A case of delayed cutaneous S. marcescens after rhinoplasty .

Severe facial infection caused by Serratia marcescens in an immunocompetent soldier

Mycobacterium abscessus subspecies abscessus infection associated with cosmetic surgical procedures: Cases series.

Cutaneous atypical mycobacterial infection with Mycobacterium fortuitum arising after endovenous radiofrequency ablation

We report on a patient with a chronic nodular cutaneous infection histologically presenting with tuberculoid granulomas and growing Mycobacterium gordonae in culture from a biopsy. The lesions were treated surgically. M. gordonae is a potentially pathogenic environmental mycobacterium only rarely causing skin infections.

Objective To review published literature of levofloxacin 750 mg for the treatment of community-acquired pneumonia (CAP), nosocomial-acquired pneumonia (NAP), and skin and skin-structure infections (SSSI) focusing on microbiology, pharmacokinetic, and pharmacodynamic parameters. Data Sources MEDLINE was searched for clinical trials and review articles (1966 to September 2004). Also included were data from the manufacturer. Search terms utilized were levofloxacin, pneumonia, skin infections, adverse effects, pharmacokinetics, pharmacodynamics, and resistance. Study Selection and Data Extraction All articles and product labeling regarding levofloxacin for the treatment of CAP, NAP, and SSSI were included for review. Data Synthesis Compared with the other currently marketed fluoroquinolones, levofloxacin demonstrates similar in vitro activity to a number of commonly identified microorganisms. Levofloxacin 750 mg has shown equivalency to various non-fluoroquinolone regimens for the treatment of NAP and SSSI. Furthermore, a short, 5-day course of levofloxacin 750 mg was similar in efficacy to a longer, 10-day course of levofloxacin 500 mg for the treatment of CAP. Adverse events associated with levofloxacin therapy are dose independent; therefore, the adverse effects seen with high-dose levofloxacin are comparable to lower doses. Conclusions The levofloxacin 750 mg dosage formulation is a logical option when evaluating the antimicrobial armamentarium commonly utilized for the empiric treatment of CAP, NAP, and SSSI. Pharmacodynamic parameters are optimized and resistance is minimized when high-dose, short-course therapy is implemented.

Cutaneous Mycobacterium shigaense Infection in Immunocompetent Woman, China

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesTo report a case of hepatic abscess caused by Candida albicans, which is a less common cause of hepatic abscesses in a non-onco-hematologic population. Fungal infections represent <2% of the total isolates in pus from hepatic abscesses in patients without onco-hematologic malignancies.MethodsA 68-year-old adult male diabetic patient came with complaints of fever with chills and rigor and right upper abdominal pain and yellowish discoloration of eyes and urine. His LFT, PT-INR, RFT were deranged. CBC report shows anemia and Leukocytosis. His CECT showed irregular multiseptated hypodense lesions in segment V, VI, VII of liver. Direct and mycological and bacterial culture examination was performed.ResultsDirect examination of pus sample showed budding yeast cells with pseudohyphae and in SDA culture at 37°C it showed white pasty colonies. The species was identified by VITEK 2 system as C. albicans. The MICs obtained of antifungals were (ug/mL): fluconazole (≤0.5); voriconazole (≤0.12); caspofungin (≤0.12); micafungin (≤0.06); amphotericin b (1); flucytosine (≤1). The patient was started on caspofungin and improved symptomatically. Then oral fluconazole was started and continued until the resolution of lesion on imaging during the follow-up.DiscussionColonization of the gastrointestinal tract is thought to be the main origin of the dissemination of Candida; neutropenia facilitates the spread of Candida from the gastrointestinal tract to the liver. The likely source of infection is GIT in this case.ConclusionWe describe a case of fungal liver abscess in an immunocompetent patient caused by Candida albicans which was successfully treated with caspofungin.

BACKGROUND Histoplasmosis is typically associated with immunocompromised individuals, but cases in immunocompetent patients are rare. Primary cutaneous histoplasmosis (PCH) is a challenging diagnosis due to its clinical polymorphism and can mimic other infectious and non-infectious diseases. Previous cases of PCH have been reported in immunocompetent patients with underlying medical conditions or trauma history. So far there have been no reports of PCH after platelet-rich plasma (PRP) application due to inadequate hygiene measures in an immunocompetent host. CASE REPORT This case report presents a rare occurrence of PCH following a cosmetic procedure (PRP injection) in an immunocompetent patient. The patient developed nodule-like lesions at the application sites, which progressed to ulceration with purulent discharge. Initially, atypical mycobacterial infection was suspected, and empirical antibiotic therapy was initiated. Complementary tests were performed, ruling out immunosuppression and systemic pathogens. The patient showed complete resolution of the lesions after one month of atypical treatment with trimethoprim-sulfamethoxazole (TMP/SMX). Pathological examination confirmed the diagnosis of PCH with intracytoplasmic inclusions of Histoplasma sp. CONCLUSIONS This case highlights the importance of considering histoplasmosis as a diagnostic possibility, especially in hyperendemic areas like Venezuela. Direct inoculation of Histoplasma sp. after aesthetic procedures without proper hygiene measures can lead to pathological lesions, even in immunocompetent individuals. TMP/SMX can be considered as an alternative treatment option in the absence of the first-line medication. Further exploration of this treatment approach may benefit patients with similar clinical conditions or when ideal treatment options are unavailable.

BackgroundIn patients with ST-elevation myocardial infarction (STEMI), urinary tract infection is the most common infection-related complication. Prostatic abscess in a patient with STEMI is very rare.Case presentationWe report the case of a 49-year-old Japanese man who developed fever and shaking chills during hospitalization for STEMI. We initially diagnosed catheter-associated urinary tract infection. However, subsequent contrast-enhanced computed tomography revealed multiple large abscesses in his prostate. We decided to treat with antimicrobial agents alone because the patient was receiving dual-antiplatelet therapy and discontinuation is very high risk for in-stent thrombosis. The patient recovered remarkably after treatment without drainage or surgery.ConclusionsHere, we described the world’s first reported case of prostatic abscess in an immunocompetent patient with STEMI. Early removal of indwelling bladder catheters in patients with STEMI receiving dual-antiplatelet therapy is important to avoid development of prostatic abscess. Furthermore, unnecessary invasive instrumentation should be avoided or limited to diminish the risk of infections.

Introduction: Cryptococcoma is a rare CNS infection caused by Cryptococcus neoformans, with a granulomatous lesion. It’s even rarer in immunocompetent patients. Diagnosis requires histopathological analysis and treatment with amphotericin B, often with surgical resection. The aim is to report four cases of cerebral cryptococcoma In Immunocompetent Patients. This is a case report study. The information of this work was obtained through review of the medical record. Case report: We report on four cases of cerebral cryptococcoma in immunocompetent patients. All cases presented with images of expansive lesions and compatible histopathological analysis. The first case was a 62-year-old man with dysphasia and decreased strength on the right side, and underwent total surgical resection, followed by 23 days of amphotericin B treatment. The second case was a 62-year-old woman who presented with orofacial dyskinesia and decreased strength on the right side, and underwent stereotactic surgery, followed by antifungal treatment. After 10 days of hospitalization, the patient developed respiratory insufficiency, progressed to cardiorespiratory arrest and brain death. The third case was a 54-year-old woman who presented with a skin infection caused by Cryptococcus. During treatment with fluconazole, the patient experienced altered sensory perception and left hemiparesis. Surgical resection of the lesion was performed, followed by 30 days of antifungal treatment. The fourth case was a 54-year-old man who presented with pulsatile headache and right hemiparesthesia, and underwent stereotactic neurosurgery, followed by 12 days of amphotericin B treatment. Conclusion: Cryptococcus neoformans infection in the CNS, manifested in the form of cryptococcoma, although rare, should be considered as a differential diagnosis for brain expansive lesions in immunocompetent individuals.

Human Parvovirus B19

Mycobacterium smegmatis is an acid-fast bacillus of rapidly growing mycobacteria (RGM) of nontuberculous mycobacteria (NTM). M. smegmatis was considered nonpathogenic to humans until 1986, when the first patient was linked to the infection. To date, fewer than 100 cases have been reported in the literature, mainly related to various surgical procedures. Herein, we report two immunocompetent patients who acquired M. smegmatis infection following cosmetic procedures. Due to the rarity of M. smegmatis infection in routine clinical practice, it is challenging for medical providers to diagnose and treat patients with M. smegmatis infection. M. smegmatis infection should be considered for patients with chronic skin and soft tissue infections at the injection site or surgical site following cosmetic procedures. Histological findings, pathogen identification by molecular testing or bacterial culture are required to make a definitive diagnosis. Medical providers should raise awareness of M. smegmatis infection for patients with chronic skin and soft tissue infections after cosmetic procedures. Stringent sterile procedures for surgical instruments, supplies, and environments should be enforced.

ABSTRACTBackgroundThe field of cosmetic filler injection has experienced rapid development over the past two decades, especially in facial augmentation utilizing hyaluronic acid (HA) fillers. Gram‐negative bacteria are found to be the main pathogens of infective nodules after HA injection. The occurrence of cutaneous infections attributed to Serratia marcescens is exceedingly rare and predominantly noted in patients with compromised immune systems.AimsTo summarize the clinical features, diagnosis, and treatment of subcutaneous infection caused by Serratia marcescens following hyaluronic acid injection.Patients/MethodsA rare case of cutaneous Serratia marcescens infection following hyaluronic acid injection was presented. A comprehensive review of the published literature describing the management of skin infection caused by S. marcescens in immunocompetent patients was then conducted, which encompassed three case series and eight case reports published between 1999 and 2017. Data extraction included information on authors, gender, age, signs and symptoms, previous treatment, corresponding management strategies, and follow‐up duration.ResultsSerratia marcescens were isolated in abscesses (n = 6, 35.29%), painful nodules (n = 2, 11.76%), ulcers (n = 6, 35.29%), and others (n = 3, 17.65%). In cases providing salvage plans (n = 11), quinolones were shown to be the most effective antibiotics for salvage, with eight full recoveries (72.73%), and trimethoprim‐sulfamethoxazole was the second most useful antibiotic (18.18%).ConclusionsWith the help of pathogen examination and drug‐sensitive tests, sensitive aminoglycosides, quinolone (especially moxifloxacin), or TMP‐SMX for at least 2 weeks can be considered as the first‐line treatment of late subcutaneous infection caused by Serratia marcescens following hyaluronic acid injection.

Human Papillomaviruses Associated with Epidermodysplasia Verruciformis in Non-Melanoma Skin Cancers: Guilty or Innocent?

BackgroundNocardia cyriacigeorgica was first described in 2001. It is an emerging pathogen that mainly affects immunocompromised patients. A brain abscess caused by N. cyriacigeorgica has been reported only in immunocompromised hosts. We present a rare case of brain abscess caused by N. cyriacigeorgica in an adult male receiving low dose steroids.Case presentationA 75-year-old male weekend gardener without an immunocompromising condition presented with neurological complaints that were initially attributed to an ischemic stroke. Due to the unusual presentation and rapid progression, his condition was thought to be caused by a cerebral space-occupying lesion. He underwent an emergent right-sided parietal craniotomy and the histopathological report of the specimen was an abscess caused by N. cyriacigeorgica. The patient received appropriate antibiotic treatment and completely recovered without sequelae.ConclusionsNocardia species are a rare cause of brain abscess in immunocompetent patients. Their clinical presentation can mimic other more common cerebral diseases, such as brain tumors (primary and secondary) and stroke. The possibility of an abscess caused by N. cyriacigeorgica should also be considered in the differential diagnosis in an immunocompetent patient.