RESUMO
A previously healthy 10-year-old girl, living in a sheep-farming community in South Africa with exposure to dogs, presented to her local hospital with generalised tonic-clonic seizures. The initial clinical assessment and laboratory work-up were unremarkable. When she presented with further seizures 6 months later, attempts to arrange neuroimaging and specialist assessment were unsuccessful owing to restrictions on routine healthcare services during the SARS-CoV-2 nationwide lockdown. Subsequently, 11 months after her first presentation, she developed focal neurological signs suggestive of raised intracranial pressure. A brain computed tomography scan revealed a left-sided cerebral cyst and imminent tonsillar herniation. An emergency burr-hole procedure was performed to relieve the raised intracranial pressure, followed by definitive neurosurgical excision of cysts. Hydatid protoscolices and hooklets were seen on microscopy of cyst fluid, and treatment with albendazole and praziquantel was initiated. While her infection was treated successfully, long-term sequelae including permanent blindness and hemiparesis could potentially have been prevented with early neuroimaging and surgical intervention.
Assuntos
Anticestoides/administração & dosagem , Encefalopatias/diagnóstico , COVID-19 , Equinococose/diagnóstico , Albendazol/administração & dosagem , Encefalopatias/tratamento farmacológico , Encefalopatias/parasitologia , Criança , Diagnóstico Tardio , Equinococose/tratamento farmacológico , Feminino , Humanos , Hipertensão Intracraniana/parasitologia , Praziquantel/administração & dosagem , Convulsões/parasitologia , África do Sul , Tomografia Computadorizada por Raios XAssuntos
Técnicas de Laboratório Clínico/métodos , Busca de Comunicante/métodos , Infecções por Coronavirus/diagnóstico , Programas de Rastreamento/métodos , Pneumonia Viral/diagnóstico , Algoritmos , Betacoronavirus , COVID-19 , Teste para COVID-19 , Monitoramento Epidemiológico , Humanos , Pandemias , Valor Preditivo dos Testes , SARS-CoV-2 , Sensibilidade e Especificidade , África do SulAssuntos
Pacientes Ambulatoriais , Infecções Respiratórias/microbiologia , Escarro/microbiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , África do SulRESUMO
A 34-year-old HIV-positive man with a history of chronic substance abuse was admitted with dual infection of Streptococcus pneumoniae and Listeria monocytogenes. Combined bacteraemia with S. pneumoniae and L. monocytogenes is very rare. To the best of our knowledge, this is the first such case documented at our institution and in South Africa. Ampicillin should be added to antibiotic regimens to improve patient outcome if L. monocytogenes infection is suspected. Co-infections that occur with L. monocytogenes may have conflicting antibiotic treatment options. This case report emphasises the need for a good relationship between the local microbiology pathologist and physician to select appropriate antibiotic treatment before definitive results are available.