Assuntos
Febre de Chikungunya , Dengue , Infecção por Zika virus , Face , Humanos , Porto Rico , Viagem , Zika virusRESUMO
Varicella-zoster virus (VZV) is an unusual cause of meningoencephalitis in the immunocompetent patient. Most cases of VZV-associated aseptic meningitis or encephalitis are associated with the skin rash of primary varicella, localized herpes zoster, or disseminated zoster. We report a case of VZV meningoencephalitis without a rash occurring in a normal host.
Assuntos
Encefalite por Varicela Zoster/diagnóstico , Encefalite por Varicela Zoster/patologia , Exantema/patologia , Herpesvirus Humano 3/isolamento & purificação , Pele/patologia , Líquido Cefalorraquidiano/virologia , DNA Viral/genética , DNA Viral/isolamento & purificação , Feminino , Humanos , Pessoa de Meia-Idade , Reação em Cadeia da PolimeraseRESUMO
We present a case of severe adenoviral pneumonia in a 20-year-old immunocompetent host with persistently high fevers. The patient was needlessly given multiple empiric antibiotics for non-existent bacterial co-infection. This case has important antibiotic stewardship lessons for practitioners in approaching fevers in the ICU.
Assuntos
Anticorpos Antivirais/sangue , Meningite Asséptica/virologia , Gagueira/virologia , Febre do Nilo Ocidental/complicações , Febre do Nilo Ocidental/diagnóstico , Vírus do Nilo Ocidental/imunologia , Aciclovir/uso terapêutico , Adulto , Anticorpos Antivirais/líquido cefalorraquidiano , Antivirais/uso terapêutico , Feminino , Humanos , Meningite Asséptica/diagnóstico , Meningite Asséptica/tratamento farmacológico , Gagueira/tratamento farmacológico , Febre do Nilo Ocidental/tratamento farmacológico , Febre do Nilo Ocidental/virologiaRESUMO
This is a case report of an adult who presented with apparent culture negative endocarditis (CNE) thought to be marantic endocarditis due to a B-cell lymphoproliferative disorder. This was a most perplexing case and was eventually diagnosed as subacute bacterial endocarditis (SBE) due to a rare slow growing organism. Against the diagnosis of SBE was the lack of fever, hepatomegaly, peripheral manifestations and microscopic hematuria. Also, against a diagnosis of SBE was another explanation for the patient's abnormal findings, e.g., elevated ferritin levels, elevated α1/α2 globulins on SPEP, an elevated alkaline phosphatase, flow cytometry showing B-lymphocytes expressing CD5, and a bone lesion in the right iliac. Findings compatible with both SBE and marantic endocarditis due to a B-cell lymphoproliferative disorder included an elevated ESR, and splenomegaly. Blood cultures eventually became positive during hospitalization. We report a case of native aortic valve (AV) subacute bacterial endocarditis (SBE) due to Aerococcus christensenii mimicking marantic endocarditis due to a B-cell lymphoproliferative disorder. To the best of our knowledge, this is the first reported case of native AV SBE due to A. christensenii presenting as marantic endocarditis.
Assuntos
Aerococcus , Endocardite Bacteriana Subaguda/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Valva Aórtica/microbiologia , Diagnóstico Diferencial , Endocardite não Infecciosa/diagnóstico , Febre , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report an unusual case of Lemierre's syndrome due to a rare species of Fusobacterium, that is, Fusobacterium nucleatum preceded by Mycoplasma pneumoniae pharyngitis and followed later by Epstein-Barr virus infectious mononucleosis.
Assuntos
Infecções por Vírus Epstein-Barr/induzido quimicamente , Fusobacterium nucleatum/isolamento & purificação , Herpesvirus Humano 4/genética , Hospedeiro Imunocomprometido , Mononucleose Infecciosa/virologia , Síndrome de Lemierre/microbiologia , Mycoplasma pneumoniae/isolamento & purificação , Adolescente , DNA Viral/análise , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/complicações , Feminino , Humanos , Mononucleose Infecciosa/complicações , Síndrome de Lemierre/complicações , Síndrome de Lemierre/diagnósticoAssuntos
Vasos Coronários/fisiopatologia , Endotélio Vascular/fisiopatologia , Terapia de Reposição Hormonal , Pós-Menopausa , Vasos Coronários/efeitos dos fármacos , Quimioterapia Combinada , Endotélio Vascular/efeitos dos fármacos , Estrogênios/uso terapêutico , Feminino , Humanos , Progesterona/uso terapêutico , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologiaRESUMO
BACKGROUND: New York area hospitals were hit hard by the swine influenza (H1N1) pandemic in spring and summer 2009. During a pandemic, the initial cases may be difficult to recognize, but subsequent clinical diagnoses were relatively straightforward, given the high volume of cases and their typical clinical presentation. Swine influenza pneumonia presents as an influenza-like illness (ILI) with dry cough, fever >102 degrees F and myalgias. A variety of other viral pneumonias, eg, cytomegalovirus, human parainfluenza virus 3 (HPIV 3), and adenovirus, as well as bacterial community-acquired pneumonias (CAPs) that may present with some of the clinical and laboratory features of H1N1 pneumonia. Most adults admitted to hospitals with ILIs during the pandemic had, in fact, definite or probable H1N1 pneumonia. The Infectious Disease Division at Winthrop-University Hospital developed a diagnostic weighted point score to identify probable H1N1 cases in hospitalized adults with rapid negative influenza diagnostic tests (RIDTs). METHODS: We present a case of an elderly male who presented with an ILI and negative RIDTs during the H1N1 pandemic. He was admitted with a diagnosis of possible H1N1, and placed on influenza precautions and oseltamivir. Although the patient had features consistent with H1N1 pneumonia, Legionnaires' disease was included in the differential diagnosis because of his elevated serum ferritin levels. A Legionella urinary antigen test was positive for Legionella pneumophila (serogroups 01-06). RESULTS: The peak seasonal incidence of sporadic Legionnaires' disease occurs in the summer and fall. Even in the midst of a pandemic, clinicians should be on the alert for other infectious diseases that may mimic H1N1 pneumonia. In our experience, the best way to differentiate H1N1 from ILIs or other bacterial CAPs is through the Winthrop-University Hospital Infectious Disease Division's diagnostic weighted point score system for H1N1 pneumonia or its rapid simplified version, ie, the diagnostic swine influenza triad. Legionnaires' disease is the atypical CAP pathogen most likely to mimic H1N1 pneumonia. CONCLUSIONS: Based on this and other nine cases at our institution during the "herald wave" of pandemic, we conclude that Legionnaires' disease may mimic swine influenza (H1N1) pneumonia.