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  • 1.

    【2hr】Respiratory Failure Associated with Ascariasis in a Patient with Immunodeficiency

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    机译 免疫功能低下患者的sis虫病引起的呼吸衰竭
    摘要：In industrialized countries, risk groups for parasitic diseases include travelers, recent immigrants, and patients with immunodeficiency following chemotherapy and radiotherapy and AIDS. A 66-year-old Polish male was admitted in December 2012 to the Department of Haematology in a fairly good general condition. On the basis of cytological, cytochemical, immunophenotypic, and cytogenetic analysis of bone marrow, the patient was diagnosed with acute myeloblastic leukemia. On the 7th day of hospitalization in the Department of Haematology, patient was moved to the Intensive Care Unit (ICU) due to acute respiratory and circulatory failure. In March 2013, 3 months after the onset of respiratory failures, a mature form of Ascaris spp. appeared in the patient's mouth. This report highlights the importance of considering an Ascaris infection in patients with low immunity presenting no eosinophilia but pulmonary failure in the central countries of Europe.
  • 2.

    【2hr】Surgical Management of Multiple Valve Endocarditis Associated with Dialysis Catheter

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    机译 透析导管相关的多瓣膜性心内膜炎的外科治疗
    摘要：Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for Staphylococcus aureus. Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients.
  • 3.

    【2hr】Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male

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    机译 一名40岁免疫功能正常男性的结核性脓胸
    摘要：Empyema necessitans (EN) is a kind of empyema that diffuses to extrapleural space and can involve chest pain. Tuberculosis (TB) is the most common cause of EN. This disease can be found in both immunocompromised and immunocompetent individuals but is usually seen in the immunocompromised individuals. Because of long duration and ambiguous symptoms of the disease, diagnosis can be hard. The disease can be treated both medically and surgically. Missing the disease can lead to undesirable effects on patient's condition and health care setting. This problem can be seen in endemic area in which controlling of TB is hard. Report of the disease in local health care center for desirable treatment and health maintenance is necessary. We explained a rare case of pulmonary TB in a patient that was healthy in other fields and just showed the minimum systemic symptoms. The patient came with a mass in lower part of back of chest cage, with a mild pain. The imaging survey showed EN. Smear and Ziehl-Neelsen stains from subcutaneous aspiration were positive for TB. This case showed importance of clinical view and awareness of this silent but serious disease in endemic area especially for TB.
  • 4.

    【2hr】Q Fever Risk in Patients Treated with Chronic Antitumor Necrosis Factor-Alpha Therapy

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    机译 慢性抗肿瘤坏死因子-α疗法治疗患者的Q发热风险
    摘要：Q fever is a zoonotic bacterial disease caused by Coxiella burnetii. Tumor necrosis factor-alpha (TNF-α) plays a pivotal role in the defense against infection with this Gram-negative coccobacillus. Theoretically, patients who are treated with anti-TNF-α medications are at risk for developing chronic Q fever. We present two patients who developed Q fever while being treated with anti-TNF-α agents and discuss the significance of timely diagnosis of C. burnetii infection in these patients.
  • 5.

    【2hr】A Case of Fluoroquinolone-Resistant Leprosy Discovered after 9 Years of Misdiagnosis

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    机译 误诊9年后发现耐氟喹诺酮类麻风病一例
    摘要：We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who, improperly treated, developed secondary mycobacterial resistance to fluoroquinolone. The patient contracted the infection 9 years prior to the current consultation, displaying on the right thigh a single papulonodular lesion, which progressively spread to the lower leg, back, and face. Initial administration of ciprofloxacin and prednisolone led to temporary and fluctuating improvement. Subsequent long-term self-medication with ciprofloxacin and corticosteroid did not heal the foul and nonhealing ulcers on the legs and under the right sole. Histopathological findings were compatible with lepromatous leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA A91V). After 6 months of standard regimen with rifampicin, clofazimine, and dapsone, clinical outcome significantly improved. Clinical characteristics and possible epidemiological implications are discussed.
  • 6.

    【2hr】Disseminated Cryptococcal Disease in a Patient with Chronic Lymphocytic Leukemia on Ibrutinib

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    机译 依鲁替尼治疗慢性淋巴细胞性白血病的隐球菌病
    摘要：Cryptococcus is a unique environmental fungus that can cause disease most often in immunocompromised individuals with defective cell-mediated immunity. Chronic lymphocytic leukemia (CLL) is not known to be a risk factor for cryptococcal disease although cases have been described mainly in patients treated with agents that suppress cell-mediated immunity. Ibrutinib is a new biologic agent used for treatment of CLL, mantle cell lymphoma, and Waldenstrom's macroglobulinemia. It acts by inhibiting Bruton's tyrosine kinase, a kinase downstream of the B-cell receptor critical for B-cell survival and proliferation. Ibrutinib use has not been associated previously with cryptococcal disease. However, recent evidence suggested that treatments aimed at blocking the function of Bruton's tyrosine kinase could pose a higher risk for cryptococcal infection in a mice model. Here, we report the first case of disseminated cryptococcal disease in a patient with CLL treated with ibrutinib. When evaluating possible infection in CLL patients receiving ibrutinib, cryptococcal disease, which could be life threatening if overlooked, could be considered.
  • 7.

    【2hr】Brucella Septic Arthritis: Case Reports and Review of the Literature

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    机译 布鲁氏菌败血症性关节炎：病例报告和文献复习
    摘要：Brucellosis is one of the commonest zoonotic infections worldwide. The disease is endemic in Saudi Arabia, the Middle East, and the Mediterranean area. Osteoarticular involvement is a frequent manifestation of brucellosis. It tends to involve the sacroiliac joints more commonly; however, spondylitis and peripheral arthritis are increasingly reported. Brucellosis can be overlooked especially in the presence of companion bacteria. Hence, it should be suspected in all patients with septic arthritis in endemic areas or in patients visiting such areas.
  • 8.

    【2hr】Chronic Leptomeningitis and Spinal Intradural Mass Secondary to Alternaria Infection in a Patient with Ventriculoperitoneal Shunt

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    机译 室腹膜分流患者继发性慢性肾小球炎和脊髓硬膜内肿块
    摘要：Fungal infection following placement of ventriculostomy or ventriculoperitoneal (VP) shunt is uncommon. We report the first case of Alternaria related central nervous system (CNS) shunt infection in a patient with CNS ependymoma manifesting as leptomeningitis and a spinal intradural mass. This case illustrates the diagnostic and management challenges.
  • 9.

    【2hr】Acute Pyelonephritis with Bacteremia Caused by Enterococcus hirae: A Rare Infection in Humans

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    机译 平肠肠球菌引起的急性细菌性肾盂肾炎：人类的罕见感染。
    摘要：Enterococci are one of the usual residents of the microflora in humans. In the last decade this genus has been reported as the third most common cause of bacteremia. We present the case of a 78-year-old female who was admitted to the emergency room because of nausea, lipothymia, and weakness. She was diagnosed with a pyelonephritis with bacteremia, with the isolation in blood and urine cultures of Escherichia coli and Enterococcus hirae. This last microorganism is a rarely isolated pathogen in humans. Currently it is estimated to represent 1–3% of all enterococcal species isolated in clinical practice.
  • 10.

    【2hr】Candida glabrata Pneumonia in a Patient with Chronic Obstructive Pulmonary Disease

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    机译 慢性阻塞性肺疾病患者的光滑念珠菌肺炎
    摘要：Pneumonia remains an important cause of morbidity and mortality among infectious diseases. Streptococcus pneumoniae and viruses are the most common cause of pneumonia. Candidiasis in such patients has been associated with haemodialysis, fungal colonization, exposure to broad-spectrum antibiotics, intensive care unit (ICU) hospitalization, and immunocompromised patients. The most common cause of infection is C. albicans. The case presented here is of a 66-year-old male patient diagnosed with C. glabrata. The patient suffered from chronic obstructive pulmonary disease.
  • 11.

    【2hr】Polymicrobial Pituitary Abscess Predominately Involving Escherichia coli in the Setting of an Apoplectic Pituitary Prolactinoma

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    机译 多发性垂体泌乳素瘤主要涉及大肠垂体催乳素瘤。
    摘要：Pituitary abscess is a rare intracranial infection that can be life-threatening if not appropriately diagnosed and treated upon presentation. The most common presenting symptoms include headache, anterior pituitary hypofunction, and visual field disturbances. Brain imaging with either computed tomography or magnetic resonance imaging usually reveals intra- or suprasellar lesion(s). Diagnosis is typically confirmed intra- or postoperatively when pathological analysis is done. Clinicians should immediately start empiric antibiotics and request a neurosurgical consult when pituitary abscess is suspected. Escherichia coli (E. coli) causing intracranial infections are not well understood and are uncommon in adults. We present an interesting case of an immunocompetent male with a history of hypogonadism presenting with worsening headache and acute right eye vision loss. He was found to have a polymicrobial pituitary abscess predominantly involving E.   coli in addition to Actinomyces odontolyticus and Prevotella melaninogenica in the setting of an apoplectic pituitary prolactinoma. The definitive etiology of this infection was not determined but an odontogenic process was suspected. A chronic third molar eruption and impaction in close proximity to the pituitary gland likely led to contiguous spread of opportunistic oral microorganisms allowing for a polymicrobial pituitary abscess formation.
  • 12.

    【2hr】Kawasaki Shock Syndrome in a 12-Year-Old Girl Mimicking Septic Shock

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    机译 模仿脓毒性休克的12岁女孩的川崎休克综合症
    摘要：Kawasaki disease is diagnosed when fever lasts for more than 5 days with the presence of four out of five of the following clinical features: bilateral conjunctival congestion, changes in the lips and oral cavity, polymorphous exanthem, changes in peripheral extremities, and acute nonpurulent cervical lymphadenopathy (Nakamura et al., 2012). The average age of onset is 2 years and 90% of patients are below 5 years of age. Boys are more affected than girls (Cox and Sallis, 2009). This case report describes an adolescent female who was initially managed as having septic shock and subsequently found to have Kawasaki shock syndrome.
  • 13.

    【2hr】Native Mitral Valve Endocarditis Caused by Neisseria elongata subsp. nitroreducens in a Patient with Marfan Syndrome: First Case in Italy and Review of the Literature

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    机译 由伸长的奈瑟氏球菌亚种引起的天然二尖瓣内膜炎。马凡综合症患者体内的硝酸还原酶：意大利首例病例及文献复习
    摘要：Neisseria elongata (NE) is an aerobic Gram-negative organism that constitutes part of the commensal human normal oropharyngeal flora. Although previously considered not to be pathogenic, it has been recognized as an occasional cause of significant infections in humans. We report here the first case in Italy of infective endocarditis of a native prolapsing mitral valve in a patient with Marfan syndrome, caused by NE subspecies nitroreducens which has been rarely isolated from clinical specimens. The culprit organism has been confirmed by mass spectrometry directly from the positive blood culture, as previously reported. The amplified gene has been deposited in GenBank under accession number . In spite of the reported aggressive nature of NE, clinical remission was promptly obtained, there being no requirement for surgery.
  • 14.

    【2hr】Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature

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    机译 在青霉素过敏的免疫受损患者中治疗继发性梅毒性骨炎的挑战：病例报告和文献复习
    摘要：Syphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present a case of a 36-year-old Caucasian gentleman with untreated HIV who complained of a skin eruption and joint pains for 6 weeks, prompting the diagnosis of secondary syphilis osteitis. Skin lesions were reminiscent of “malignant” syphilis. CD4 count was 57 cells/μL. RPR was elevated with 1 : 64 titer and positive confirmatory TP-PA. Radiography of the limbs revealed polyostotic cortical irregularities corroborated on bone scintigraphy. The patient had an unknown penicillin allergy and was unwilling to conduct a trial of penicillin-based therapy. He was subsequently treated with doxycycline 100 mg twice daily for 6 weeks and commenced antiretroviral therapy, noting dramatic improvement in both the skin lesions and joint pains. Unfortunately, he defaulted on follow-up, precluding serial RPR and bone imaging. Penicillin allergies have proven to be quite a conundrum in such patients, without much recourse for alternative therapy. Doxycycline with/without azithromycin is other options worth considering.
  • 15.

    【2hr】Bacteremia with an Unusual Pathogen: Mycobacterium neoaurum

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    机译 具有异常病原体的细菌血症：新分枝杆菌
    摘要：Mycobacterium neoaurum (M. neoaurum) is an infrequently encountered cause of infection in humans. It is a member of the rapidly growing mycobacteria family. It predominately afflicts those with a compromised immune status and a chronically indwelling vascular access. Isolation of this organism is challenging yet the advent of 16s ribosomal sequencing paved the way for more sensitive detection. No treatment guidelines are available and treatment largely depends on the experience of the treating physician and nature of the isolate. We report a case of M. neoaurum bacteremia in an immune competent host, with a chronically placed peripherally inserted central catheter (PICC line).
  • 16.

    【2hr】A Case of Acinetobacter Septic Pulmonary Embolism in an Infant

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    机译 一例婴儿不动杆菌败血症性肺栓塞
    摘要：Case Characteristics. An 11-month-old girl presented with fever and breathlessness for 5 days. Patient had respiratory distress with bilateral coarse crepitations. Chest radiograph revealed diffuse infiltrations in the right lung with thick walled cavities in mid and lower zone. Computed tomography showed multiple cystic spaces and emboli. Blood culture grew Acinetobacter species. Intervention. Patient was treated with Meropenem and Vancomycin. Outcome. Complete clinical and radiological recovery was seen in child. Message. Blood cultures and CT of the chest are invaluable in the evaluation of a patient with suspected septic pulmonary embolism. With early diagnosis and appropriate antimicrobial therapy, complete recovery can be expected in patients with septic pulmonary embolism.
  • 17.

    【2hr】Two Cases of Legionella pneumophila Pneumonia with Prolonged Neurologic Symptoms and Brain Hypoperfusion on Single-Photon Emission Computed Tomography

    包量

    机译 单光子发射计算机断层扫描显示2例伴有长期神经系统症状和脑灌注不足的肺炎军团菌肺炎
    摘要：Cerebral and cerebellar symptoms are frequently associated with Legionnaires' disease. However, corresponding brain lesions are difficult to demonstrate using either computed tomography (CT) or magnetic resonance imaging (MRI). We report here two patients with Legionella pneumophila pneumonia accompanied by prolonged neurologic symptoms. In contrast to brain CT and MRI, which failed to detect any abnormalities, single-photon emission computed tomography (SPECT) showed multiple sites of hypoperfusion within the brains of both patients. These cases suggest that vasculopathy, which is detectable by SPECT, might be one of the causes of neurologic symptoms in patients with Legionnaires' disease.
  • 18.

    【2hr】Ultrasonographic Diagnosis of Schistosoma mansoni Eggs in Rectum

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    机译 曼氏血吸虫卵在直肠中的超声诊断
    摘要：Schistosomiasis is a trematode infection endemic in more than 70 countries that affects an estimated 250 million people. We report the case of a 60-year-old healthy female referred for endoscopic ultrasound after rectal examination revealed granular lesions. Ultrasound revealed the presence of deep mucosal nodular lesions with calcified/hyperechoic inclusions. Histologic evaluation has confirmed the final diagnosis of chronic schistosomal colitis. In patients with nonspecific intestinal lesions without a suspected diagnosis of schistosomiasis, endoscopic ultrasound can be enlightening. Schistosomiasis is still an endemic infection in some parts of Brazil and other tropical regions, causing colorectal lesions with unspecific presentation.
  • 19.

    【2hr】Tuberculosis of the Breast: An Initial Presentation of the Metabolic Syndrome with Type 2 Diabetes Mellitus in a Young Nigerian Woman

    包量

    机译 乳房结核：尼日利亚年轻女性的2型糖尿病代谢综合征的初步表现。
    摘要：Breast tuberculosis is an uncommon presentation of extra pulmonary tuberculosis. A 40-year-old obese woman presented with a right breast abscess which had failed to heal after surgical drainage. There was no family history of breast disease. Biopsy and histology of the lesion showed chronic granulomatous inflammation with positive stains for acid fast bacilli compatible with tuberculosis. Further evaluation confirmed metabolic syndrome with type 2 diabetes mellitus. She was placed on antituberculosis chemotherapy and appropriate therapy for diabetes mellitus with complete resolution of the lesion. We report this case because of its rarity and to highlight the association between tuberculosis an infectious disease and overnutrition in diabetes mellitus, a noncommunicable disease.
  • 20.

    【2hr】Fatal Dengue Myocarditis despite the Use of Extracorporeal Membrane Oxygenation

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    机译 尽管使用了体外膜氧合致死性登革热心肌炎
    摘要：Dengue is an important mosquitoes-borne viral disease which is endemic in tropics and subtropics region. Rapid spreading of disease to previously unaffected region was found in recent years. Atypical manifestations, such as myocarditis, were reported during large outbreak. There is a wide range of clinical manifestations of cardiac involvement in dengue, but rarely fatal. Here we reported a case of fulminant dengue myocarditis in fatal outcome despite cardiac mechanical support.
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