000 http://www.hindawi.com/journals/criid/2017/5864694/ Purulent pericarditis is a rare diagnosis with life-threatening implications due to the rapid accumulation of pericardial material, swiftly progressing to tamponade physiology. The nature of its quickly evolving and severe implications demands a low threshold for diagnostic consideration where appropriate. We present an unusual case of purulent pericarditis secondary to Streptococcus intermedius in a previously healthy male adolescent without traditional risk factors, which raises the question of whether emergent S. intermedius species may have acquired novel molecular mechanisms. Kara J. Denby, Ryan D. Byrne, and Oscar G. Gómez-Duarte Copyright © 2017 Kara J. Denby et al. All rights reserved. Neurosyphilis with Concomitant Cryptococcal and Tuberculous Meningitis in a Patient with AIDS: Report of a Unique Case Sun, 27 Aug 2017 10:26:53 +0000 http://www.hindawi.com/journals/criid/2017/4103858/ Meningitis in individuals living with acquired immunodeficiency syndrome (AIDS) is most frequently infectious in origin and usually due to opportunistic infections. The most common pathogens are Cryptococcus neoformans and Mycobacterium tuberculosis. Treponema pallidum causes neurosyphilis and can complicate HIV infections at any time after the initial infection. Simultaneous infections of the central nervous system caused by these pathogens are very uncommon even in the setting of severe immunosuppression. We report the case of a newly diagnosed HIV/AIDS young man who was found to have neurosyphilis with Cryptococcus meningitis. After a few weeks of treatment and initiation of antiretroviral therapy, he was also diagnosed with tuberculous meningitis, which was probably unmasked by the development of immune reconstitution inflammatory syndrome (IRIS). To the best of our knowledge, this is the only case of reported neurosyphilis and meningitis caused concomitantly by Cryptococcus and Mycobacterium tuberculosis. Jose Armando Gonzales Zamora, Luis Alberto Espinoza, and Rita N. Nwanyanwu Copyright © 2017 Jose Armando Gonzales Zamora et al. All rights reserved. Transmission of Donor-Derived Trypanosoma cruzi and Subsequent Development of Chagas Disease in a Lung Transplant Recipient Mon, 21 Aug 2017 07:13:49 +0000 http://www.hindawi.com/journals/criid/2017/5381072/ Donor infection status should be considered when accepting an organ for transplant. Here we present a case of Chagas disease developing after a lung transplant where the donor was known to be Trypanosoma cruzi antibody positive. The recipient developed acute Trypanosoma cruzi infection with reactivation after treatment. Chagas disease-positive donors are likely to be encountered in the United States; donor targeted screening is needed to guide decisions regarding organ transplant and posttransplant monitoring. A. B. Corey, D. Sonetti, J. D. Maloney, S. P. Montgomery, B. L. Rademacher, L. J. Taylor, J. A. Smith, and R. Striker Copyright © 2017 A. B. Corey et al. All rights reserved. Pneumonia due to a Rare Pathogen: Achromobacter xylosoxidans, Subspecies denitrificans Tue, 15 Aug 2017 09:31:06 +0000 http://www.hindawi.com/journals/criid/2017/3969682/ Achromobacter xylosoxidans, subspecies denitrificans, is a gram-negative rod recently implicated as an emerging cause of infection in both immunosuppressed and immunocompetent populations. Few cases are reported in literature involving multiple body systems. Diagnosis depends on cultures of appropriate specimens, and management usually is by administration of appropriate antibiotics (usually agents with antipseudomonal activity). We report a rare case of pneumonia due to infection with this organism, in a patient with preexisting bronchiectasis secondary to chronic aspiration. Hesham Awadh, Munthir Mansour, Obadah Aqtash, and Yousef Shweihat Copyright © 2017 Hesham Awadh et al. All rights reserved. New Diagnosis of AIDS Based on Salmonella enterica subsp. I (enterica) Enteritidis (A) Meningitis in a Previously Immunocompetent Adult in the United States Mon, 14 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/1051975/ Salmonella meningitis is a rare manifestation of meningitis typically presenting in neonates and the elderly. This infection typically associates with foodborne outbreaks in developing nations and AIDS-endemic regions. We report a case of a 19-year-old male presenting with altered mental status after 3-day absence from work at a Wisconsin tourist area. He was febrile, tachycardic, and tachypneic with a GCS of 8. The patient was intubated and a presumptive diagnosis of meningitis was made. Treatment was initiated with ceftriaxone, vancomycin, acyclovir, dexamethasone, and fluid resuscitation. A lumbar puncture showed cloudy CSF with Gram negative rods. He was admitted to the ICU. CSF culture confirmed Salmonella enterica subsp. I (enterica) Enteritidis (A). Based on this finding, a 4th-generation HIV antibody/p24 antigen test was sent. When this returned positive, a CD4 count was obtained and showed 3 cells/mm3, confirming AIDS. The patient ultimately received 38 days of ceftriaxone, was placed on elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (Genvoya) for HIV/AIDS, and was discharged neurologically intact after a 44-day admission. Andrew C. Elton, James Levin, and Matthew P. Lazio Copyright © 2017 Andrew C. Elton et al. All rights reserved. Early Onset Prosthetic Joint Infection and Bacteremia due to Campylobacter fetus Subspecies fetus Tue, 08 Aug 2017 08:18:40 +0000 http://www.hindawi.com/journals/criid/2017/5892846/ Campylobacter fetus is a zoonotic pathogen that occasionally causes serious, relapsing, invasive disease, especially in immunocompromised hosts. We report a case of relapsing C. fetus diarrheal illness in a 75-year-old woman which resulted in secondary bacteremia and seeding of the left knee prosthetic joint. Patient responded favorably to debridement and retention of prosthesis in addition to six weeks of meropenem followed by chronic oral doxycycline suppressive therapy. Igor Dumic, Mohan Sengodan, Joni J. Franson, Diego Zea, and Poornima Ramanan Copyright © 2017 Igor Dumic et al. All rights reserved. Infectious Endocarditis from Enterococcus faecalis Associated with Tubular Adenoma of the Sigmoid Colon Mon, 07 Aug 2017 09:05:26 +0000 http://www.hindawi.com/journals/criid/2017/3095031/ Introduction. Enterococcus faecalis (E. faecalis), a constituent of the gut microbiota, can be associated with both colonic lesions and endocarditis. Since this microorganism is one of the endocarditis etiological agents, there is a need for greater study in regard to the association with endocarditis and colonic lesions. Case Presentation. This is the case description of a 53-year-old man with history of prolapse of the anterior mitral valve leaflet who was diagnosed with endocarditis by E. faecalis and treated with ampicillin and gentamicin. Upon investigation by colonoscopy, he was found to have a tubular adenoma with low grade dysplasia. Conclusion. There are a few descriptions in scientific literature of an association between endocarditis by E. faecalis and colonic lesions. However, further studies with significant correlation between the two pathologies are required, so that proper measures can be implemented in clinical practice. Emilly Caroline de Freitas Silva, Camila Ronchini Montalvão, and Simone Bonafé Copyright © 2017 Emilly Caroline de Freitas Silva et al. All rights reserved. Add-On Therapy with Ertapenem in Infections with Multidrug Resistant Gram-Negative Bacteria: Pediatric Experience Wed, 26 Jul 2017 08:26:27 +0000 http://www.hindawi.com/journals/criid/2017/8096420/ Optimal therapy for infections with carbapenem resistant GNB is not well established due to the weakness of data. Patients presenting with bloodstream infections caused by multidrug resistant Klebsiella pneumoniae were treated with a combination treatment. Optimal therapy for infections with carbapenem resistant Gram-negative bacteria is a serious problem in pediatric patients. We presented three cases who were successfully treated with addition of ertapenem to the combination treatment for bacteremia with multidrug resistant Klebsiella pneumoniae. Dual carbapenem treatment approach is a new approach for these infections and requires more data in children. Sevgen Tanır Basaranoglu, Yasemin Ozsurekci, Kubra Aykac, Kamile Oktay Arıkan, Ayse Buyukcam, Ali Bulent Cengiz, Mehmet Ceyhan, and Ates Kara Copyright © 2017 Sevgen Tanır Basaranoglu et al. All rights reserved. Reviewing the Emergence of Lactococcus garvieae: A Case of Catheter Associated Urinary Tract Infection Caused by Lactococcus garvieae and Escherichia coli Coinfection Mon, 24 Jul 2017 07:33:53 +0000 http://www.hindawi.com/journals/criid/2017/5921865/ Lactococcus garvieae is considered a low virulence organism which is rarely associated with human infections. Most of the reported cases have been associated with bacteremia with or without endocarditis. We report a rare case of catheter associated urinary tract infection (CAUTI) caused by Lactococcus garvieae and Escherichia coli coinfection without any bacteremia in a patient with indwelling urinary catheter placed for benign prostatic hyperplasia (BPH). The patient also had a history of gastroesophageal reflux disease (GERD) with long standing famotidine treatment. In our case, Lactococcus garvieae was initially misidentified as Enterococcus species but was later detected by automated microbial identification system VITEK-2 (BioMerieux, Marcy-l'Étoile, France) and was confirmed with API 32 Strep system (BioMerieux, Marcy-l'Étoile, France). The patient responded well to a two-week course of cephalosporin. Interestingly, apart from the acid suppressive treatment, no other risk factors were identified. Tatvam T. Choksi and Farhan Dadani Copyright © 2017 Tatvam T. Choksi and Farhan Dadani. All rights reserved. A Case of Fulminant Meningococcemia: It Is All in the Complement Thu, 20 Jul 2017 07:30:07 +0000 http://www.hindawi.com/journals/criid/2017/6093695/ Eculizumab is a novel monoclonal antibody that inhibits complement-mediated hemolysis in patients with paroxysmal nocturnal hemoglobinuria (PNH). Complement deficiency is a well-known risk factor for meningococcal infection. We describe a case of a young patient with PNH treated with eculizumab who presented with a life-threatening case of nongroupable meningococcemia. As this new biologic agent becomes more widely prescribed, providers should be aware of the increased risk of meningococcemia. In addition to vaccination, providers may consider the use of oral penicillin for antibiotic prophylaxis against Neisseria meningitidis in these cases of functional complement deficiency. Kellie L. Hawkins, Mariah Hoffman, Sonia Okuyama, and Sarah E. Rowan Copyright © 2017 Kellie L. Hawkins et al. All rights reserved. Fungal Bezoar: A Rare Cause of Ureteral Obstruction Wed, 19 Jul 2017 06:18:40 +0000 http://www.hindawi.com/journals/criid/2017/6454619/ A 52-year-old male, with diabetes mellitus and alcoholic liver disease, presented to the Emergency Room for right flank pain of 3 days’ duration, associated with dysuria. Physical examination revealed right flank tenderness with fever and hypotension; laboratory findings showed acute kidney injury and large blood and leucocytes in the urine. A CT abdomen and pelvis showed hydronephrosis of the right collecting system of a horseshoe kidney with air and hyperdense debris in the renal pelvis. Patient was treated for multisensitive Proteus mirabilis emphysematous pyelonephritis, and a right nephrostomy tube was inserted. Symptoms recurred in 4 weeks, and repeated urine culture grew Candida albicans and CT scan showed same high density material within the right moiety of the horseshoe kidney. Patient underwent ureteroscopy, and a white fluffy material was aspirated from the right renal pelvis. Pathology of the aspirate confirmed the presence of fungal balls. Patient was given 2 weeks of oral fluconazole. Fungal pyelonephritis is unusual and difficult to treat. Candida species is responsible for the clear majority of the cases. A fungus ball should be managed with surgical and medical therapy. This patient had an endoscopic procedure to remove the fungus ball and received fluconazole. His symptoms resolved and urine culture was done before termination of the treatment was negative. Nabil Zeineddine, Wissam Mansour, Sandy El Bitar, Marco Campitelli, and Neville Mobarakai Copyright © 2017 Nabil Zeineddine et al. All rights reserved. Imported Asymptomatic Bancroftian Filariasis Discovered from a Plasmodium vivax Infected Patient: A Case Report from Singapore Tue, 18 Jul 2017 08:47:44 +0000 http://www.hindawi.com/journals/criid/2017/1972587/ Human lymphatic filariasis is a vector-borne disease mainly caused by the parasitic nematode Wuchereria bancrofti and transmitted worldwide within the tropical and subtropical regions. Singapore was once endemic for bancroftian filariasis but recent reports are scarce and the disease is nearly forgotten. The case report presented here reports the incidental hospital laboratory finding of an asymptomatic microfilaremia in a relapsing Plasmodium vivax imported case during a malaria treatment follow-up appointment. The parasite was identified by microscopy as W. bancrofti and retrospective investigation of the sample collected during malaria onset was found to be also positive. Additional confirmation was obtained by DNA amplification, sequencing, and phylogenetic analysis of the mitochondrial cox1 gene that further related the parasite to W. bancrofti strains from the Indian region. Considering the large proportion of asymptomatic filariasis with microfilaremia, the high number of migrants and travellers arriving from the surrounding endemic countries, and the common presence of local competent mosquito vectors, Singapore remains vulnerable to the introduction, reemergence, and the spread of lymphatic filariasis. This report brings out from the shadow the potential risk of lymphatic filariasis in Singapore and could help to maintain awareness about this parasitic disease and its public health importance. Jean-Marc Chavatte and Roland Jureen Copyright © 2017 Jean-Marc Chavatte and Roland Jureen. All rights reserved. Pertussis Reinfection in an Adult: A Cause of Persistent Cough Not to Be Ignored Thu, 13 Jul 2017 08:05:31 +0000 http://www.hindawi.com/journals/criid/2017/4786141/ Pertussis is traditionally considered as a disease of the childhood; however, accumulating evidence suggests a stable increase of its incidence among adults and adolescents, during the last decades. Despite the fact that reinfection after natural disease or vaccination is not uncommon, the index of clinical suspicion of pertussis diagnosis in adults remains low. In this article, we report a case of pertussis reinfection 30 years after natural infection, which was complicated by pneumonia, and we discuss our diagnostic and therapeutic approach, aiming to raise clinicians’ degree of suspicion regarding pertussis diagnosis in adults. Prompt recognition and appropriate therapy of adult patients can result in the effective control of the symptoms, prevention of severe complications, and spread of the infection to children; thus, they are of great clinical and public health importance. Theocharis Koufakis, Anastasia Paschala, and Dimitrios Siapardanis Copyright © 2017 Theocharis Koufakis et al. All rights reserved. A Case of Strongyloidiasis: An Immigrant Healthcare Worker Presenting with Fatigue and Weight Loss Wed, 28 Jun 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/6718284/ Background. Strongyloides stercoralis is an intestinal nematode parasite classified as a soil-transmitted helminth, endemic in tropical and subtropical regions. Strongyloides stercoralis can remain dormant for decades after the initial infection. Case. We describe a patient who was diagnosed with Strongyloides stercoralis infection three weeks after a left inguinal hernia repair and discuss approaches to prevention, diagnosis, and treatment. Conclusions. Physicians in the United States often miss opportunities to identify patients with chronic strongyloidiasis. Symptoms may be vague and screening tests have limitations. We review current strategies for diagnosis and treatment of chronic intestinal strongyloidiasis in immigrant patients who have significant travel history to tropical regions and discuss the clinical features and management of the infection. Tarundeep Grewal, Heela Azizi, Alexa Kahn, Zaid Shakir, Sahar Takkouche, Khin N. Aung, William Lois, and Muhammad Hasan Copyright © 2017 Tarundeep Grewal et al. All rights reserved. Plesiomonas shigelloides: An Unusual Cause of Septic Abortion Sun, 28 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/9363707/ Plesiomonas shigelloides, the only oxidase-positive Enterobacteriaceae, is an inhabitant of freshwater and estuary ecosystems. We report the first possible case of Plesiomonas shigelloides-induced septic abortion. This 24-year-old female was successfully treated by dilatation and curettage as well as antimicrobial therapy. Gilbert Cornut, Xavier Marchand-Senecal, Christiane Gaudreau, Jeremie Berdugo, Gilles Gariepy, Catherine Tremblay, and Patrice Savard Copyright © 2017 Gilbert Cornut et al. All rights reserved. Invasive Mucormycosis Induced Pneumopericardium: A Rare Cause of Pneumopericardium in an Immunocompromised Patient Wed, 17 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/1424618/ Mucor and Rhizopus cause life-threatening infections primarily involving the lungs and sinuses, which disseminate very rapidly by necrosis and infarction of the contiguous tissues. We present a case of a 64-year-old African American posttransplant patient who presented with a productive cough and weight loss. He had a past surgical history of renal transplant for renal cell carcinoma and was on dual immunosuppressive therapy, that is, mycophenolate and tacrolimus. During his hospital stay, he developed a pneumopericardium due to the direct extension of a lung lesion. The diagnosis was made by radiological imaging and PCR result which was consistent with Mucor species. He was treated with antifungal therapy. The purpose of this report is to highlight the unusual association of mucormycosis with pneumopericardium. Sana Khan, Muhammad Waqar Elahi, Waqas Ullah, Hafez Mohammad Ammar Abdullah, Ejaz Ahmad, Mayar Al Mohajer, and Aneela Majeed Copyright © 2017 Sana Khan et al. All rights reserved. Necrotizing Pseudomonas aeruginosa Community-Acquired Pneumonia: A Case Report and Review of the Literature Wed, 17 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/1717492/ Lung cavities are not typically associated with community-acquired pneumonia (CAP). CAP due to P. aeruginosa is rare and even less commonly causes necrotizing pneumonia. We report a case of P. aeruginosa CAP that progressed to necrotizing pneumonia and was eventually fatal. Procalcitonin (PCT) has been well investigated in guiding antibiotic therapy (especially CAP) in adults. In this case, PCT at presentation and sequentially was negative. We discuss this caveat and present hypotheses as to the sensitivity and specificity of PCT and C-reactive protein (CRP) in these patients. To better characterize P. aeruginosa CAP, we undertook a review of cases indexed in PubMed from 2001 to 2016 (). The data reveal that risk factors for P. aeruginosa CAP include smoking, alcohol use, obstructive lung disease, sinusitis, and hot tub use. The route of infection for P. aeruginosa CAP remains unknown. One of the most interesting findings on reviewing cases was that P. aeruginosa CAP involves the right upper lobe in the vast majority. We suggest that when physicians in the community see patients with distinctly upper lobe necrotizing or cavitary pneumonia, they should consider P. aeruginosa in their differential diagnosis. Further studies are needed to clarify route of infection, role of PCT and CRP, and optimal therapy including drug and duration. Satish Maharaj, Carmen Isache, Karan Seegobin, Simone Chang, and Grant Nelson Copyright © 2017 Satish Maharaj et al. All rights reserved. Yokenella regensburgei Septicemia in a Chinese Farmer Immunosuppressed by HIV: A Case Report and Literature Review Tue, 16 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/5962463/ Yokenella regensburgei is a member in the family Enterobacteriaceae and a few cases have been reported in immunocompromised hosts. Herein, we described a case of septicemia in a human immunodeficiency virus (HIV) infected patient in South West China, which is the first reported case of Y. regensburgei infection in HIV-infected populations. We then reviewed the literature on all the reported cases of Y. regensburgei infection worldwide and presented some common features of them. Our case report and literature review will help increase the knowledge of the bacterium Y. regensburgei and its clinical implications. Xiangbo Chi, Min Liu, and Yaokai Chen Copyright © 2017 Xiangbo Chi et al. All rights reserved. Native Valve Endocarditis due to Veillonella Species: A Case Report and Review of the Literature Sun, 14 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/4896186/ Veillonella species are fastidious bacteria that have been isolated from skin, dental, and respiratory tract infections and rarely have been implicated in serious infections like meningitis, endocarditis, and osteomyelitis. A 76-year-old woman presented to our hospital with fever, vomiting, and generalized weakness for 3 days. A transthoracic echocardiogram showed a mobile structure on anterior mitral valve leaflet measuring 0.9 cm suggestive of vegetation. Empiric therapy with vancomycin and piperacillin-tazobactam was started with clinical resolution of her symptoms. On day 6, the blood culture drawn at admission grew Veillonella species. A transesophageal echocardiogram confirmed a 1.2 0.4 cm echo dense structure attached to the left ventricular side of the anterior mitral leaflet. The patient was discharged home after 10 days of inpatient antibiotic therapy and completed 4 weeks of IV ceftriaxone at home without any adverse events. She was reevaluated in the clinic after completion of treatment and repeat blood cultures remained negative. We report the first case of successful treatment of endocarditis due to Veillonella species with once daily ceftriaxone. Lakshmi Saladi, Cosmina Zeana, and Manisha Singh Copyright © 2017 Lakshmi Saladi et al. All rights reserved. Spontaneous Nosocomial Pseudomonas aeruginosa Meningitis Presenting as Trismus Mon, 08 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/8705860/ We describe the case of a 78-year-old female receiving adjuvant postsurgical chemotherapy for colon adenocarcinoma who spontaneously developed nosocomial Pseudomonas meningitis causing severe trismus. The patient was initially admitted for ileus, developing neck stiffness and trismus on the thirteenth day of admission. Cerebrospinal fluid grew pansensitive Pseudomonas aeruginosa. Magnetic resonance imaging of the brain was consistent with bilateral subacute infarcts secondary to meningitis. The patient responded well to 21 days of broad spectrum antimicrobial therapy modified to ceftazidime alone following speciation and sensitivity. Outpatient follow-up at 46 days revealed normal maximal mouth opening with the ability to chew and tolerate a full diet. Trismus is a motor disturbance of the trigeminal nerve with difficulty in opening the mouth. Infectious etiologies commonly described include tetanus, odontogenic infections, or deep neck space infections. This is the first reported case of simultaneous nosocomial Pseudomonas meningitis and trismus in a patient with no history of neurosurgery or lumbar spinal manipulation. C. J. Parr, J. Wheeler, A. Sharma, and C. Smith Copyright © 2017 C. J. Parr et al. All rights reserved. Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation Mon, 08 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/7074508/ Severe fulminant myocarditis causing cardiogenic shock can be a rapidly progressing, life threatening condition. Respiratory syncytial virus (RSV) is a very rare infectious culprit infrequently described in medical literature as a cause of myocarditis, particularly in adults. We present a case of acute fulminant myocarditis in a patient with PCR positive RSV infection requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). Anamaria Milas, Aditya Shah, Neesha Anand, Meghan Saunders-Kurban, and Samir Patel Copyright © 2017 Anamaria Milas et al. All rights reserved. Is It Necessary to Specifically Define the Cause of Surgically Treated Biliary Tract Infections? A Rare Case of Raoultella planticola Cholecystitis and Literature Review Sun, 07 May 2017 07:54:29 +0000 http://www.hindawi.com/journals/criid/2017/4181582/ Raoultella planticola is an aquatic and soil organism that does not notoriously cause invasive infections in humans. Infections in the literature are limited only in case reports. We present a very rare case of R. planticola cholecystitis. A 71-year-old female patient with abdominal pain was diagnosed with acute cholecystitis. Patient received intravenous antibiotic treatment, but the treatment failed and the patient underwent an open cholecystectomy. The final pathological result was gangrenous cholecystitis complicated with R. planticola. Eventually, the patient recovered with appropriate antimicrobial therapy. Patients with acute cholecystitis are usually treated without any microbiological sampling and antibiotic treatment is started empirically. To date, there have only been 5 reported biliary system related R. planticola infections in humans. We believe that Raoultella species might be a more frequent agent than usually thought, especially in resistant cholecystitis cases. Resistant strains should be considered as a possible causative organism when the patient’s condition worsened despite proper antimicrobial therapy. It should be considered safe to send microbiological samples for culture and specifically define the causative microorganisms even in the setting of a cholecystectomized patient. Suat Can Ulukent, İnanc Samil Sarici, Nuri Alper Sahbaz, Yigit Mehmet Ozgun, Ozlem Akca, and Kamuran Sanlı Copyright © 2017 Suat Can Ulukent et al. All rights reserved. A Case of Urinary Tract Infection and Severe Sepsis Caused by Kluyvera ascorbata in a 73-Year-Old Female with a Brief Literature Review Wed, 03 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criid/2017/3848963/ Infections that are caused by Kluyvera bacteria have been previously reported in the medical literature; however, they seem to be less common. Herein, we report a case of urinary tract infection and severe sepsis caused by Kluyvera ascorbata in a 73-year-old female. We also did a brief literature review of infections caused by this organism in adults. Majd Alfreijat Copyright © 2017 Majd Alfreijat. All rights reserved. Disseminated Mycobacterium chimaera Presenting as Vertebral Osteomyelitis Mon, 24 Apr 2017 09:28:25 +0000 http://www.hindawi.com/journals/criid/2017/9893743/ Mycobacterium chimaera, a member of the Mycobacterium avium complex, is a slow-growing, nontuberculous mycobacterium associated with outbreaks in cardiac-surgery patients supported on heart-lung machines. We report a case of an elderly woman on chronic prednisone who presented with a six-month history of worsening chronic back pain, recurrent low-grade fevers, and weight loss. Imaging identified multilevel vertebral osteomyelitis and lumbar soft-tissue abscess. Abscess culture identified M. chimaera. Daphne M. Moutsoglou, Frank Merritt, and Ethan Cumbler Copyright © 2017 Daphne M. Moutsoglou et al. All rights reserved.