Listeria monocytogenes tricuspid valve endocarditis with septic pulmonary emboli in a liver transplant recipient

Listeria monocytogenes has long been known as a pathogen of immunocompromised hosts, including solid organ and bone marrow transplant recipients. Its principal manifestations include bacteremia and meningitis. Endocarditis due to Listeria is far less common and in general affects the left side of the heart. We here report an unusual case of Listeria tricuspid valve endocarditis and septic pulmonary emboli in a sulfa-intolerant liver transplant recipient with a history of relapsing cytomegalovirus (CMV) hepatitis and an indwelling Hickman catheter. The literature on Listeria endocarditis and infections in transplant recipients is reviewed. The possible relationship between susceptibility to Listeria infection and the discontinuation of trimethoprim-sulfamethoxazole prophylaxis is of interest.     

Brain abscess caused by Cladophialophora (Xylohypha) bantiana in a renal transplant patient

Infectious disease is the most significant cause of morbidity and mortality in allotransplantation because of heavy immunosuppression. Brain abscesses caused by melanized fungi have been found occasionally and are an example of this complication. In this paper, we describe a case in a 61‐year‐old black man, who received a cadaveric kidney transplantation in December 1993, followed by triple therapy with cyclosporine, azathioprine, and prednisone. The patient developed right hemiparesis at the beginning of April 1998. A computed tomography scan showed a mass in the left parieto‐temporal region of the brain. The patient underwent surgery and a brown‐colored encapsulated brain abscess was resected. Histology of the tissue revealed a large number of pigmented fungal hyphae. Culture in a Sabouraud dextrose medium with cyclohexamide and chloramphenicol at 25°C resulted in the growth of dark‐green colonies. The fungus identified was Cladophialophora bantiana, based on characteristic microscopic features and on growth at 40°C. The abscess recurred in spite of treatment with fluconazole. The patient was submitted to a second brain surgical procedure and was treated with amphotericin B in addition to fluconazole. Ten days later the patient's blood cultures became positive for Escherichia coli. After 3 days the patient died due to septic shock.     

Listeria monocytogenes-associated acute hepatitis in a liver transplant recipient

ABSTRACT— We report a case of Listeria monocytogenes bacteriemia with liver involvement mimicking acute viral hepatitis in a liver transplant recipient. The patient presented with fever, jaundice and alanine aminotransferase levels ten times the upper limit of normal. Liver biopsy showed signs of acute hepatitis and occasional granulomas. Both blood and liver biopsy cultures were positive for Listeria monocytogenes. The patient received a 3 week course of ampicillin and gentamicin with clinical and biochemical recovery. Liver involvement during Listeria infections is unusual, and most cases occur in patients with underlying hepatic disease and impaired cell-mediated immunity. To our knowledge only one such case has previously been reported in a liver transplant patient. Furthermore, in the present case we isolated the causal agent from the liver biopsy specimen.     

Pseudotumoral presentation of fungating mycetoma caused by Phaeoacremonium fuscum in a renal transplant patient

Eumycetoma is an unusual infection in immunocompromised patients outside the tropics, caused by a variety of fungal pathogens. We describe the case of a 51‐year‐old renal transplant recipient who presented with a large pseudotumoral foot lesion necessitating complete surgical excision of the lesion. Cultures and molecular diagnosis confirmed Phaeoacremonium fuscum. This is the first case, to our knowledge, of fungating mycetoma caused by this fungal species in a solid organ transplant recipient.     

猪肉产业链中单核细胞增生李斯特菌的流行病学研究进展

单核细胞增生李斯特菌(Listeria monocytogenes, Lm)是一种重要的人兽共患食源性病原菌,该菌可沿猪肉产业链进行传播,所引起的李斯特菌病时有报道,对消费者健康造成了巨大威胁。猪通过摄食Lm污染的饲料而引起感染,猪李斯特菌病以暴发或散发方式发生,病死率较高。猪体表携带的Lm和排出粪便中的Lm导致饲养环境的污染,从而在养殖场中循环传播。Lm的检出率随着猪屠宰工序的进行逐步提高,肉制品在加工环节可发生交叉污染。销售环节中Lm的污染被进一步放大,生肉和即食性食品中的污染不容乐观。临床研究表明国内人李斯特菌病以散发为主,而国外以暴发为主。本文概述近年来国内外猪肉产业链中Lm的流行规律,为有效预防和控制李斯特菌病奠定了理论基础。     

Gordonia terrae kidney graft abscess in a renal transplant patient

We present the first report, to our knowledge, of a renal abscess cause by an infection from Gordonia terrae in a kidney transplant patient. The patient simultaneously had pulmonary tuberculosis and a perirenal allograft abscess caused by G. terrae. After treatment with imipenem, in addition to anti‐tuberculous drugs, the patient was cured.     

Recurrent Listeria monocytogenes bacteraemia in a liver transplant patient

Summary We report a case of a recurrentListeria monocytogenes bacteraemia in a 46 year-old liver transplant patient. Serotyping revealed that the two episodes of bacteraemia were caused by different strains. The possibility of a recrudescence of a persisting infection was rejected. We concluded that the recurrent bacteraemia in this predisposed patient was due to re-infection, and that antibiotic treatment (amoxicillin plus an aminoglycoside) resulted in a complete eradication of the infective microorganism. Therefore long-term suppressive antibiotic treatment was not indicated. The source of theseL. monocytogenes infections was not found.

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Rezidivierende Listeria monocytogenes-Bakteriämie bei einer Lebertransplantat-Empfängerin

Zusammenfassung Wir berichten über eine rezidivierendeListeria monocytogenes-Bakteriämie bei einer 46 Jahre alten Lebertransplantat-Empfängerin. Durch Serotypisierung wurde festgestellt, daß die beiden Bakteriämien durch verschiedene Stämme ausgelöst wurden. Die Möglichkeit einer wiederaufflackernden persistierenden Infektion wurde ausgeschlossen. Wir gehen davon aus, daß die rezidivierende Bakteriämie bei dieser prädisponierten Patientin durch Reinfektion verursacht wurde und daß die Antibiotikatherapie (Ampicillin plus Aminoglykosid) den Infektionserreger vollständig eliminiert hatte. Es bestand folglich keine Indikation für eine Antibiotika-Langzeit-Suppressionstherapie. Die Infektionsquelle für dieseL.-monocytogenes-Infektionen wurde nicht gefunden.

     

Endoscopic transpapillary abscess drainage for a patient with giant pyogenic liver abscess

The primary modalities for management of liver abscesses are usually antibiotics and percutaneous drainage. However, in patients with ascites or bleeding tendency, the percutaneous puncture of liver abscesses may be unsuitable. We applied a new approach, nasobiliary tube drainage, for a giant pyogenic liver abscess following diagnostic endoscopic retrograde cholangiopancreatography. Pyogenic liver abscess is often biliary in origin, and this new approach includes assessment of biliary abnormality for the management of the abscess, enabling treatment of parients in whom puncture of the abscess is considered dangerous because of massive ascites around the liver. We propose that this procedure is useful in the management of a subgroup of patients with pyogenic liver abscess. To our knowledge, no previous reports of endoscopic transpapillary abscess drainage in pyogenic liver abscess are available.     

Pneumoperitoneum caused by ruptured gas-containing liver abscess

An 84-year-old woman was admitted to our hospital with high fever, and she suddenly complained of severe abdominal pain the next day. Computed tomography revealed a gas-containing abscess in the lateral segment of the liver, with spontaneous pneumoperitoneum. An emergency lateral segmentectomy was performed, and Klebsiella pneumoniae was cultured from the liver tissue, abscess, and blood. The patient made a satisfactory recovery and was discharged on the thirty-first postoperative day. Pneumoperitoneum caused by the rupture of a gas-containing liver abscess is rare, and to our best knowledge, this is the first report, in the English-language literature, of a patient who has undergone successful hepatectomy for such a condition.     

Incidental hepatic schistosomiasis in a liver transplant recipient

E. Ariza‐Heredia & R.R. Razonable. Incidental hepatic schistosomiasis in a liver transplant recipient.
Transpl Infect Dis 2011. All rights reserved Abstract: Hepatic schistosomiasis is a well recognized cause of chronic liver disease and portal hypertension. Herein, we describe a case of a 62‐year‐old Kuwaiti man who underwent liver transplantation for non‐alcoholic steatohepatitis and, as an incidental finding in the histopathology of the explanted liver, eggs consistent with Schistosoma were found. In endemic regions, hepatic schistosomiasis is often observed as an incidental finding in explanted livers of patients who receive liver transplantation for other indications. In the context of this case, we provide a brief review of the management of schistosomiasis in transplant recipients.     

Successful eradication of invasive Scopulariopsis brumptii in a liver transplant recipient

Ten months after orthotopic liver transplant, a 53‐year‐old male patient developed cough and fever. Imaging revealed diffuse ground‐glass opacities involving all lobes, and subsequent bronchoscopic washings revealed Scopulariopsis brumptii infection. The patient initially had significant clinical deterioration requiring intubation and extracorporeal membrane oxygenation. However, combination antifungal therapy, including posaconazole and terbinafine, eventually proved successful in eradicating the infection.     

Invasive Saccharomyces cerevisiae in a liver transplant patient: case report and review of infection in transplant recipients

Saccharomyces cerevisiae, an ascosporogenous yeast commonly used in the production of food, is an emerging infection in immunocompromised patients. We report the case of a 60‐year‐old man whose orthotopic liver transplant was complicated by S. cerevisiae fungemia and peritoneal abscess, successfully treated with caspofungin and drainage. We also review the literature of invasive saccharomycoses in recipients of hematologic and solid organ transplants.     

Disseminated Cunninghamella bertholletiae infection with spinal epidural abscess in a kidney transplant patient: case report and literature review

Cunninghamella bertholletiae is a rare cause of invasive mucormycosis. We report the case of a 42‐year‐old Thai woman who suffered from disseminated C. bertholletiae infection. The patient developed dry cough, sharp shooting pain in the left buttock referred to the left leg, and fever 1 month after undergoing deceased‐donor kidney transplantation. Radiographic studies exhibited multiple pulmonary cavities, osteomyelitis of the sacral spine, epidural abscess along the lumbrosacral spine, and paravertebral soft tissue involvement. Surgical debridement of the epidural abscess concurrent with prolonged intravenous administration of amphotericin B resulted in a good outcome.     

A middle-aged lady with a pyogenic liver abscess caused by Clostridium perfringens

The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens ) is a rare, but rapidly fatal infection. It is usually associated with malignancy and immunosuppression. We report the case of 50-year-old lady with the secondary liver metastases from rectal cancer presented with fever and epigastric pain. The identification of Grampositive bacilli septicaemia, the presence of gas-forming liver abscess and massive intravascular hemolysis should lead to the suspicion of C. perfringens infection. Here we review twenty cases published since 1990 and their clinical features are discussed. The importance of "an aggressive treatment policy" with multidisciplinary team approach is emphasized.     

Cryptosporidium parvum-associated sclerosing cholangitis in a liver transplant patient

Abstract: Cryptosporidium parvum causes severe long-standing diarrhea in immunocompromised patients. Sclerosing cholangitis caused by C. parvum is a rare complication in transplant recipients. We report herein the presentation of Cryptosporidium -associated cholangitis in an adult liver transplant patient diagnosed by liver biopsy. The patient improved on treatment with azithromycin and paromomycin.     

Rare cause of jaundice in a post liver transplant patient

A hepatitis B virus carrier suffering from acute flare of chronic hepatitis B infection underwent deceased‐donor liver transplantation. He was put on the immunosuppressive agent tacrolimus. On routine follow‐up, he was found to have abnormal liver function. Computed tomography scan of the abdomen did not show any dilatation of the biliary system. Liver biopsy showed scattered microabscesses, and a microgranuloma was detected. Endoscopic retrograde cholangiography was performed and a biliary anastomotic stricture (BAS) was noted. In addition, the Chinese liver fluke, Clonorchis sinensis, was discovered. Balloon dilatation and stenting were performed. The patient was given a course of praziquantel. His liver function improved and normalized. We present the case of a liver transplant recipient with cholangitis caused by C. sinensis infestation and infection and biliary obstruction resulting from BAS.     

Bordetella bronchiseptica bloodstream infection in a renal transplant patient

Bordetella bronchiseptica is a gram‐negative coccobacillus that infects animals, but rarely affects humans. B. bronchiseptica has been reported to cause disease in immunocompromised hosts. We present a case of a 61‐year‐old man with a renal transplant who developed B. bronchiseptica bacteremia likely as a result of close contact between dogs and his skin cancer biopsy sites. The patient was successfully treated with 2 weeks of oral levofloxacin. This case alerts physicians to B. bronchiseptica as a cause of bacteremia in solid organ transplant patients with exposure to animals.     

Brain abscesses caused by Cladophialophora bantiana in a lung transplant patient: A case report and review of the literature

Cladophialophora bantiana brain abscesses are rare, but are frequently and quickly lethal in transplanted patients. We report the case of a 63‐year‐old man who had undergone lung transplantation for chronic obstructive pulmonary disease and presented with headaches and a neurological deficit. Magnetic resonance imaging revealed multiple brain abscesses. C. bantiana was identified by DNA sequencing performed directly on cerebral tissue obtained by surgical biopsy. After 6 months of antifungal treatment, the brain abscesses were replaced by ischemic sequelae. The patient died suddenly 2 months later from a pulmonary bacterial infection. This is the second reported case of C. bantiana brain abscesses in a lung transplant recipient, to our knowledge, who experienced a long survival period with medical antifungal treatment alone. We review the literature and discuss our treatment.