RESUMEN

Tuberculosis (TB) is a common infectious disease that most often affects the lungs, but it can also affect any other organ with a wide range of clinical manifestations. There are three forms of hepatic involvement: diffuse hepatic tuberculosis combined with pulmonary tuberculosis; diffuse hepatic tuberculosis without pulmonary involvement; and nodular or focal/local hepatic tuberculosis, which is a very rare form and presents a diagnostic challenge. We here report the case of a young Moroccan man presenting with biliary colic that had been evolving for a month, associated with a forme fruste of tuberculous impregnation. CT scan and magnetic resonance imaging (MRI) of the liver showed nodular hepatic lesions. The diagnosis of focal hepatic tuberculosis was confirmed based on anatomopathological examination of biopsies obtained during laparoscopy. The patient received antitubercular treatment with good clinical-biological outcome.

Asunto(s)

Antituberculosos , Inmunocompetencia , Laparoscopía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Tuberculosis Hepática , Humanos , Masculino , Tuberculosis Hepática/diagnóstico , Tuberculosis Hepática/tratamiento farmacológico , Antituberculosos/administración & dosificación , Biopsia , Marruecos , Adulto

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Ecthyma grangrenosum is an unusual condition, mostly related to Pseudomonas septicemia. Ecthyma-like skin lesions caused by cutaneous phaeohyphomycosis are extremely rare. Here, we report a case of a 20-year-old Thai man, previously healthy, presenting multiple ecthyma-like skin lesions in both arms and both legs for 2 months. Physical examination revealed ill-defined erythematous plaque with central necrotic crust at both arms and both legs. Tissue biopsy showed a neutrophil collection identified by GMS stain revealing septate hyphae organisms in the vascular lumen. The skin culture was positive for Curvularia lunata, while the final diagnosis was cutaneous phaeohyphomycosis caused by Curvularia lunata. He was empirically treated with amphotericin B and then voriconazole. Itraconazole was administered as a definitive regimen, resulting in complete resolution after 2 months of treatment. Cutaneous phaeohyphomycosis is also an uncommon cause of ecthyma-like lesions and should be considered for investigation when initial results do not demonstrate a bacterial etiology.

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Nocardia is widely distributed in the natural environment and typically cause opportunistic infections. However, it is important to note that the pathogenicity of different Nocardia species may vary significantly. Here we reported the first case of brain abscess caused by Nocardia beijingensis (N. beijingensis) infection in China. A 70-year-old male immunocompetent individual came to our hospital for treatment due to headache. After examination, it was found that he had a brain abscess caused by N. beijingensis. By utilizing a combination of surgical intervention and antibiotic therapy, the patient ultimately achieved full recovery. In addition, we isolated this strain and displayed its ultrastructure through scanning electron microscopy. The phylogenetic tree was analyzed by 16 S rRNA sequence. A literature review of N. beijingensis infections in all immunocompetent and immunocompromised patients was presented. It highlighted that abscess formation appears to be a common manifestation of N. beijingensis infection, and N. beijingensis has become an emerging pathogen in immunocompetent individuals.

Asunto(s)

Absceso Encefálico , Nocardiosis , Nocardia , Humanos , Masculino , Absceso Encefálico/microbiología , Absceso Encefálico/diagnóstico , Nocardiosis/diagnóstico , Nocardiosis/microbiología , Nocardiosis/tratamiento farmacológico , Anciano , Nocardia/aislamiento & purificación , Nocardia/genética , China , Inmunocompetencia , Antibacterianos/uso terapéutico , Filogenia

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Rothia dentocariosa is a commensal organism that is typically found in the oropharyngeal and respiratory tracts, and it typically possesses a low virulence profile, especially for immunocompetent patients. The case presented here represents an extremely rare case of deep neck cellulitis, myositis, and reactive lymphadenitis secondary to R. dentocariosa in an immunocompetent female. A 35-year-old female with no significant past medical history presented to the emergency department with neck pain with reduced range of motion, fever, chills, sinus congestion, and headache for one day. After a thorough workup, blood cultures grew R. dentocariosa in the days following admission. The patient subsequently recovered without any notable sequelae after proper antibiotic treatment. Since Rothia species are currently considered a low-virulence organism that typically causes endocarditis in immunocompromised hosts, this case should serve as a reference for its possible virulence level in immunocompetent hosts. In spite of this organism's pathological rarity, this case highlights the importance of understanding the microbiology, historical context, and treatment for R. dentocariosa as a cause for deep neck cellulitis, myositis, and reactive lymphadenitis.

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Primary central nervous system lymphoma is a rare form of central nervous system malignancy. It predominantly affects immunocompromised individuals and the elderly population. Diffuse large B-cell lymphoma is the most common type. This case report presents a 35-year-old female patient presented with progressive difficulty maintaining balance, headaches, seizures, and blurry vision for 2 months. Physical examination was unremarkable except for sluggish bilateral pupillary reaction and lower extremity weakness. MRI revealed multiple bilateral intraaxial masses. Biopsy and immunohistochemistry confirmed diffuse large B-cell lymphoma, nongerminal center B-cell type. However, the diagnosis was delayed for 4 months. The delay in the diagnosis was caused by its atypical presentation, a surgical site infection, and limited resources, which led the patient to disregard the recommended treatment and leave the hospital against medical advice. Even in the absence of risk factors of primary central nervous system lymphoma, it should be considered as a differential in a young patient with neurologic symptoms and intraaxial mass. Minimally invasive biopsy techniques and readily available immunohistochemistry are essential for prompt diagnosis and guiding treatment.

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We present a case of invasive pulmonary aspergillosis in an immunocompetent young female. An 18-year-old female presented with symptoms of a left-sided middle cerebral artery (MCA) stroke with right arm weakness and aphasia. Computed tomography (CT) brain confirmed the diagnosis of stroke. Further history revealed that the patient had been experiencing low-grade fevers with occasional shortness of breath for the past year. The blood work had eosinophilia at that time for which she was given mebendazole but saw little improvement. Chest X-rays showed upper lobe consolidation for which a tuberculosis (TB) workup was also done, which also came out negative. At the current presentation, she underwent further workup with echocardiography and eventual ultrasound-guided mediastinal biopsy that ultimately led to the correct diagnosis of aspergillosis. However, sadly, it was already too late for the patient who passed away one day after the commencement of the amphotericin B therapy. This paper hopes to decrease the threshold of clinical suspicion for invasive aspergillosis (IA) regardless of the immunity status of the patient, especially if they are presenting with an unrelenting mediastinal or pulmonary symptom complex in the setting of eosinophilia.

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BACKGROUND: Intradural spinal fungal infection is a rare phenomenon that can carry a significant increase in morbidity and mortality. In this systematic review and case report presentation of a 75-year-old male with an intradural cervical mass that was diagnosed as a fungal infection intraoperatively. The objective of this paper is to analyze and report on intradural spinal fungal infections in immunocompetent patients. METHOD: We performed a systematic literature review following the PRISMA protocol for studies of intradural fungal infections published in the past 25 years. Original articles with a description of treatment outcomes of such patients were included. RESULTS: 8 studies were included in this review with the addition of the present case. There were 5 males and 4 females with the average age of patients was 45.6-year-old (range 24-75). Aspergillus and Candida species being the most isolated fungal organism. The origin of the lesions was identified and iatrogenic in four cases. Most patients underwent decompressive laminectomy with biopsy, abscess drainage, or resection of the identified lesion. There were two instances of cervical lesions, but most of the lesions were in the thoracic and lumbar spine. Half of the cases reported symptoms improvement, but two patients died from the infection or complications from the infections. CONCLUSION: Intradural fungal infections are rare with only ten total cases reported in the past 25 years. Nonetheless, they can be associated with significant mortality and morbidity. Thus, the timeline from presentation to intervention should be evaluated and determined carefully.

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Background: Although tuberculosis (TB) of the central nervous system is quite common, tuberculous pyogenic ventriculitis is not only rare; it is a devastating disease in an immunocompetent patient if left untreated. Case Description: We present the case of a 43-year-old man who underwent successful treatment for tuberculous pyogenic ventriculitis that presented with meningeal syndrome and loss of consciousness. Conclusion: Tuberculous pyogenic ventriculitis is a rare manifestation of intracranial tuberculous infection. Despite advances in imaging techniques, the diagnosis of intraventricular TB is essentially biological.

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Recent reports of fatal meningoencephalitis from Kerala, South India, are creating ripples among medical and health administrations. Free-living amoebae (FLA) have been attributed to these infections. Despite their free-living nature, these amoebae have been recognized as potential opportunistic organisms that occasionally cause infections in immunocompetent and immunocompromised individuals. The pathophysiology, epidemiology, and clinical course of diseases caused by FLA are not completely understood. Exposure to humans and animals is imminent given their presence in the air, water, and soil. Human infections, although infrequent, can lead to severe morbidity and mortality as evidenced by the recently emerging reports from Kerala, South India. Since these infections were noticed among children, it is unlikely that they were immunocompromised. Therefore, in this editorial, we speculate on the possibility of frequent upper respiratory tract viral infections as predisposing factors for infection with FLA.

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Introduction: Extrapulmonary legionella disease is rare and occasionally reported in immunocompromised patients; it includes lymphadenitis, panniculitis, hepatitis, atrio-ventricular block, arthritis, prosthetic valve endocarditis and myocarditis. In this article, we report a rare case of legionella suppurative lymphadenitis in an immunocompetent patient. Case: 53-year-old female patient from the Philippines, non-smoker, previously healthy who presented to our facility for chills and respiratory distress following a course of corticosteroid intake. She was admitted for respiratory failure and septic shock, and was diagnosed with legionella infection associated with extrapulmonary dissemination (lymphadenitis) leading to her death 72 h after admission. Discussion: Legionella is an important cause of community acquired pneumonia (CAP) and a delay in appropriate antibiotic therapy was associated with an increased mortality rate. Since legionnaire's disease is indistinguishable from other forms of pneumonia without diagnostic testing, empiric antibiotic therapy regimen should cover legionella species. In unfortunate cases, a delay in the diagnosis and treatment may lead to extrapulmonary manifestations such as lymphadenitis and will be associated with worse patient outcomes. Conclusion: Legionella is an important cause of community acquired pneumonia which if left untreated can become complicated with extrapulmonary manifestations such as lymphadenitis and become eventually fatal to patients. A prompt early diagnosis and appropriate antimicrobial therapy covering legionella should be considered whenever treating community acquired pneumonia.

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Background: This study aimed to investigate the clinical characteristics of pediatric patients hospitalized with community-acquired pneumonia (CAP) and concomitant cytomegalovirus (CMV) infection. Methods: This cross-sectional study enrolled consecutive pediatric patients admitted with CAP who tested positive for CMV DNA in bronchoalveolar lavage fluid (BALF). Flexible fiberoptic bronchoscopy was performed when routine treatment for CAP proved ineffective. The study participants were further stratified into two groups based on CMV serological test results: recent CMV infection group and CMV replication group. Clinical characteristics were compared between these two groups. Results: Among 124 patients aged 1-11 months included in this study, 80 (64.5%) patients were categorized as having recent CMV infection, and 44 (35.5%) tested positive for CMV replication. Co-infection with other pathogens was detected more frequently in the CMV replication group (n = 29, 65.9%) than in the recent CMV infection group (n = 35, 43.7%; P = 0.018). Patients with recent CMV infection were younger and exhibited higher levels of alanine transaminase (ALT) and aspartate aminotransferase compared to those with CMV replication (all P < 0.05). Multivariable regression analysis showed age was independently associated with recent CMV infection (odds ratio [OR], 0.707; 95% confidence interval [CI], 0.586-0.853; P < 0.001). Notably, receiver operating characteristic curve analysis showed that a CMV PCR level of 3,840 copies/ml in blood samples had a sensitivity of 34.7% and specificity of 90.0% for diagnosis of recent CMV infection with an area under the curve (AUC) of 0.625 (95% CI: 0.513-0.736, P = 0.048). A CMV PCR level of 6,375 copies/ml in urine samples had a sensitivity of 77.1% and specificity of 61.5% for diagnosis of recent CMV infection with an AUC of 0.695 (95% CI: 0.531-0.858, P = 0.04). Furthermore, multivariate linear regression analysis revealed that the blood CMV DNA copy number was associated with ALT (B = 0.001; P < 0.001). Conclusions: The CMV DNA copy numbers in blood and urine could serve as discriminatory markers between recent CMV infection and CMV replication. Measuring CMV DNA levels in blood may be an effective method for monitoring liver function impairment in pediatric patients presenting with CAP and concurrent CMV infection.

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Key Clinical Message: Although rare, crusted scabies can affect immunocompetent individuals with no identifiable risk factors. A high index of suspicion, regardless of an individual's immunological status or absence of traditional risk factors, should be maintained by health professionals to facilitate prompt referral to a dermatologist. Abstract: Crusted scabies is an uncommon variant of human scabies characterized by extensive crusted and scaly hyperkeratotic papules, and plaques resulting from profound proliferation of mites in the skin. It is highly contagious and typically occurs in immunocompromised individuals. Reports of cases in healthy adults are rare. It is often resistant to routine treatment. We report a case of a 30-year-old immunocompetent male who presented to us with an extensive pruritic papular rash that started in the inter-digital web spaces of his hands. Within 3 months from onset, the lesions progressed, and became hyperkeratotic, scaly, non-pruritic, spreading to involve his entire body (sparing his face only). Crusty scabies was eventually diagnosed and treated by a dermatologist after months of misdiagnosis at peripheral facilities. Although rare, crusted scabies can affect immunocompetent individuals. A high index of suspicion is required, regardless of immunological status. Among immunocompetent individuals, a thorough search for traditional risk factors is imperative.

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Background: Metagenomic next-generation sequencing (mNGS) technology has been widely used to diagnose various infections. Based on the most common pathogen profiles, targeted mNGS (tNGS) using multiplex PCR has been developed to detect pathogens with predesigned primers in the panel, significantly improving sensitivity and reducing economic burden on patients. However, there are few studies on summarizing pathogen profiles of pulmonary infections in immunocompetent and immunocompromised patients in Jilin Province of China on large scale. Methods: From January 2021 to December 2023, bronchoalveolar lavage fluid (BALF) or sputum samples from 546 immunocompetent and immunocompromised patients with suspected community-acquired pneumonia were collected. Pathogen profiles in those patients on whom mNGS was performed were summarized. Additionally, we also evaluated the performance of tNGS in diagnosing pulmonary infections. Results: Combined with results of mNGS and culture, we found that the most common bacterial pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii in both immunocompromised and immunocompetent patients with high detection rates of Staphylococcus aureus and Enterococcus faecium, respectively. For fungal pathogens, Pneumocystis jirovecii was commonly detected in patients, while fungal infections in immunocompetent patients were mainly caused by Candida albicans. Most of viral infections in patients were caused by Human betaherpesvirus 5 and Human gammaherpesvirus 4. It is worth noting that, compared with immunocompetent patients (34.9%, 76/218), more mixed infections were found in immunocompromised patients (37.8%, 14/37). Additionally, taking final comprehensive clinical diagnoses as reference standard, total coincidence rate of BALF tNGS (81.4%, 48/59) was much higher than that of BALF mNGS (40.0%, 112/280). Conclusions: Our findings supplemented and classified the pathogen profiles of pulmonary infections in immunocompetent and immunocompromised patients in Jilin Province of China. Most importantly, our findings can accelerate the development and design of tNGS specifically used for regional pulmonary infections.

Asunto(s)

Líquido del Lavado Bronquioalveolar , Secuenciación de Nucleótidos de Alto Rendimiento , Huésped Inmunocomprometido , Metagenómica , Humanos , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Metagenómica/métodos , Masculino , Líquido del Lavado Bronquioalveolar/microbiología , Líquido del Lavado Bronquioalveolar/virología , Femenino , Persona de Mediana Edad , China , Adulto , Anciano , Adulto Joven , Bacterias/genética , Bacterias/aislamiento & purificación , Bacterias/clasificación , Esputo/microbiología , Esputo/virología , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , Adolescente , Inmunocompetencia , Neumonía/diagnóstico , Neumonía/microbiología , Neumonía/virología , Anciano de 80 o más Años

RESUMEN

Cryptococcus is an invasive and opportunistic fungus usually associated with immunocompromised individuals. Invasion of the choroid plexus by Cryptococcus is rare. This report presents the radiologic findings of a previously healthy male with bilateral choroid plexus invasion complicated by obstructive hydrocephalus.

RESUMEN

Invasive aspergillosis (IA) is a rare occurrence, but it should be considered in cases involving pituitary or sellar masses. Here, we present a unique case report of IA affecting the sellar region with para-sellar extension and bilateral carotid artery impingement, notably with minimal involvement of paranasal sinuses. The patient, a 16-year-old immunocompetent female from a developing country, presented without any comorbidities or classic risk factors typically associated with IA. Her initial symptoms included headaches, diplopia, and nausea. Clinically and radiologically, the patient was initially diagnosed with either craniopharyngioma or pituitary macroadenoma. Hormonal studies revealed panhypopituitarism. Previous reports of IA have not described cases with these specific presentations, particularly in this age group and immune status.

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Shigella flexneri (S. flexneri) is a facultatively anaerobic gram-negative bacterium that is a member of Enterobacteriaceae. The bacterium has been known to cause mild symptoms, such as diarrhea, to more severe diseases such as hemorrhagic colitis. Fortunately, such instances of severe diseases are rare. Nevertheless, even though S. flexneri is a more benign bacterium of the Shigella genus when compared to Shigella dysenteriae, this doesn't mean that it should be neglected. In fact, the ability of this microorganism to cause inflammation of the colon or colitis and disrupt tissue architecture can allow other organisms that would otherwise be benign to cause severe complications, hence allowing said organisms to be opportunistic. Here, we would like to present a case of S. flexneri colitis resulting in bacillus bacteremia and eventually causing an inappropriate physiological host response leading to hypotension, systematic organ failure, etc., also known as septic shock. The pathogenesis and treatment of this patient will also be discussed.

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Magnusiomyces capitatus is an uncommon opportunistic fungal pathogen primarily affecting immunocompromised individuals. While rare, cases have been reported in immunocompetent patients. We present a documented case of Magnusiomyces capitatus invasive infection in an immunocompetent patient with no previous medical history. This case shows that invasive fungal infections by Magnusiomyces capitatus might affect even the immunocompetent patients.

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Progressive multifocal leukoencephalopathy (PML) is considered an often fatal, demon-leading disease primarily associated with immunosuppression. Immunocompromised individuals predominantly exhibit this manifestation, while immunocompatible patients rarely encounter it. We present a unique case of PML in an immunocompetent individual who initially presented with stroke-like symptoms, received management, and was subsequently discharged. He returned to our hospital a few days later with similar complaints, prompting further investigations that revealed PML, a condition often overlooked, especially in individuals with an intact immune system. Although he received successful treatment with mefloquine and other anti-malarial medications and followed up on an outpatient basis, his subsequent outcome was unfavourable. As a result, this case emphasises the importance of having PML as a significant differential and therapeutic option.

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Nocardia farcinica is an aerobic gram-positive bacterium that is pathogenic to humans. It usually causes local and adjacent tissues' diseases at the entry of infection (most commonly occur in the lungs, skin, or central nervous system), which can also spread to other organs through the bloodstream such as joints, kidneys, and liver. However, these infections are often seen as opportunistic that occur in immunocompromised patients. Here, we report for the first time two immunocompetent patients lacking evidence of local infections, with multiple lymph node enlargements and fever as main clinical manifestations, finally diagnosed as nocardiosis by Metagenomic Next-Generation Sequencing testing (mNGS) from formalin-fixed and paraffin-embedded (FFPE) lymph node tissue, after all the other standard tests were negative. Both patients recovered after receiving anti-nocardia therapies. These two cases indicates that in healthy population, there may be more potential nocardia infections than we expected. Multiple lymph node enlargements and fever suggest a possibility of nocardiosis, especially in patients with fever of unknown origin (FUO). mNGS detection from FFPE lymph node tissue is an accurate, reliable and traceable method for diagnosis of nocardiosis.

RESUMEN

The present study focused on comparing the gene expression profiles of different mouse models of prostate cancer, focusing on the TRAMP transgenic model and its derived cell lines and extending the comparisons to relevant genetically engineered mouse models and human prostate cancer datasets. Employing RNA sequencing, we examined different levels of prostate cancer aggressiveness from the original TRAMP cells to the TRAMP-C2 (TC2) derived cell line and extending to the aggressive TC2-Ras (TC2R) cells and tumors. TC2R acquire the ability to grow in bone tissue upon implantation, unlike the parental TC2 cells. Analysis identified upregulated genes in cell cycle regulation, immune response, and mitotic processes in TRAMP compared to wild-type tissues. TC2 cells exhibited unique gene profiles enriched in ECM organization and tissue development pathways, while TC2R cells showed increased cytokine signaling and motility genes, with decreased ECM and immune response pathways. In vivo TC2R models demonstrated enhanced ECM organization and receptor tyrosine kinase signaling in tumors, notably enriching immune processes and collagen degradation pathways in intratibial tumors. Comparative analysis among mouse and human datasets showed overlaps, particularly in pathways relating to mitotic cycle regulation, ECM organization, and immune interactions. A gene signature identified in TC2R tumors correlated with aggressive tumor behavior and poor survival in human datasets. Further immune cell landscape analysis of TC2R tumors revealed altered T cell subsets and macrophages, confirmed in single-cell RNA-seq from human samples. TC2R models thus hold significant promise in helping advance preclinical therapeutics, potentially contributing to improved prostate cancer patient outcomes.