Co-infections of the central nervous system (CNS) caused by bacterial and viral pathogens are considered to be rare. Herpes simplex virus type-1 (HSV-1) reactivation following Streptococcus pneumoniae infection is wel...Co-infections of the central nervous system (CNS) caused by bacterial and viral pathogens are considered to be rare. Herpes simplex virus type-1 (HSV-1) reactivation following Streptococcus pneumoniae infection is well described but most cases are related to oral or cutaneous lesions or in respiratory samples. HSV-1 CNS reactivation after Streptococcus pneumoniae meningitis is a very rare event and may have significant morbidity and mortality. In this case report, we describe a 71-year-old female patient that presented with a history of abdominal pain and confusion/disorientation that had tonic-clonic seizures while in the Emergency Department. The diagnostic work-up confirmed CNS co-infection caused by Streptococcus pneumoniae and HSV-1. Of note, beyond age, the patient had no known risk factors for both entities and recovered fully after antibiotic and antiviral therapy. This case underlines that clinicians must be aware of CNS co-infection despite being a rare diagnosis. This should be suspected particularly in patients who present an unusual clinical course of CNS infection.展开更多
Neisseria meningitidis is a gram-negative diplococcus which causes invasive disease. The most frequent clinical manifestations caused by infection with this pathogen, are meningitis and fulminant septic shock. More be...Neisseria meningitidis is a gram-negative diplococcus which causes invasive disease. The most frequent clinical manifestations caused by infection with this pathogen, are meningitis and fulminant septic shock. More benign forms with a subacute or chronic pattern are rare but still can evolve to meningitis and have a fatal outcome. This entity is difficult to recognize, as febrile erythema with otherwise good general condition may simulate other diseases, namely viral infections. The authors reported the cases of two healthy young adults who were misdiagnosed with a viral infection. What they really had was a meningococcemia without meningitis presenting with mild and unspecific symptoms, such as, intermittent fever and a discrete macular rash. We pretend to highlight this rare, unspecific and heterogeneous symptoms which can provoke negligence of a potentially life threatening condition.展开更多
A 74-year-old man with terminal chronic kidney disease, under hemodialysis and with residual diuresis, was admitted due to myalgia, arthralgia, fever and pyuria in the previous 10 days. The patient had a recent diagno...A 74-year-old man with terminal chronic kidney disease, under hemodialysis and with residual diuresis, was admitted due to myalgia, arthralgia, fever and pyuria in the previous 10 days. The patient had a recent diagnosis of high-grade non-invasive bladder cancer and was doing weekly BCG intravesical administrations. The symptoms started three days before the fifth administration. He had done cefixime as an outpatient and started piperacillin-tazobactam on hospital admission, but the fever persisted, and there was no bacterial isolation in urine or blood culture. On the tenth and seventeenth day after the last BCG intravesical administration Mycobacterium bovis was still isolated in the urine culture. The diagnosis of BCGitis was made and treatment was started, with a good response. Forty days after the last administration and under treatment, the culture remained positive for Mycobacterium bovis in the urine. We raise the question about the safety of BCG administration in patients with residual diuresis.展开更多
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major oppo...Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major opportunistic infection associated with HIV infection. We report a case of a previously healthy patient who was diagnosed with PML.展开更多
文摘Co-infections of the central nervous system (CNS) caused by bacterial and viral pathogens are considered to be rare. Herpes simplex virus type-1 (HSV-1) reactivation following Streptococcus pneumoniae infection is well described but most cases are related to oral or cutaneous lesions or in respiratory samples. HSV-1 CNS reactivation after Streptococcus pneumoniae meningitis is a very rare event and may have significant morbidity and mortality. In this case report, we describe a 71-year-old female patient that presented with a history of abdominal pain and confusion/disorientation that had tonic-clonic seizures while in the Emergency Department. The diagnostic work-up confirmed CNS co-infection caused by Streptococcus pneumoniae and HSV-1. Of note, beyond age, the patient had no known risk factors for both entities and recovered fully after antibiotic and antiviral therapy. This case underlines that clinicians must be aware of CNS co-infection despite being a rare diagnosis. This should be suspected particularly in patients who present an unusual clinical course of CNS infection.
文摘Neisseria meningitidis is a gram-negative diplococcus which causes invasive disease. The most frequent clinical manifestations caused by infection with this pathogen, are meningitis and fulminant septic shock. More benign forms with a subacute or chronic pattern are rare but still can evolve to meningitis and have a fatal outcome. This entity is difficult to recognize, as febrile erythema with otherwise good general condition may simulate other diseases, namely viral infections. The authors reported the cases of two healthy young adults who were misdiagnosed with a viral infection. What they really had was a meningococcemia without meningitis presenting with mild and unspecific symptoms, such as, intermittent fever and a discrete macular rash. We pretend to highlight this rare, unspecific and heterogeneous symptoms which can provoke negligence of a potentially life threatening condition.
文摘A 74-year-old man with terminal chronic kidney disease, under hemodialysis and with residual diuresis, was admitted due to myalgia, arthralgia, fever and pyuria in the previous 10 days. The patient had a recent diagnosis of high-grade non-invasive bladder cancer and was doing weekly BCG intravesical administrations. The symptoms started three days before the fifth administration. He had done cefixime as an outpatient and started piperacillin-tazobactam on hospital admission, but the fever persisted, and there was no bacterial isolation in urine or blood culture. On the tenth and seventeenth day after the last BCG intravesical administration Mycobacterium bovis was still isolated in the urine culture. The diagnosis of BCGitis was made and treatment was started, with a good response. Forty days after the last administration and under treatment, the culture remained positive for Mycobacterium bovis in the urine. We raise the question about the safety of BCG administration in patients with residual diuresis.
文摘Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major opportunistic infection associated with HIV infection. We report a case of a previously healthy patient who was diagnosed with PML.
