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  • 1.

    【2hr】Prepatellar Bursal Infection Caused by Mycobacterium tuberculosis with an In Situ Total Knee Arthroplasty: A Case Report and Comprehensive Literature Review

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    机译 结核分枝杆菌伴原位全膝关节置换术引起的pat骨前囊感染：一例报道及综合文献复习
    摘要：Prepatellar bursal infection is a rare occurrence. The incidence of tuberculosis, including musculoskeletal type, is increasing. We present a case of isolated prepatellar bursal swelling associated with a discharging sinus; the condition developed in an elderly patient 4 years after total knee arthroplasty. Aspiration of the bursa revealed acid-fast bacilli on Ziehl–Neelsen staining, typical of Mycobacterium tuberculosis; this was confirmed later on culture. The patient was successfully treated with a 6-month course of antituberculous chemotherapy. To the best of our knowledge, only two previous cases of tuberculous prepatellar bursal infection have been reported in English literature. Our case illustrates the importance of considering tuberculous prepatellar bursal infection in the differential diagnosis of anterior knee swelling. All physicians treating patients with musculoskeletal disease should be aware of the possibility of this diagnosis and maintain a high index of suspicion; this is especially true in areas where tuberculosis is still endemic and in high-risk patients, such as the elderly.
  • 2.

    【2hr】Cerebellar Neurocysticercosis as Long-Term Complication of Allogeneic Haematopoietic Stem Cell Transplantation from Haploidentical Donor

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    机译 小脑神经囊虫病作为单倍体供体的同种异体造血干细胞移植的长期并发症。
    摘要：Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is uncommon in developed countries. We report a case of allogeneic haematopoietic stem cell transplantation from a haploidentical donor complicated, in the long term, by T. solium infection of the central nervous system and successfully treated with empiric antiparasitic therapy with albendazole plus dexamethasone. Revised diagnostic criteria proposed by Del Brutto et al. were used for the definitive diagnosis of cerebellar neurocysticercosis.
  • 3.

    【2hr】First Case of Esophagitis Dissecans Superficialis in an HIV Patient: A Case Report and Literature Review

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    机译 艾滋病毒患者中的第一例食管分离性食管炎：病例报告和文献复习
    摘要：Esophagitis dissecans superficialis (EDS), a rare desquamative esophageal disease of uncertain etiology, is characterized by sloughing of fragments of esophageal mucosa. To the best of our knowledge, there has been no reported case of EDS in an HIV-infected patient. We report the first case of EDS in an adult HIV-infected male, who was hospitalized due to dysphagia. Esophagogastroscopy was performed, and the endoscopic findings together with the histopathologic findings of esophageal tissues were consistent with EDS. However, his symptom of dysphagia was not explained by EDS, but was the early symptoms of muscle-specific kinase (MuSK) myasthenia gravis (MG) that we finally diagnosed later by progression of the symptoms and electrophysiologic study. His symptoms had gradually improved after a course of intravenous immunoglobulin treatment. This is the first case of EDS and MuSK myasthenia gravis in an HIV-infected patient. A high index of suspicion of EDS should be made when taking care of the patients with desquamative or sloughing esophagitis especially with unknown etiology.
  • 4.

    【2hr】Community-Acquired Pneumonia due to Streptococcus pneumoniae: When to Consider Coinfection with Active Pulmonary Tuberculosis

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    机译 肺炎链球菌引起的社区获得性肺炎：何时考虑合并活动性肺结核
    • 作者：Ruslan Garcia
    • 刊名：Case Reports in Infectious Diseases
    • 2019年第期
    摘要：Community-acquired pneumonia (CAP) is an important cause of hospitalizations in adults. In the United States, Streptococcus pneumoniae is the most frequently identified bacterial pathogen responsible for CAP. Other etiologic pathogens of CAP vary based on the geographic region. Mycobacterium tuberculosis is an uncommon cause of CAP in the United States, while it is a principal cause in many African and Asian countries. Coinfection with Streptococcus pneumoniae and Mycobacterium tuberculosis is rare and has only been reported in the setting of underlying HIV infection in areas of high tuberculosis prevalence. Here, we report a case of CAP in the absence of HIV, where Streptococcus pneumoniae was identified on admission and delay in diagnosis of concomitant active pulmonary tuberculosis led to inappropriate isolation. In addition to a high index of suspicion, epidemiologic and radiographic findings can be helpful to recognize tuberculosis as a cause of CAP even when other pathogens have already been identified.
  • 5.

    【2hr】Empyema Necessitans due to Interruption of Antituberculosis Treatment

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    机译 因抗结核治疗中断而引起脓胸
    摘要：Empyema necessitans is a rare presentation of tuberculous infection, commonly encountered in immunocompromised patients. The diagnosis can be challenging due to the paucibacillary nature of the condition and nonspecific symptoms. Identifying the organism in culture is the gold standard method of diagnosis. We describe a patient with chronic kidney disease, who developed empyema necessitans due to interruption of antituberculous therapy. Initially, he was started on antituberculous therapy based on a clinical diagnosis of smear-negative pulmonary tuberculous infection; this resulted in Stevens–Johnson syndrome needing a long course of steroid therapy. He later presented with a painful chest lump and was diagnosed as empyema necessitans. Finding the etiology for this rare presentation lead to a diagnostic dilemma, finally confirming the TB infection from the culture. This case highlights the importance of being aware of unusual complications of tuberculous infection in immunocompromised settings.
  • 6.

    【2hr】Descending Thoracic Aortic Aneurysm due to Brucella melitensis

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    机译 布鲁氏菌引起的胸主动脉下降
    摘要：Brucellosis is an endemic infection mainly in the Middle East and the Mediterranean region that can involve any system. However, cardiovascular involvement commonly seen as endocarditis is a rare occurrence, but it is one of the main causes of mortality and morbidity. Brucella mycotic aneurysms are extremely rare and carry a higher morbidity and mortality. Here, we present a case of Brucella mycotic aneurysms in the descending aorta complicated by an aortoesophageal fistula in a 52-year-old diabetic man. The diagnosis was made by thoracic CT angiogram showing a saccular aneurysm arising from the descending aorta and two positive cultures of Brucella melitensis. Transthoracic and transesophageal echocardiograms ruled out infective endocarditis. Aortoesophageal fistula complicating a Brucella mycotic aneurysm in the absence of evidence of endocarditis has not yet been reported in the literature.
  • 7.

    【2hr】Native Valve Infective Endocarditis with Osteomyelitis and Brain Abscess Caused by Granulicatella adiacens with Literature Review

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    机译 原发性粒细胞增多症引起的天然瓣膜感染性心内膜炎合并骨髓炎和脑脓肿的文献复习
    摘要：Granulicatella adiacens is a type of NVS (nutritionally variant streptococci) rarely causing infective endocarditis (IE). NVS are fastidious and unable to sustain growth on routine culture media due to lack of specific nutrients. Endocarditis caused by NVS due to their virulence is associated with higher treatment failures and mortality rates. New antimicrobial susceptibility patterns are indicative of a significant rise in penicillin resistance and susceptibility differences between NVS subspecies. Initial empirical therapy is essential as a delay in using the appropriate agent leads to poor results. We present a case of an immunocompetent young female with recent intravenous drug abuse resulting in native mitral valve endocarditis with ruptured chordae tendineae and septic embolization, causing brain abscess and lumbar spine osteomyelitis. She was transferred to a tertiary center where she underwent mitral valve replacement successfully and treated with six weeks of intravenous vancomycin and ertapenem. To our knowledge, ours is the first case report of G. adiacens endocarditis in an adult with brain abscess and osteomyelitis with an excellent response to antibiotic therapy. Based on our case report, literature review, and new antimicrobial susceptibility patterns, updates to treatment guidelines are suggested to improve the therapeutic outcomes.
  • 8.

    【2hr】Granulicatella adiacens and Abiotrophia defectiva Native Vertebral Osteomyelitis: Three Cases and Literature Review of Clinical Characteristics and Treatment Approach

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    机译 重症无性菌和缺铁营养缺陷型原生椎体骨髓炎：三例临床特征及治疗方法文献复习
    摘要：Granulicatella adiacens and Abiotrophia defectiva are an increasingly recognized cause of osteoarticular infections. We describe two cases of G. adiacens and one case of A. defectiva native vertebral osteomyelitis (NVO) and review all published cases. Nine cases of G. adiacens NVO and two cases of A. defectiva NVO were previously described. Patients were usually middle-aged men, and classical risk factors for NVO were present in half of the cases. Concomitant bacteremia was reported in 78.6% of cases, and concurrent infective endocarditis occurred in 36.4% of this sub-group of patients. Many different antibiotic schemes were recorded, with median treatment duration of 6 weeks. In the most recent reports, glycopeptides represented the most frequent empirical therapy, possibly due to the increasing emergence of G. adiacens and A. defectiva penicillin-resistant strains. Stabilization surgery was rarely required (14.3% of cases), and clinical cure was generally achieved. In conclusion, Granulicatella spp. and Abiotrophia spp. NVO is rare but increasingly described. A total antibiotic course of six weeks seems to be appropriate for noncomplicated cases, and clinical outcome is generally favorable.
  • 9.

    【2hr】Pulmonary Infections Caused by Emerging Pathogenic Species of Nocardia

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    机译 诺卡氏菌病原菌引起的肺部感染
    摘要：Pulmonary infections are the most common clinical manifestations of Nocardia species. There is an increase in cases of nocardial infections occurring worldwide attributable to the increase in the immunosuppressed population. The availability of molecular methods has aided the detection of more number of cases as well as unusual species. Still, it remains one of the most underdiagnosed pathogens. Recognition of drug resistance in this organism has now mandated early and precise identification with speciation for effective treatment and management. Nocardial species identity can predict antimicrobial susceptibility and guide clinical management. Here, we report two cases of pulmonary nocardiosis caused by unusual species of Nocardia, namely, N. cyriacigeorgica and N. beijingensis identified by 16S rRNA gene-based sequencing. These cases are being reported for their rarity.
  • 10.

    【2hr】Cervical Spinal Osteomyelitis with Epidural Abscess following an Escherichia coli Urinary Tract Infection in an Immunocompetent Host

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    机译 免疫性宿主中大肠杆菌尿路感染后伴硬膜外脓肿的颈脊髓型脊髓炎
    摘要：Spinal epidural abscess (SEA) is uncommon with an incidence reported as 0.33–1.96 abscesses per 10,000 hospital admissions per year. Two-thirds of the cases were caused by Staphylococcus aureus. Escherichia coli (E. coli) is a less common cause of SEA, and it is usually after urinary tract infection in patient with preexisting risk factor. A 69-year-old male with a past medical history significant for prostatitis was admitted with fever, altered mental status, neck pain, progressive lower extremities weakness, and frequent falls for 7 days. Both blood and urine cultures grew E. coli. Lumbar puncture showed 94 RBCs, 24 WBCs (16% neutrophils and 46% lymphocytes), and elevated protein level at 1140 mg/dl with no bacteria. C-spine MRI showed epidural abscess along the anterior and right lateral margin of the cord causing cord compression from C5 through C7, anterior perivertebral abscess from C4 through T2, marrow edema involving C6 and C7 vertebral bodies with increased signal in the intervertebral disc space at C6-C7, and consistent with osteomyelitis and discitis. Anterior cervical decompression with evacuation of anterior epidural abscess with fusion was done. The culture from the epidural abscess grew E coli. A diagnosis of SEA should be considered in patients presenting with progressive weakness and neurological deficits following UTI and is to be confirmed by MRI. E. coli could be the culprit for epidural abscess and spine osteomyelitis even in immunocompetent patients.
  • 11.

    【2hr】Pylephlebitis: A Case of Inferior Mesenteric Vein Thrombophlebitis in a Patient with Acute Sigmoid Diverticulitis—A Case Report and Clinical Management Review

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    机译 肾盂静脉炎：急性乙状结肠憩室炎患者的肠系膜下静脉血栓性静脉炎一例—病例报告和临床管理回顾
    摘要：Pylephlebitis is a rare complication of intra-abdominal infections and describes thrombosis and infection as two different pathophysiological phenomena in the cause of this disease. The nonspecific presentation of disease makes its diagnosis difficult and thus leads to high mortality. The treatment comprises antibiotics and also includes controversial use of anticoagulation in these patients. Here, we present a patient with past medical history of human immunodeficiency virus and past diverticulitis who presented with fever, chills, diarrhea, neck pain, and photophobia. He was diagnosed with acute sigmoid diverticulitis with associated inferior mesenteric vein thrombophlebitis. He improved after intravenous antibiotics and anticoagulation and was discharged. He underwent sigmoid colectomy 3 months after his initial presentation and was advised to take anticoagulation for a total of 6 months.
  • 12.

    【2hr】Chronic Q Fever with Vascular Involvement: Progressive Abdominal Pain in a Patient with Aortic Aneurysm Repair in the United States

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    机译 慢性Q热与血管介入：在美国主动脉瘤修复患者的进行性腹痛。
    摘要：Q fever is a zoonotic bacterial infection caused by Coxiella burnetii. Chronic Q fever comprises less than five percent of all Q fever cases and, of those, endocarditis is the most common presentation (up to 78% of cases), followed by vascular involvement. Risk factors for chronic Q fever with vascular involvement include previous vascular surgery, preexisting valvular defects, aneurysms, and vascular prostheses. The most common symptoms of chronic Q fever with vascular involvement are nonspecific, including weight loss, fatigue, and abdominal pain. Criteria for diagnosis of chronic Q fever include clinical evidence of infection and laboratory criteria (antibody detection, detection of Coxiella burnetii DNA, or growth in culture). Treatment of chronic Q fever with vascular involvement includes a prolonged course of doxycycline and hydroxychloroquine (≥18 months) as well as early surgical intervention, which has been shown to improve survival. Mortality is high in untreated chronic Q fever. We report a case of chronic Q fever with vascular involvement in a 77-year-old man with prior infrarenal aortic aneurysm repair, who lived near a livestock farm in the southeastern United States.
  • 13.

    【2hr】Endocarditis following Consumption of Cereal Associated with Salmonella enterica Subtype Mbandaka Outbreak

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    机译 食用沙门氏菌沙门氏菌Mbandaka暴发相关谷物后的心内膜炎
    摘要：A 69-year-old immunocompromised man developed mitral valve endocarditis due to Salmonella enterica serotype Mbandaka, contracted from the cereal outbreak. The patient had a history of HLA-matched related hematopoietic stem cell transplant with persistent graft-versus-host disease (GVHD). This case report discusses prior international outbreaks that occurred due to Salmonella enterica subtype Mbandaka, the risks of developing endovascular infections from salmonellosis, and persistent infections that may develop more frequently with S. enterica serotype Mbandaka. The patient received a six-week course of intravenous antibiotics and remains on oral suppressive antibiotics, with his length of therapy to be determined based on his GVHD treatment.
  • 14.

    【2hr】A Case Study of Stevens–Johnson Syndrome-Toxic Epidermal Necrolysis (SJS-TEN) Overlap in Mycoplasma pneumoniae-Associated Tracheobronchitis

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    机译 史蒂文斯-约翰逊综合征中毒表皮坏死症（SJS-TEN）重叠在肺炎支原体相关气管支气管炎中的病例研究
    摘要：Stevens–Johnson syndrome is a medical emergency which is characterized by skin and mucosal reaction to the use of certain drugs. Atypical Steven–Johnson syndrome can occur due to various microorganisms and Mycoplasma pneumoniae being one of them. We present a clinical course, diagnosis, and successful management of Steven–Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap due to Mycoplasma pneumoniae in a 17-year-old Nepalese female. In the resource-limiting country and hospitals where serology and PCR for M. pneumoniae is not easily accessible, a simple bedside cold agglutination test can be done to increase the suspicion of infectious cause (most common M. pneumoniae ) of SJS-TEN overlap. M. pneumoniae infection should be considered in all cases of mucositis, especially in patients having preceding respiratory tract infections (tracheobronchitis).
  • 15.

    【2hr】Successful Clearance of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia with Daptomycin, Linezolid, and Meropenem Salvage Therapy

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    机译 达托霉素，利奈唑胺和美罗培南挽救疗法成功清除了耐甲氧西林金黄色葡萄球菌细菌血症
    摘要：Staphylococcus aureus is one of the most virulent Gram-positive organisms responsible for a multitude of infections, including bacteremia. Methicillin-resistant Staphylococcus aureus (MRSA) is of special concern in patients with bacteremia. Due to its associated poor clinical outcomes, morbidity, and mortality, the superlative salvage regimen for persistent MRSA bacteremia remains uncertain. An 85-year-old white female presented with persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Empiric antibiotic therapy with linezolid was initiated prior to blood culture results. Once MRSA bacteremia was confirmed, alternative antibiotic therapy with daptomycin was initiated. Blood cultures remained positive for MRSA despite three days of daptomycin therapy after which ceftaroline was added to the antibiotic regimen. Blood cultures remained positive for MRSA despite seven days of combination therapy with daptomycin and ceftaroline. Salvage therapy was then initiated with daptomycin, linezolid, and meropenem. One day following initiation of salvage therapy, blood cultures revealed no bacterial growth for the remainder of the length of stay. This report supports the effectiveness of salvage therapy consisting of daptomycin, linezolid, and meropenem in patients with persistent MRSA bacteremia.
  • 16.

    【2hr】Primary Pyomyositis: Contact Sports as the Rare Risk Factors

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    机译 原发性脓性肌炎：接触运动是罕见的危险因素
    摘要：Primary pyomyositis is an infectious disorder that mostly involves children and adults. Direct injury to the muscle or any traumatic process that can cause bacteremia has been described as the common risk factor. Contact sports without direct contusion or injury to the muscle is an uncommon culprit for the manifestation of this disease. In our case, a young male athlete presented to the emergency room with vague signs and symptoms including right leg muscle pain and fever. He denied any direct injury or contusion of the muscle. CT scan was done and showed edematous gluteus minimus muscle. MRI as one of the best tools for investigating soft tissues was done and exhibited myositis. Blood culture became positive for the methicillin-susceptible Staphylococcus aureus. Appropriate antibiotics were started, and the patient condition was improved. Considering prominent risk factors, early diagnosis and treatment of pyomyositis are major key factors for the management of these infectious conditions as it may cause loss of the limb or even result in mortality.
  • 17.

    【2hr】Bilateral Sensorineural Deafness in a Young Pregnant Female Presenting with a Fever: A Rare Complication of a Reemerging Disease—Spotted Fever Group Rickettsioses

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    机译 一名年轻女性发烧的双侧双感性神经性耳聋：一种新出现的疾病的罕见并发症-发烧组立克次体病
    摘要：Background Rickettsial illnesses are a group of arthropod-borne remerging diseases. They are subdivided into three groups as typhus, spotted fever, and scrub typhus group. Complications such as reversible bilateral deafness due to spotted fever rickettsioses are infrequently reported in the literature.
  • 18.

    【2hr】Emerging Fungal Infections in the Era of Antibiotic Stewardship

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    机译 抗生素管理时代的真菌感染
    摘要：Pneumonia is one of the most common causes of infection seen worldwide and still remains one of the most common causes of mortality despite significant advancements in medicine. With the increase in immunosuppression and antimicrobial usage, emerging infectious agents have been isolated in patients with pneumonia. The authors present a case in which Nonomuraea solani, Candida glabrata, and Candida dubliniensis were isolated from a bronchoalveolar lavage from an immunosuppressed patient with pneumonia.
  • 19.

    【2hr】Fatal Infection Caused by Chromobacterium violaceum: A Case Report from a Tertiary Care Hospital in Bangladesh

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    机译 紫色杆菌引起的致命感染：孟加拉国三级医院的一例病例报告
    摘要：Chromobacterium violaceum is a Gram-negative bacterium, found in tropical and subtropical regions. C. violaceum infection rarely occurs, but once occurs, it is associated with significant mortality due to severe systemic infection. Since the first human case from Malaysia in 1927, >150 cases of C. violaceum infection have been reported worldwide. We have described here a fatal case of C. violaceum infection in a tertiary care hospital in Dhaka, Bangladesh. To the best of our knowledge, this is the first case of C. violaceum infection in Bangladesh.
  • 20.

    【2hr】A Case of Polymicrobial, Gram-Negative Pulmonic Valve Endocarditis

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    机译 一例多菌性革兰氏阴性肺动脉瓣性心内膜炎
    摘要：Infective endocarditis due to Gram-negative, non-HACEK bacteria is a rare clinical entity. Even moreso, isolated pulmonic valve endocarditis accounts for less than 1.5–2% of all cases of infective endocarditis. These disease pathologies commonly occur in the setting of intravenous drug abuse, indwelling catheters or cardiac devices, or underlying structural heart disease. We present a unique case of pulmonic valve endocarditis in the setting of persistent polymicrobial bacteremia with Klebsiella pneumoniae and Citrobacter koseri with recent gastrointestinal instrumentation evolving into isolated pulmonic valve endocarditis.
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