Case Report: Management of Acanthamoeba Rhinosinusitis in a Patient with Chronic Lymphocytic Leukemia.

Infections caused by free-living amoebae pose a significant public health threat owing to growing populations of immunocompromised hosts combined with diagnostic delays, treatment difficulties, and high case fatality rates. Nasopharyngeal infections caused by Acanthamoeba are rare and the optimal treatment is not well established. We report a case of Acanthamoeba rhinosinusitis in a patient with chronic lymphocytic leukemia who presented with headaches and chronic rhinosinusitis refractory to multiple courses of antibiotics. A diagnosis of Acanthamoeba rhinosinusitis was established through broad-range polymerase chain reaction testing on sinus tissue. The patient had a favorable response to treatment, which included surgical debridement, cessation of immunosuppressants, and a three-drug regimen consisting of miltefosine, fluconazole, and sulfadiazine.

Roseomonas Species Bacteremia With Associated Endocarditis and Possible CNS Septic Embolic Phenomenon.

Rosemonas species has been associated with infections in both immunocompetent and immunocompromised hosts, manifesting as peritonitis, bacteremia, catheter-related bacteremia, endophthalmitis, spondylitis, and endocarditis. Here we present a man in his 60s who was brought to our institution for sudden onset of aphasia, right-sided paresthesia, and new onset tonic-clonic seizure episodes. At presentation, he was found to have severe lactic acidosis, acute kidney failure, bilateral hydronephrosis, elevated prostate-specific antigen (PSA), and an enlarged prostate. Blood cultures obtained on admission later grew Roseomonas species for which he was started on meropenem. A trans-esophageal echocardiogram (TEE) showed multiple very thin mobile densities on the ventricular side of the aortic valve; magnetic resonance imaging (MRI) of the brain revealed an 11 mm acute/subacute hemorrhage. The patient was discharged in stable condition on Ertapenem intravenous therapy for six weeks. Roseomonas mucosa can be a cause of endocarditis. The antimicrobial resistance profile of Roseomonas spp suggests that carbapenems, fluoroquinolones or aminoglycosides are the drugs of choice for Roseomonas infections and that infectious diseases involved in cases of Roseomonas infections should be instituted promptly for proper management.

Cryptococcosis.

Cryptococcosis is an invasive fungal infection of global significance caused by yeasts of the genus Cryptococcus. The prevalence of HIV in certain areas of the world and the expanding population of immunocompromised patients contribute to the ongoing global disease burden. Point-of-care serologic testing has allowed for more rapid diagnosis and implementation of screening programs in resource-limited settings. Management involves therapy aimed at reduction in fungal burden, maintenance of intracranial pressure, and optimization of host immunity. Despite diagnostic and therapeutic advances, cryptococcosis continues to be a disease with unacceptably high incidence and mortality, particularly in resource-limited settings.

Evolution of Nipah Virus Infection: Past, Present, and Future Considerations.

Nipah virus (NiV) is a zoonotic paramyxovirus of the Henipavirus genus first identified in Malaysia in 1998. Henipaviruses have bat reservoir hosts and have been isolated from fruit bats found across Oceania, Asia, and Africa. Bat-to-human transmission is thought to be the primary mode of human NiV infection, although multiple intermediate hosts are described. Human infections with NiV were originally described as a syndrome of fever and rapid neurological decline following contact with swine. More recent outbreaks describe a syndrome with prominent respiratory symptoms and human-to-human transmission. Nearly annual outbreaks have been described since 1998 with case fatality rates reaching greater than 90%. The ubiquitous nature of the reservoir host, increasing deforestation, multiple mode of transmission, high case fatality rate, and lack of effective therapy or vaccines make NiV's pandemic potential increasingly significant. Here we review the epidemiology and microbiology of NiV as well as the therapeutic agents and vaccines in development.