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Frontiers in Public Health 2024Scrub typhus, caused by the , is a widespread vector-borne disease transmitted by chigger mites. Hemophagocytic lymphohistiocytosis (HLH) is considered to be one of the...
BACKGROUND
Scrub typhus, caused by the , is a widespread vector-borne disease transmitted by chigger mites. Hemophagocytic lymphohistiocytosis (HLH) is considered to be one of the potentially severe complications. The diagnosis of scrub typhus-associated HLH may be overlooked due to the non-specific clinical characteristics and the absence of pathognomonic eschar.
CASE PRESENTATION
We obtained clinical data from two patients in the South of Sichuan, China. The first case involved a 6-year-old girl who exhibited an unexplained fever and was initially diagnosed with sepsis, HLH, and pulmonary infection. The other patient presented a more severe condition characterized by multiple organ dysfunction and was initially diagnosed with septic shock, sepsis, HLH, acute kidney injury (AKI), and pulmonary infection. At first, a specific examination for scrub typhus was not performed due to the absence of a characteristic eschar. Conventional peripheral blood cultures yielded negative results in both patients, and neither of them responded to routine antibiotics. Fortunately, the causative pathogen was detected in the plasma samples of both patients using metagenomics next-generation sequencing (mNGS) and further confirmed by polymerase chain reaction. Subsequently, they both were treated with doxycycline and recovered quickly.
CONCLUSION
The unbiased mNGS provided a clinically actionable diagnosis for an uncommon pathogen-associated infectious disease that had previously evaded conventional diagnostic approaches.
Topics: Scrub Typhus; Humans; Female; Child; Orientia tsutsugamushi; Lymphohistiocytosis, Hemophagocytic; China; Male; Doxycycline
PubMed: 38784570
DOI: 10.3389/fpubh.2024.1321123 -
Traditional cheese consumption leading to hemodialysis induced by rifampin treatment: A case report.Toxicology Reports Jun 2024This case report details the journey of a 51-year-old man residing in a remote Iranian village, involved in livestock rearing, who was hospitalized due to Brucellosis...
This case report details the journey of a 51-year-old man residing in a remote Iranian village, involved in livestock rearing, who was hospitalized due to Brucellosis contracted from consuming traditional cheese and dairy products. Initially treated with doxycycline and rifampin, complications arose during antituberculosis therapy, with the patient developing symptoms of nausea, vomiting, and edema alongside renal function deterioration necessitating medication cessation. Subsequent manifestations of proteinuria, toxic hepatitis, and nephrotic syndrome prompted renal biopsy, revealing drug-induced glomerular and tubular damage. Swift cessation of rifampicin, combined with prednisolone therapy, led to symptom amelioration, resulting in the cessation of dialysis and the patient's discharge within three weeks. This case underscores the intricate relationship between traditional cheese consumption, medication-induced renal complications, and the importance of timely intervention and appropriate management in achieving a successful patient outcome.
PubMed: 38778801
DOI: 10.1016/j.toxrep.2024.04.012 -
BMC Infectious Diseases May 2024Lagenidium deciduum is an oomycete that can cause infections in mammals that present similarly to pythiosis and mucormycosis. Most of the existing case reports have...
BACKGROUND
Lagenidium deciduum is an oomycete that can cause infections in mammals that present similarly to pythiosis and mucormycosis. Most of the existing case reports have occurred in canines and have been fatal. In animals, medical therapy has not been successful, so surgical excision is the mainstay of treatment. Lagenidium sp. infections in humans are rare. There is only one case of a human Lagenidium sp. infection in the literature, and it presented as an ocular infection. The human ocular infection was resistant to medical therapy and required a penetrating keratoplasty for cure. Additional reports of effective therapy are needed to guide management of this emerging pathogen. We present the first case of a cutaneous Lagenidium deciduum infection in a human patient, which is also the first documented case of a Lagenidium deciduum infection in an immunocompromised host of any species.
CASE PRESENTATION
An 18-year-old female with relapsed acute myeloid leukemia, awaiting a haploidentical stem cell transplant, presented with erythematous cutaneous lesions on her left hip and bilateral buttocks that enlarged and blackened over several days. About 1 week later, boil-like lesions appeared on her bilateral buttocks. The skin lesions were initially presumed to be bacterial in origin, so the patient was treated with clindamycin and cefepime with little improvement. Upon further investigation, fungal cultures and skin biopsies revealed aseptate hyphae, so the patient was switched to isavuconazole and amphotericin B due to concern for mucormycosis. Phenotypic characterization and DNA sequencing were performed by the Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, which identified the causal fungal organism as Lagenidium deciduum. All of her cutaneous lesions were surgically excised, and the patient was treated with micafungin, terbinafine, doxycycline, and azithromycin. Micafungin and terbinafine were continued until she achieved engraftment post-transplant.
CONCLUSIONS
We report the first successful treatment of a human Lagenidium infection in an immunocompromised host through a combination of aggressive surgical excision and prolonged antifungal therapy during the prolonged neutropenia associated with allogeneic stem cell transplant. Prompt diagnosis and management may prevent disseminated oomycosis.
Topics: Humans; Female; Leukemia, Myeloid, Acute; Antifungal Agents; Adolescent; Lagenidium; Dermatomycoses; Immunocompromised Host
PubMed: 38778275
DOI: 10.1186/s12879-024-09281-5 -
Journal of Microbiology, Immunology,... May 2024Mycoplasma genitalium is an emerging etiology of sexually transmitted infections (STIs) with increasing resistance to antimicrobials. Surveillance on the epidemiology of...
BACKGROUND
Mycoplasma genitalium is an emerging etiology of sexually transmitted infections (STIs) with increasing resistance to antimicrobials. Surveillance on the epidemiology of M. genitalium infection and antimicrobial resistance is warranted.
METHODS
Between September 2021 and August 2023, people with HIV (PWH) and people without HIV (PWoH) at risk of STIs were screened for M. genitalium infection using a multiplex polymerase-chain-reaction assay of specimens collected from the rectum, urethra, oral cavity, and vagina. The prevalences of resistance-associated mutations (RAMs) of M. genitalium to fluoroquinolones, macrolides, and tetracycline were investigated.
RESULTS
During the 2-year study period, 1021 participants were enrolled, including 531 PWH and 490 PWoH. Overall, 83 (8.1%) and 34 (7.6%) participants had M. genitalium infection at baseline and during follow-up, respectively, with the rectum being the most common site of detection (61.5%). With the first course of antimicrobial treatment, 27 of 63 (42.9%) participants with M. genitalium infection were cured during follow-up, including 24 of 58 (41.4%) who received doxycycline monotherapy. The prevalence of RAMs to macrolides, fluoroquinolones, and tetracyclines at baseline were 24.3%, 22.4%, and 7.9%, respectively. Though PWH had more M. genitalium infection (10.2% vs 5.9%, p = 0.01), a higher rate of RAMs to macrolides (41.0% vs 14.7%, p < 0.01) was found in PWoH.
CONCLUSIONS
Among high-risk populations, the prevalence of M. genitalium infection was 8.1%. The overall genotypic resistance of M. genitalium to macrolides and fluoroquinolones was moderately high in Taiwan. Detection of M. genitalium infection and antimicrobial resistance is warranted to ensure resistance-guided antimicrobial treatments to be administered.
PubMed: 38777653
DOI: 10.1016/j.jmii.2024.05.004 -
Cureus Apr 2024Lyme disease is a progressive infectious disease caused by the species that affects multiple organ systems, including the brain, heart, skin, and musculoskeletal...
Lyme disease is a progressive infectious disease caused by the species that affects multiple organ systems, including the brain, heart, skin, and musculoskeletal systems. The cardiac manifestations of Lyme disease typically present with atrioventricular nodal conduction abnormalities and, more rarely, myocarditis. We report a case of an immunocompromised 57-year-old woman who presented with acute onset shortness of breath, hypervolemia, injective conjunctiva, and global vision loss of the left eye in the setting of a recent tick bite. Serologic testing confirmed borreliosis, and cardiac testing demonstrated acute isolated systolic heart failure without any cardiac conduction system abnormalities on the electrocardiogram. The diagnosis of Lyme carditis was made, and the patient was started on doxycycline with complete recovery of cardiac systolic function. This case demonstrates atypical cardiac manifestations of Lyme disease and highlights the difficulty in workup and understanding of Lyme carditis particularly in immunocompromised patients.
PubMed: 38770473
DOI: 10.7759/cureus.58605 -
Cureus Apr 2024A black hairy tongue is a benign, self-limiting condition characterized by the discolouration of the tongue due to defective desquamation. Clinical presentation varies,...
A black hairy tongue is a benign, self-limiting condition characterized by the discolouration of the tongue due to defective desquamation. Clinical presentation varies, with most cases being asymptomatic although aesthetically unpleasant to the patient. Prevalence varies geographically, ranging from 0.6% to 11.3%. It can be triggered by various factors such as medications, smoking, alcohol, poor oral hygiene, or even underlying systemic conditions such as malignancy. Several antibiotics such as doxycycline, erythromycin, amoxicillin-clavulanate, metronidazole, and piperacillin-tazobactam, have been reported to cause black hairy tongues. Onset can range from a few weeks to as long as five weeks. Diagnosis relies on clinical assessment with a good history and visual examination. Definitive treatment remains unclear, but the condition typically improves by identifying and discontinuing the causative agent and maintaining adequate oral hygiene. Complications are rare, and the prognosis is excellent. This case report aims to raise awareness of the association between the black hairy tongue and co-amoxiclav, which may impose additional burdens on patients, healthcare providers, and the health system if failed to be recognized and treated appropriately.
PubMed: 38770449
DOI: 10.7759/cureus.58657 -
Veterinary Research Forum : An... 2024A 6-year-old male domestic short-haired cat () was presented with weakness, anorexia, fever, icterus, a painful abdomen, ruffled hair and a tick infestation, and it had...
A 6-year-old male domestic short-haired cat () was presented with weakness, anorexia, fever, icterus, a painful abdomen, ruffled hair and a tick infestation, and it had no prior surgery. Laboratory analysis revealed left-shifted neutrophils, thrombocytopenia, low albumin content and high serum bilirubin concentration as well as activities of hepatic enzymes including alanine aminotransferase and aspartate aminotransferase. Azotemia and increased serum levels of creatinine and urea were also recorded. In Giemsa-stained blood smear, gamonts were observed within neutrophils. Species-specific polymerase chain reaction assay was used to amplify an approximately 590 bp fragment of gene and confirmed infection. The cat was treated with imidocarb dipropionate and doxycycline and recovered completely. Six-month follow-up showed no recurrence. This study reveals the presence of in Iran and it should be considered in differential diagnosis in febrile and icteric cats. To the authors' knowledge, this is the first description of infection in a cat in Iran.
PubMed: 38770203
DOI: 10.30466/vrf.2023.2005996.3928 -
MedRxiv : the Preprint Server For... May 2024Doxycycline post-exposure prophylaxis (Doxy-PEP) reduces bacterial sexually transmitted infections (STIs) but may select for tetracycline resistance in Neisseria...
Doxycycline post-exposure prophylaxis (Doxy-PEP) reduces bacterial sexually transmitted infections (STIs) but may select for tetracycline resistance in Neisseria gonorrhoeae and co-resistance to other antibiotics, including ceftriaxone.. The implementation of doxy-PEP should be accompanied by monitoring doxycycline resistance, but the optimal strategy to detect changes in the prevalence of resistance has not been established. We used a deterministic compartmental model of gonorrhea transmission to evaluate the performance of two strategies in providing early warning signals for rising resistance: (1) phenotypic testing of cultured isolates and (2) PCR for tetM in remnants from positive Nucleic Acid Amplification Tests (NAATs) used for gonorrhea diagnosis. For each strategy, we calculated the resistance proportion with 90% simulation intervals as well as the time under each sampling strategy to achieve 95% confidence that the resistance proportion exceeded a resistance threshold ranging from 11-30%. Given the substantially larger available sample size, PCR for tetM in remnant NAATs detected increased high-level tetracycline resistance with high confidence faster than phenotypic testing of cultured specimens. Our results suggest that population surveillance using molecular testing for tetM can complement culturebased surveillance of tetracycline resistance in N. gonorrhoeae and inform policy considerations for doxy-PEP.
PubMed: 38765970
DOI: 10.1101/2024.05.07.24306823 -
Frontiers in Veterinary Science 2024The increasing resistance of has posed a significant threat to the poultry industry in recent years. The tet gene is the primary determinant of tetracycline resistance...
INTRODUCTION
The increasing resistance of has posed a significant threat to the poultry industry in recent years. The tet gene is the primary determinant of tetracycline resistance in numerous bacteria, and the enzyme modification gene tet(X) is predominantly detected in tetracycline-resistant strains.
METHODS
In this study, we evaluated the susceptibility of both the standard strain and clinical isolates of to doxycycline. And the expression levels of tet(X), tet(A), and tet(O) genes were detected. To assess drug susceptibility, shuttle plasmids were constructed to transfer the tet(X) gene into the standard strain of followed by treatment with chlorogenic acid.
RESULTS AND DISCUSSION
The results revealed that the minimum inhibitory concentration of doxycycline for the standard strain was 0.25μg/mL, whereas it exceeded 8μg/mL for the clinical isolates. Furthermore, there was a significant upregulation observed in expression levels of tet(X), tet(A), and tet(O) genes among induced strains. Interestingly, when transferring the tet(X) gene into the standard strain, its sensitivity to doxycycline decreased; however, MIC values for chlorogenic acid remained consistent between both standard and drug-resistant strains of . Moreover, we made a surprising discovery that screening passage with chlorogenic acid resulted in increased sensitivity of to doxycycline. Further analysis demonstrated a reversal in expression trends among three differentially expressed genes within induced drug resistance group after intervention with chlorogenic acid. The main objective behind this study is to investigate both killing effect exerted by chlorogenic acid on drug-resistant as well as its regulatory impact on drug resistance genes. This will provide novel insights and theoretical basis towards development of chlorogenic acid as a promising drug for treatment and control of drug resistance in .
PubMed: 38764851
DOI: 10.3389/fvets.2024.1368579 -
La Revue de Medecine Interne May 2024Q fever is a zoonosis caused by Coxiella burnetii. Acute infection is mainly asymptomatic. In other cases it mainly causes a flu-like illness, a pneumonia, or an...
INTRODUCTION
Q fever is a zoonosis caused by Coxiella burnetii. Acute infection is mainly asymptomatic. In other cases it mainly causes a flu-like illness, a pneumonia, or an hepatitis. We present an atypical case of an acute Q fever revealed by a massive pleural effusion.
CASE REPORT
We report the case of a 43-year-old man referred to our hospital for an acute respiratory distress. Further analyses showed an exudative eosinophilic pleural effusion, associated with a pulmonary embolism and a deep femoral vein thrombosis. Aetiologic explorations revealed an acute Q fever (IgM and IgG against C. burnetii phase II antigens) associated with anti-phospholipids. The outcome was favorable with vitamin K antagonists, doxycycline, and hydroxychloroquine, till the negativation of the anti-phospholipid antibodies.
DISCUSSION AND CONCLUSION
During acute C. burnetii infections, anti-phospholipid antibodies are highly prevalent but thrombotic complications are rare. The 2023 ACR/EULAR APS criteria restricts the diagnosis of APS, as in our case of acute severe infection. In front of an atypical pneumonia and/or thrombotic events, screening of C. burnetii and anti-phospholipid antibodies could be useful. Given its low level of evidence, prolongated treatment by doxycycline, hydroxychloroquine ± anticoagulant for C. burnetii's associated anti-phospholipid syndrome is discussed, but succeeded in our case.
PubMed: 38762438
DOI: 10.1016/j.revmed.2024.05.006