RESUMEN
Acinetobacter species are non-fermentative Gram-negative coccobacilli that are ubiquitous in the environment. The archetype pathogen within the genus is Acinetobacter baumannii, however, other species have the potential to cause human infection, especially in the hospital setting. We describe a patient with infection due to Acinetobacter radioresistens, a rare agent of human disease, which is often misidentified using biochemical methods. Acinetobacter radioresistens is the source of the Class D OXA-23 carbapenemase that can confer carbapenem resistance in A. baumannii. Therefore, accurate identification of A. radioresistens is important for clinical management and to potentially prevent the spread of carbapenem resistance.
RESUMEN
BACKGROUND: Globicatella sanguinis is an uncommon pathogen that may be misdiagnosed as viridans group streptococci. We review the literature of Globicatella and report 2 clinical cases in which catalase-negative Gram-positive cocci resembling viridans group streptococci with elevated minimum inhibitory concentrations (MICs) to ceftriaxone were inconsistently identified phenotypically, with further molecular characterization and ultimate identification of G sanguinis. METHODS: Two clinical strains (from 2 obese women; 1 with a prosthetic hip infection and the other with bacteremia) were analyzed with standard identification methods, followed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry, 16S recombinant ribonucleic acid (rRNA), and sodA polymerase chain reaction (PCR). The existing medical literature on Globicatella also was reviewed. RESULTS: Standard phenotypic methods failed to consistently identify the isolates. 16S PCR yielded sequences that confirmed Globicatella species. sodA sequencing provided species-level identification of G sanguinis. The review of literature reveals G sanguinis as an increasingly reported cause of infections of the urine, meninges, and blood. To our knowledge, this is the first reported case of an orthopedic infection caused by Globicatella sanguinis. A review of the 37 known cases of G sanguinis infection revealed that 83% of patients are female, and 89% are at the extremes of age (<5 or >65 years). CONCLUSIONS: Globicatella sanguinis, an uncommon pathogen with elevated minimum inhibitory concentrations to third-generation cephalosporins, is difficult to identify by phenotypic methods and typically causes infections in females at the extremes of age. It may colonize skin or mucosal surfaces. Advanced molecular techniques utilizing 16S rRNA with sodA PCR accurately identify G sanguinis.
RESUMEN
The diagnosis of blastomycosis during pregnancy is rare, but can carry significant clinical questions for both the infected mother and developing fetus. Furthermore, given its rarity, providers have little available data to help manage and counsel patients in this uncommon, yet serious, scenario. We present a case of blastomycosis in a woman at 38weeks' gestation and review all published cases of blastomycosis during pregnancy. It is our hope to provide a multidisciplinary understanding of the current knowledge surrounding the presentation, diagnosis, management, and outcome of this unusual infection.
Asunto(s)
Blastomicosis/diagnóstico , Blastomicosis/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adulto , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Blastomyces/aislamiento & purificación , Femenino , Humanos , Itraconazol/uso terapéutico , Enfermedades Pulmonares Fúngicas/microbiología , EmbarazoRESUMEN
Pulmonary nocardiosis is commonly recognized as an opportunistic infection in patients with predisposing immunosuppressive conditions. However, reports of pulmonary nocardiosis in the immunocompetent host are rare. Here, we report a case series of four patients with pulmonary nocardiosis without a predisposing condition.
RESUMEN
Bacillus Calmette-Guérin (BCG) is widely used for the treatment of bladder cancer. We report a case of BCG-associated mycotic thoracic aortic aneurysm that was successfully treated with resection and antimycobacterial therapy.
Asunto(s)
Aneurisma Infectado/etiología , Aneurisma de la Aorta Torácica/etiología , Vacuna BCG/efectos adversos , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/efectos adversos , Administración Intravesical , Anciano , Aneurisma Infectado/diagnóstico , Aneurisma de la Aorta Torácica/diagnóstico , Vacuna BCG/administración & dosificación , Diagnóstico Diferencial , Humanos , Imagenología Tridimensional , Masculino , Tomografía Computarizada por Rayos X , Neoplasias de la Vejiga Urinaria/tratamiento farmacológicoRESUMEN
Rhodotorula is an emerging opportunistic fungal pathogen that is rarely reported to cause endocarditis. We describe a case involving a patient who developed endocarditis due to Rhodotorula mucilaginosa and Staphylococcus epidermidis, proven by culture and histopathology. The case illustrates the unique diagnostic and therapeutic challenges relevant to Rhodotorula spp.
Asunto(s)
Coinfección/diagnóstico , Endocarditis/diagnóstico , Micosis/diagnóstico , Rhodotorula/aislamiento & purificación , Infecciones Estafilocócicas/diagnóstico , Staphylococcus epidermidis/aislamiento & purificación , Coinfección/microbiología , ADN de Hongos/química , ADN de Hongos/genética , ADN Ribosómico/química , ADN Ribosómico/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Endocarditis/microbiología , Femenino , Genes de ARNr , Histocitoquímica , Humanos , Microscopía , Persona de Mediana Edad , Datos de Secuencia Molecular , Micosis/complicaciones , Micosis/microbiología , ARN de Hongos/genética , ARN Ribosómico/genética , Rhodotorula/clasificación , Rhodotorula/genética , Análisis de Secuencia de ADN , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/microbiología , Staphylococcus epidermidis/clasificación , Staphylococcus epidermidis/genéticaRESUMEN
BACKGROUND: Varicella-zoster virus is a member of the herpes virus family that causes varicella during a primary infection and herpes zoster (HZ) when reactivated. Patients who are immunocompromised often have atypical presentations of HZ and experience complications such as multidermal involvement and dissemination. OBJECTIVE: We report a case of disseminated HZ in an immunocompetent patient with a history of splenectomy for idiopathic thrombocytopenic purpura (ITP). Our 46-year-old female patient presented with a painful vesiculopapular dermatomal rash with approximately 80 other lesions diffusely spread over her body. She was in good health but had a splenectomy for ITP 21 years earlier and a history of recurrent herpes labialis. The latter led to the tentative diagnosis of a widespread herpes simplex infection. However, laboratory results confirmed a diagnosis of disseminated herpes zoster. A workup of the patient's immune status did not reveal any abnormalities other than the patient's previously noted splenectomy. CONCLUSIONS: This case adds to the two reports of patients developing cutaneous disseminated HZ several years after splenectomy. Our case serves as a reminder that patients with a history of splenectomy appear to be at increased risk for cutaneous dissemination of HZ.
Asunto(s)
Anticuerpos Antivirales/análisis , Herpes Zóster/etiología , Herpesvirus Humano 3/inmunología , Huésped Inmunocomprometido , Púrpura Trombocitopénica Idiopática/cirugía , Piel/patología , Esplenectomía/efectos adversos , Diagnóstico Diferencial , Femenino , Herpes Zóster/diagnóstico , Herpes Zóster/virología , Humanos , Persona de Mediana Edad , Púrpura Trombocitopénica Idiopática/inmunologíaAsunto(s)
Osteomielitis/complicaciones , Infecciones Neumocócicas/complicaciones , Streptococcus pneumoniae , Macroglobulinemia de Waldenström/complicaciones , Anciano , Femenino , Humanos , Húmero/patología , Imagen por Resonancia Magnética , Osteomielitis/microbiología , Osteomielitis/patología , Infecciones Neumocócicas/patologíaRESUMEN
Guidelines for the diagnosis and treatment of patients with encephalitis were prepared by an Expert Panel of the Infectious Diseases Society of America. The guidelines are intended for use by health care providers who care for patients with encephalitis. The guideline includes data on the epidemiology, clinical features, diagnosis, and treatment of many viral, bacterial, fungal, protozoal, and helminthic etiologies of encephalitis and provides information on when specific etiologic agents should be considered in individual patients with encephalitis.
Asunto(s)
Antiinfecciosos/uso terapéutico , Encefalitis/diagnóstico , Encefalitis/tratamiento farmacológico , Encefalitis/microbiología , Medicina Basada en la Evidencia , HumanosRESUMEN
BACKGROUND: Human babesiosis is a tickborne malaria-like illness that generally resolves without complication after administration of atovaquone and azithromycin or clindamycin and quinine. Although patients experiencing babesiosis that is unresponsive to standard antimicrobial therapy have been described, the pathogenesis, clinical course, and optimal treatment regimen of such cases remain uncertain. METHODS: We compared the immunologic status, clinical course, and treatment of 14 case patients who experienced morbidity or death after persistence of Babesia microti infection, despite repeated courses of antibabesial treatment, with those of 46 control subjects whose infection resolved after a single course of standard therapy. This retrospective case-control study was performed in southern New England, New York, and Wisconsin. RESULTS: All case patients were immunosuppressed at the time of acute babesiosis, compared with <10% of the control subjects. Most case patients experienced B cell lymphoma and were asplenic or had received rituximab before babesial illness. The case patients were more likely than control subjects to experience complications, and 3 died. Resolution of persistent infection occurred in 11 patients after 2-10 courses of therapy, including administration of a final antimicrobial regimen for at least 2 weeks after babesia were no longer seen on blood smear. CONCLUSIONS: Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness. Such patients generally require antibabesial treatment for >or=6 weeks to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.
Asunto(s)
Babesiosis/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Animales , Antiprotozoarios/uso terapéutico , Babesiosis/tratamiento farmacológico , Babesiosis/parasitología , Estudios de Casos y Controles , Quimioterapia Combinada , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Zoonosis/parasitologíaAsunto(s)
Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/tratamiento farmacológico , Adulto , Algoritmos , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Derivaciones del Líquido Cefalorraquídeo , Niño , Humanos , Lactante , Recién Nacido , Meningitis Bacterianas/microbiologíaAsunto(s)
Profilaxis Antibiótica , Endocarditis Bacteriana , Infecciones Estafilocócicas , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/epidemiología , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/epidemiología , Humanos , Factores de Riesgo , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
Fungal prosthetic valve endocarditis (PVE) is a serious complication of valve replacement surgery. We report the first case of documented Pichia ohmeri PVE in an immunocompetent man who was successfully treated with valve replacement and antifungal therapy with amphotericin B.