Successful treatment of thrombotic microangiopathy associated with dengue infection: A case report and literature review

Dengue infection has been associated with multiple renal complications, including glomerulonephritis, acute tubular necrosis, tubulointerstitial nephritis, and thrombotic microangiopathy (TMA), this last one being a rare complication of dengue, with only a few reported cases. TMA associated with dengue can be explained by an alteration in the activity of the enzyme ADAMTS13, leading to thrombotic thrombocytopenic purpura; or it can be secondary to direct or indirect endothelial injury by the virus, which leads to hemolytic uremic syndrome. Here, we present a case of severe TMA, not related to ADAMTS13, which was clearly associated with dengue infection.     

糖尿病足混合感染1例及文献复习

在糖尿病足形成的三大病理(缺血、神经病变和感染)中,感染被认为是最重要的环节。通常,轻度的局灶性浅表溃疡是由革兰阳性需氧球菌(如金黄色葡萄球菌或链球菌)引起;而深部溃疡则由多种细菌混合感染所致,病原菌除了革兰阳性球菌外,还包括革兰阴性杆菌(大肠埃希菌、克雷伯菌、产气肠杆菌、奇异变形杆菌和铜绿假单孢菌等)和厌氧菌(脆弱类杆菌和消化链球菌)等[1]。临床上,由于创面感染无法控制,最终导致截肢的病例屡见不鲜(约90%的糖尿病性截肢与感染相关[2]),给患者带来了巨大的身心痛苦和负担。由此,控制感染在糖尿病足患者的治疗中至关重要,而早期准确分离并确定致病菌对感染控制非常重要,有助于指导临床医师精准使用敏感抗生素,从而降低中远期并发症,提高临床治疗效果。     

Perinatal dengue infection

We report a case of vertical transmission of dengue infection in an infant. The mother's was a term pregnancy with a history of chronic hypertension. She presented with high fever of 3 days duration 5 days prior to delivery. Her initial complete blood count showed platelet count of 64,000/mm3. Dengue hemorrhagic fever was diagnosed 2 days later and symptomatic treatment was given. During labor her platelets dropped to 11,000/mm3 and platelet concentrate was given. Cesarean section was performed due to prolonged second stage of labor. Her infant was normal at birth except for petechiae on the left thigh. The child's platelet count was 34,000/mm3 and low grade fever was detected on the first day. Clinical sepsis was suspected and antibiotic treatment was started and continued for 4 days until all the cultures came back as negative. Both mother and her baby made an uneventful recovery and were discharged 6 days after delivery with normal platelet counts. Maternal blood was positive for IgM antibody to dengue virus. Both cord blood and the baby's blood were positive for dengue virus serotype 2 by PCR.     

Neonatal Trichomonas vaginalis infection: a case report and review of literature

Neonatal infection with Trichomonas vaginalis is an unusual occurrence. We present a case of T. vaginalis found on routine urinalysis in a five-day-old neonate born at 29 weeks gestational age. The patient was treated with metronidazole and had complete resolution of the infection. This report discusses the significance of diagnosis and treatment of T. vaginalis in the neonate.     

星形诺卡菌肺部感染1例并文献复习

[摘要]?诺卡菌广泛分布于外界环境中,由其引起的化脓性肺部感染称为肺诺卡菌病。临床感染常见致病菌为星形诺卡菌。肺诺卡菌病缺乏特异性临床表现和影像学特征,目前尚无特异性的诊断指标,临床极易造成误诊、漏诊。诺卡菌的分离与培养为诊断该病的金标准。本文现对1例星形诺卡菌肺部感染病例进行分析,并结合文献复习,对该病的临床特征、影像学特点、实验室诊断及治疗进行探讨,为临床诊治该类疾病提供借鉴和参考。     

甲氧西林耐药的金黄色葡萄球菌感染一例并文献复习

目的 通过对1例金黄色葡萄球菌染色体基因盒(SCCmec)Ⅴ型的甲氧西林耐药的金黄色葡萄球菌(MRSA)感染病例的分析,增强对MRSA社区或医院获得性感染的认识.方法 对2008年6月19日北京医院皮肤科收治、呼吸科会诊的1例SCCmec Ⅴ型的MRSA感染病例分离自血及痰标本的3株MRSA菌株进行培养及体外药物敏感试验.应用PCR方法对分离菌株进行甲氧西林耐药性决定因子A(mec A)基因鉴定和杀白细胞素(PVL)基因检测,应用多重PCR方法对其进行SCCmec分型.结果 患者男,73岁,因剥脱性皮炎入院,病程中出现MRSA败血症,继之出现双侧肺炎,最终因感染性休克死亡.药物敏感试验结果显示,该MRSA菌株除对β-内酰胺类抗生素耐药外,对其他抗生素如克林霉素敏感,对莫西沙星、庆大霉素为中介性耐药.分离的3株MRSA均属于SCCmec β型.结论 该患者为医院获得性MRSA感染,但其菌株具有社区获得性MRSA的特点,临床医师应注意鉴别.     

Disseminated gonococcal infection in Japan: a case report and literature review

Disseminated gonococcal infection (DGI) is quite a rare condition, especially in the Japanese population; only 10 cases have been reported in case notes and minutes. We describe a man in which Neisseria gonorrhoeae was suspected to have infected the patient through his pharynx. He developed chills, fever, tonsillitis, papules, tenosynovitis and migratory polyarthralgia without genitourinary symptoms. After conducting a literature review, we suggest that being male is a possible risk factor and that blood culture can be used for diagnosing DGI in Japan. DGI should be considered as a diagnosis for patients with fever, dermatitis and joint pain in Japan.     

Corynebacterium jeikeium prosthetic joint infection: case report and literature review

Corynebacterium jeikeium (C. jeikeium) prosthetic joint infections (PJIs) are extremely rare. Previously reported cases required total resection arthroplasty. We describe a case of C. jeikeium PJIs successfully treated with partial removal of the prosthesis and administration of 6 weeks vancomycin followed by chronic suppression with minocycline.     

Dermatomyositis and HIV infection: case report and review of the literature

Since the 1980s, a host of autoimmune phenomena and rheumatologic illnesses have been linked to infection with the human immunodeficiency virus (HIV). Given the broad effects of this virus on both the humoral and cell-mediated arms of the immune system, illnesses such as polymyositis and Reiter’s syndrome appear to be more prevalent in HIV-infected individuals and occur in the absence of well-described predispositions. The activities of some rheumatologic illnesses exhibit an inverse relationship with the course of HIV infection, such as rheumatoid arthritis, which becomes more quiescent with advancing disease. Dermatomyositis is a rheumatologic illness that very infrequently occurs and during our review of literature only three other cases were reported. We present the case of a Caucasian male in his mid-20s who presented with acquired immunodeficiency syndrome and subsequently developed dermatomyositis. In this review, we highlight the current relationship between HIV infection and autoimmunity, the possible ways HIV infection may foster an environment favorable for the development of dermatomyositis, and review the previously reported cases of individuals with HIV infection who developed dermatomyositis. The complex issues of how to treat individuals with HIV and dermatomyositis is also discussed.     

马赛分枝杆菌肺病一例并文献复习

目的 分析马赛分枝杆菌肺病的临床特征,探讨其鉴别诊断方法.方法 分析患者的临床表现及实验室检测结果,对其临床分离菌株进行细菌学检查和分子生物学鉴定,采用PCR扩增rpoB和hsp65基因片段和双向DNA测序,并与美国国立生物技术信息中心(NCBI)数据库比对进行菌种鉴定.结果 患者女,72岁,体质瘦弱,因反复出现呼吸道症状而入院,既往多次治疗无效.该病例的临床分离菌株经细菌学检查和分子生物学鉴定确定为马赛分枝杆菌,rpoB和hsp65基因片段测序结果与NCBI数据库马赛分枝杆菌相应片段的同源性分别为100%和99%,结合临床表现确诊为马赛分枝杆菌肺病.药敏试验结果显示该菌株对多种药物耐药,根据药敏试验结果和患者的身体条件确定治疗方案,采用静脉滴注头孢西丁和口服阿米卡星治疗有效.结论 马赛分枝杆菌肺病多发于免疫功能低下人群,其临床和影像学表现与结核病相似,通过实验室细菌学检测和菌种鉴定,可以对二者进行鉴别.

Abstract：

Objective To analyze the clinical features and differential diagnosis of pulmonary infection with Mycobacterium massiliease (M.ruassiliense ).Methods The clinical manifestations and laboratory test results of our patient were analyzed and the strain isolated from the patient was tested by bacteriological and molecular methods.The partial gene fragments of rpoB and hsp65 were amplified by PCR, sequenced and compared with GeneBank database in NCBI for identification of Mycobacterium species.Results The patient was a 72 year old female, who had been admitted to hospital several times because of recurrent respiratory symptoms which had failed to improve upon treatment.This time, pulmonary infection with M.massiliense was confirmed by clinical manifestation and laboratory results.M.massilence isolated from the sputum of our patient was confirmed by bacteriological and molecular methods.The results of specific segments of rpoB and hsp65 tested by PCR and sequence analysis, and compared with that of mycobacterium in NCBI, showed that the DNA homology was 100% and 99% respectively.The results of drug sensitivity test showed that this strain was resistant to multiple drugs.According to the results of drug susceptibility tests and the condition of the patient, therapy with cefoxitin sodium and amikacin was used and the drugs were effective.Conclusions The clinical manifestations and the chest imaging of pulmonary infection with M.massiliens were similar to those of Mycobacterium tuberculosis, which can be differentiated by laboratory tests.     

Merkel cell carcinoma and HIV infection: a case report and review of the literature

Merkel cell carcinoma (MCC) is a skin cancer of neuroendocrine origin that occurs most often in sun-exposed areas. In the general population, it is a disease of older adults, with only 5% of cases occurring below the age of 50 years. Immunosuppression is the significant risk factor for the development of MCC and recently it was suggested that individuals with HIV have a relative risk of 13.4 to developed MCC in comparison with the general population. We report a case of MCC in an HIV-infected patient and we review nine patients with HIV with MCC. Our patient was a 54-year-old man who came to our attention without a known HIV diagnosis. He was apparently in good health and had no risk factor for HIV, but by the atypical site of the lesion and by the relative young age of the patient we suspected a case of immunosuppression and for this reason we did HIV test that had a positive result. The patient was treated with surgery and chemotherapy but died as a result of liver metastases 25 months after his tumor was diagnosed.     

Acanthamoeba infection in lung transplantation: report of a case and review of the literature

A 49-year-old woman underwent bilateral lung transplantation for advanced idiopathic pulmonary fibrosis. During the postoperative period she received immunosuppressive medications as well as corticosteroids. Aspergillus fumigatus grew from a sputum sample, and she was treated with nebulized amphotericin. She was discharged on tacrolimus and prednisone. After initially doing well, she required re-hospitalization for treatment of cytomegalovirus and Pseudomonas aeruginosa pneumonia. She was treated with ganciclovir and cefepime and, after a 2-week hospitalization, was discharged. Seven months after transplantation she developed progressive sinusitis, treated with antibiotics and sinus debridement surgery. Aspergillus organisms were recovered and, at the periphery of the tangled masses of Aspergillus hyphae, numerous amebic cysts were also identified, which were morphologically consistent with Acanthamoeba spp. Subsequent electron microscopy and immunofluorescent staining confirmed this impression. She was initially treated with intravenous amphotericin, later changed to voriconazole and caspofungin. Debridement of the sinuses 3 weeks later revealed fungal hyphae but no amebae. Infections with Acanthamoeba have rarely been reported in lung transplantation but have been recognized in bone-marrow and renal transplant patients, and have been lethal in many cases, particularly in patients with immunosuppression due to human immunodeficiency virus infection. More recently, aggressive antimicrobial therapy has resulted in successful outcomes, as discussed herein.     

Kikuchi's disease: a case report and literature review

Kikuchi-Fujimoto disease, also known as hystiocytic necrotizing lymphadenitis, is an unusual entity which affects predominantely young Asiatic females, although its distribution is world-wide. Cardinal symptoms are fever and adenopathy, generally cervical, although generalized and extraganglionar cases have been described. Considered a self-limiting disease, it has to be differentiated by pathologic analysis from other less-benign disorders such as lymphoma or histiocytoma, which bear worse prognosis and may require specific treatment. Although the origin of this disease is unknown, a viral origin is postulated and the immune system is involved Kikuchi disease has been associated to other entities such as subcutaneous lupus erythematosus, Hashimoto thyroiditis, etc... requiring that patients be followed immunologically alter diagnosis of this disease. We present a case of Kikuchi disease associated with subacute lymphocytic thyroiditis.     

Cowden's disease: a case report and literature review

Cowden's disease, or multiple hamartoma syndrome, is an uncommon condition with characteristic mucocutaneous lesions associated with abnormalities of the breast, thyroid, and gastrointestinal tract. We describe a 51-year-old man with hyperplastic polyposis of the entire alimentary tract as the most prominent feature of this disease. We also present a review of 85 cases of this entity as reported in the English medical literature, and summarize the pertinent findings.