Non-immunocompromised Patient Research Articles

Ventilator-associated pneumonia due to Aeromonas hydrophila: A rare case report

Introduction. Aeromonas hydrophila is an opportunistic pathogen that can cause various infections, including pneumonia, in immunocompromised individuals. This case report presents a rare occurrence of ventilator-associated pneumonia (VAP) caused by Aeromonas hydrophila in an apparently non-immunocompromised patient. Case presentation. The patient exhibited signs and symptoms of VAP and was successfully treated with intravenous ciprofloxacin. The discussion highlights the characteristics of Aeromonas species, its virulence factors, risk factors for infection, and antibiotic profile. Conclusion. It emphasizes the need for awareness and suspicion of Aeromonas as a potential cause of VAP in ICU settings, as well as the importance of early detection and appropriate treatment for improved outcomes.

A clinical case report of Balamuthia granulomatous amoebic encephalitis in a non-immunocompromised patient and literature review

BackgroundBalamuthia granulomatous amoebic encephalitis (GAE) is a peculiar parasitic infectious disease of the central nervous system, about 39% of the infected Balamuthia GAE patients were found to be immunocompromised and is extremely rare clinically. The presence of trophozoites in diseased tissue is an important basis for pathological diagnosis of GAE. Balamuthia GAE is a rare and highly fatal infection for which there is no effective treatment plan in clinical practice.Case presentationThis paper reports clinical data from a patient with Balamuthia GAE to improve physician understanding of the disease and diagnostic accuracy of imaging and reduce misdiagnosis. A 61-year-old male poultry farmer presented with moderate swelling pain in the right frontoparietal region without obvious inducement three weeks ago. Head computed tomography(CT) and magnetic resonance imaging(MRI) revealed a space-occupying lesion in the right frontal lobe. Intially clinical imaging diagnosed it as a high-grade astrocytoma. The pathological diagnosis of the lesion was inflammatory granulomatous lesions with extensive necrosis, suggesting amoeba infection. The pathogen detected by metagenomic next-generation sequencing (mNGS) is Balamuthia mandrillaris, the final pathological diagnosis was Balamuthia GAE.ConclusionWhen a head MRI shows irregular or annular enhancement, clinicians should not blindly diagnose common diseases such as brain tumors. Although Balamuthia GAE accounts for only a small proportion of intracranial infections, it should be considered in the differential diagnosis.

Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review.

Epidural injections are frequent and safe procedures. Severe complications are infrequent, and they have been reported in elderly comorbid patients with predisposing factors. The objectives of this work are to present a case of an extensive epidural lumbar abscess in a young non-comorbid male patient after a therapeutic L5-S1 injection and a literature review about this subject. An otherwise healthy 24-year-old man who present a case of an extensive epidural lumbar abscess after a therapeutic nerve root block due to a disc herniation. After 7 days of fever and low back pain, he required two surgical interventions and intravenous antibiotic therapy. We reviewed 18 patients with epidural abscess consequence of spinal injections. Their mean age was 54.5 y.o, 66.5% were male, and 66.5% had at least one predisposing risk factor. Symptoms Onset occurred at 8 days on average after the procedure, but the correct diagnosis was made at the 25th-day average. Only 22% presented the classic diagnostic triad, the most frequently isolated germ was Staphylococcus Aureus (66%) and 89% were treated surgically with a 33% rate of complete recovery, 17% mortality and 28% remained with neurological sequelae. Epidural abscesses are infrequent and serious, complication after spinal diagnostic and therapeutic injections, even in young patients without comorbidities. We consider it fundamental to maintain a diagnostic suspicion, even in this subgroup of patients.

Incessant Pleural Drainage - Can It Be a Masquerading Esophageal-Pleural Fistula?

Spontaneous esophageal-pleural fistula (EPF) is extremely rare. We present a case of a 52-year gentleman who presented with shortness of breath and decreased appetite, whose chest X-ray and ultrasonogram of thorax depicted a pleural effusion like picture. Intercostal drainage tubes were inserted to alleviate his dyspnea. Plain computerized tomography (CT) thorax initially revealed a pleural cyst, which was surgically drained. Subsequent CT thorax with contrast and barium swallow revealed EPF, which was confirmed with endoscopy. Pleural fluid analysis revealed candida as the cause of EPF. Candida as a cause of EPF that too in an nonimmunocompromised patient is very rare. Multidisciplinary approach is required to diagnose and prevent mortality in such cases.

Primary non-Hodgkin lymphoma of the chiasm and optic tract in a nonimmunocompromised patient: illustrative case.

Chiasmatic and optic track lymphoma as the primary lesion of the central nervous system (CNS) is extremely rare. The authors report a case of a previously healthy 62-year-old woman who presented with quick and progressive visual impairment leading to bilateral blindness. Brain imaging studies suggested glioma or lymphoma of the chiasm and the posterior visual pathway. Postoperative examination revealed low-grade malignant B-cell lymphoma. No evidence of extracranial lymphoma was found, so a final diagnosis of primary CNS lymphoma (PCNSL) was made. To the authors' knowledge, PCNSL confined to the optic chiasm has rarely been reported in nonimmunocompromised patients. The present case of lymphoma affecting the optic chiasm and optic tract is extremely rare.

Bilateral simultaneous lower motor nerve facial palsy as presenting symptom of cryptococcal meningitis in a non-immunocompromised patient.

Bilateral simultaneous lower motor nerve facial palsy as presenting symptom of cryptococcal meningitis in a non-immunocompromised patient.

Pulmonary Aspergillosis in a COVID 19 Patient: A Case Report and Literature Review

As the COVID 19 pandemic evolves, concerns about fungal co-infections and superinfections are increasing, mainly towards invasive pulmonary aspergillosis (IPA), which increases significantly the risk of mortality in these patients, thus requiring early detection and diagnosis for better treatment efficiency. We’re describing the case of a young, non-immunocompromised patient with SARS COV 2 infection, who developed an IPA due to Aspergillus flavus.

Profuse telangiectasias in an immunocompetent patient misleading presentation revealing a hepatosplenic-Tγδ-cell lymphoma.

Here we present the case of an hepato‐splenic‐Tγδ‐cell lymphoma interestingly occurring in a non‐immunocompromised patient, with profuse telangiectasias giving originally misleading orientation towards the diagnosis of B angiotropic lymphoma.

A Penile prosthesis in an organ transplanted diabetic: a challenging case

Most patients with erectile dysfunction have various comorbidities. These may lead to an increase in postoperative complications after penile prosthesis implantation especially with regard to prosthesis infection. This case study reports on the outcome of a penile prosthesis implantation in an immunocompromised patient with underlying comorbidities of diabetes and post kidney transplantation. A literature review regarding surgical site infection after this procedure reinforce the finding that the incidence of infection need be no greater than a non-immunocompromised patient.

Staphylococcus aureus mediastinitis following a skin infection in a non-immunocompromised patient: A case report.

Mediastinitis is a severe inflammation of the structures located in the mid-chest cavity. Three main causes of infective mediastinitis are traditionally recognized: Deep infection of a sternal wound following cardiothoracic surgery, perforation of the esophagus, and the descending necrotizing mediastinitis as a result of odontogenic, pharyngeal or cervical infections. Mediastinitis, as a complication of skin infection with hematogenous spread is infrequent. Methicillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacteria, and is responsible for numerous severe infections. MRSA mediastinitis is a rare infection and is typically associated with complications of sternotomy and retropharyngeal abscesses. Here, the second known case of mediastinitis of a hematogenous origin in a non-immunocompromised 41-year-old patient following primary skin infection, accompanied by sternal osteomyelitis, lung consolidation and pleural effusion is described; MRSA was the responsible pathogen. The clinical course was favorable after 6 weeks of antibiotics administration without drainage or surgical intervention.

Peritoneal and intestinal tuberculosis in a non-immunocompromised patient without pulmonary involvement

Peritoneal and intestinal tuberculosis in a non-immunocompromised patient without pulmonary involvement

Rare case of fungal arthritis of knee joint in non-immunocompromised patient

Fungal septic arthritis is a rare medical and surgical problem in orthopaedics. It mainly occurs in immunocompromised state. However our patient was not immunodeficient. The knee is most common site involved. Sometimes polyarticular involvement is also seen. Our case had monoarticular left knee joint involvement. Debridement and Antifungal therapy are the main stay of the treatment. Few cases of fungal septic arthritis are reported in literature. Our Patient showed good result with our treatment. Keywords: Amphotericin B, Debridement of joint, Orthopaedic management and Poor prognosis.

A Case of Recurrent Kaposi’s Sarcoma in an HIV-Negative Patient

<strong>Background:</strong> Kaposi’s Sarcoma (KS) is an angioproliferative disease of endothelial tissue, as a result of Human Herpesvirus 8 (HHV-8) infection. Theoretically, there are four types of KS: Classic, Epidemic, Endemic, and Iatrogenic. The Classic variant is seen among men of 50–70 years of age, of Mediterranean or European descent. The Epidemic form is seen among HIV seropositive patients. The Endemic variant is seen among HIV seronegative men, of African American descent, typically 20–30 years of age, and lastly, the Iatrogenic subtype is seen among those undergoing immunosuppressive treatment. In this paper, we present a case of an HIV-negative, non-immunocompromised patient with recurrent Human Herpesvirus 8 (HHV-8) positive Kaposi’s Sarcoma, who does not resemble any of the aforementioned types. <strong>Presentation:</strong> A 65-year-old male presented to the outpatient clinic with the chief complaint of a nodular lesion over the left posterior thigh for the past two months. Past history was significant for biopsy-confirmed Kaposi’s sarcoma over the right thigh four months prior. There was no history of an immunocompromised state and testing for HIV returned negative. The patient’s complete blood count and complete metabolic panel were normal, and the patient had no signs of any underlying systemic illness. The patient underwent surgical excision of the lesion on the left lower extremity, which revealed Kaposi’s sarcoma, nodular type with immunohistochemical staining of lesional cells positive for HHV-8, and with clear margins. <strong>Conclusion:</strong> The pathogenesis of KS has been attributed to viral oncogenesis as a result of dysfunction of the p53 tumor suppressor gene. Establishing this mechanism required decades of research, and through this process, it has been elucidated that immunosuppression is necessary for KS tumorigenesis. However, data is now emerging on the occurrence of KS in immunocompetent individuals, thus highlighting the importance of further research in the understanding of this tumor’s pathogenesis. Additionally, to the best of our knowledge recurrent KS in an immunocompetent individual has been sparingly described, especially in a non-endemic population.

IL-7 Immunotherapy in a Nonimmunocompromised Patient With Intractable Fungal Wound Sepsis.

A nonimmunocompromised patient developed life-threatening soft tissue infection with Trichosporon asahii, Fusarium, and Saksenaea that progressed despite maximum antifungal therapies and aggressive debridement. Interleukin-7 immunotherapy resulted in clinical improvement, fungal clearance, reversal of lymphopenia, and improved T-cell function. Immunoadjuvant therapies to boost host immunity may be efficacious in life-threatening fungal infections.

Unusual case of follicular lymphoma presenting as solitary painless scalp swelling: Case report and review of literature

Follicular lymphoma (FL) is the second most frequent non-Hodgkin lymphoma accounting for about 10%–20% of all lymphomas. FL usually presented with peripheral adenopathy involving cervical, inguinal, and femoral regions. FL presenting as a scalp swelling without involvement of underlying cerebral parenchyma or systemic manifestation in a nonimmunocompromised patient is an extremely rare medical condition requiring aggressive treatment and neurosurgical intervention. We report the case of a 33-year-old male presenting with progressively increasing painless large left-sided frontal scalp swelling. The patient underwent near-total excision of lesion. Histopathology report suggested FL. We report this case for discussion regarding pathophysiology, diagnosis, and appropriate clinical management.

Multifocal skeletal tuberculosis in nonimmunocompromised patient: Thumb infection as the tip of an iceberg

Multifocal skeletal tuberculosis in nonimmunocompromised patient: Thumb infection as the tip of an iceberg

Peritoneal and intestinal tuberculosis in a non-immunocompromised patient without pulmonary involvement

Peritoneal and intestinal tuberculosis in a non-immunocompromised patient without pulmonary involvement

A clinical case report of brain abscess caused by Nocardia brasiliensis in a non-immunocompromised patient and a relevant literature review

BackgroundBrain abscess due to the Nocardia genus is rare and usually found in immunocompromised patients. The most common subtype implicated is Nocardia farcinica while brain abscess due to Nocardia brasiliensis is comparatively rare. Diagnosis of brain abscess is based mainly on bacteriological culture from pus collected at the site of infection, and brain imaging. Stereotaxic aspiration or surgical resection combined with adequate duration of treatment with antibiotics to which the bacteria are sensitive represent effective treatment strategies.Case presentationWe report a rare case of brain abscess caused by Nocardia brasiliensis in a non-immunocompromised patient. He admitted to our hospital twice with a headache. Stereotaxic aspiration was performed at the patient’s first appointment at the hospital, and a craniotomy was used to excise the lesion during subsequent abscess recurrence.ConclusionEarly diagnosis, reasonable surgical intervention, and adequate duration of treatment with effective antibiotics are critical for treating brain abscess.

An Interdisciplinary Team Decreases Hospital Acquired Infections in HCT Patients

Topic Significance & Study Purpose/Background/Rationale Prevention of healthcare-associated infections (HAI) is a priority of regulatory and national agencies and CMS implemented payment reductions for HAIs as of 2015. Central Line Associated Blood Stream Infections (CLABSI) in hospitalized patients are challenging HAIs that are known to increase lengths of stay, financial burdens, and overall mortality. HAI definitions are based on non-immunocompromised patient populations and immunocompromised patients often have increased reporting for these infections. Our NCCN hospital sought to better describe CLABSIs in our hematopoietic cell transplant (HCT) population to assure appropriate reporting of HAIs and to identify opportunities for quality improvement. Methods, Intervention, & Analysis An interdisciplinary team including the Infection Prevention Medical Director, Infection Preventionists and Physicians, Pharmacist, inpatient Nurse Manager and a Clinical Nurse Specialist met monthly to perform intensive reviews of CLABSI events that occurred on an inpatient HCT unit. The review included patient risk factors for infection and the degree to which nurses followed the central line care bundle. As a result of these reviews, a Staff RN group was formed who were educated to became unit experts on CLABSI and central line care. Subsequently, CLABSI rates reduced by 30%. Findings & Interpretation CLABSI reviews found common organisms across cases, opportunities for improvement in nursing practice as well as trends in patient characteristics where gaps in care may exist. By expanding these reviews to other HAIs, situations where standard definitions may not directly apply were identified, particularly with Clostridium Difficile Infection (CDI). The interdisciplinary CDI review focused on common causes of diarrhea which were then categorized and shared with staff to aid in patient care decisions. Discussion & Implications Intensive review of HAI events and identification of trends in the immunocompromised patient population assures accurate reporting of these cases. Reviews also allow for development of internal classifications of causes and ongoing process improvement in patient care by identifying unique situations leading to those infections. While this process requires resources to perform data collection and to review cases, the subsequent potential improvement in patient care may offset those. Multidisciplinary case review can help to improve practice, decrease infections, and potentially decrease the cost of patient care.

THE CASE OF THE FUNGUS IN THE HONEYCOMB

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Aspergillomas are fungal balls that typically develop in pre-existing pulmonary cavities such as those caused by tuberculosis, sarcoidosis, histoplasmosis, cystic fibrosis and lung abscesses but are rarely associated with UIP. Aspergillomas are typically distributed as either multiple bilateral pulmonary aspergillomas or as an isolated aspergilloma. The most commonly reported cases of aspergillomas have been found in post-tuberculosis cavities, accounting for 11 to 17% of cases, with an increased incidence in areas of high tuberculosis prevalence. For this reason, aspergillomas are typically found in the upper lobes with lower/middle lobe findings often associated with other cavitary pulmonary diseases. CASE PRESENTATION: We present an unusual case of multiple, unilateral aspergillomas in a non-immunocompromised patient with usual interstitial pneumonia (UIP). Patient is a 73-year-old female with seropositive rheumatoid arthritis (not on immunosuppressive therapy) who was evaluated for weight loss and minor hemoptysis. Chest CT showed classic bibasilar honeycomb changes typical of UIP. There were nodular opacities within the honeycomb changes suggestive of mycetomas seen exclusively in the right lung base. These were subsequently identified as aspergillomas by correlating the chest CT with bronchoscopic cultures that grew A. fumigatus. The patient’s symptoms resolved spontaneously after 6 months without treatment for either aspergillomas or UIP. At follow up after 2 years, the patient remained symptom free without further episodes of hemoptysis and her weight was stable. DISCUSSION: This case is a unique presentation for several reasons. First, aspergillomas are rarely associated with UIP. Second, multiple aspergillomas usually occur in immunocompromised patients whereas our patient was not immunocompromised. Third, despite the bilateral distribution of honeycombing in this patient, the aspergillomas were strictly unilateral. Finally, whereas aspergillomas are usually upper lobe predominant, our patient’s aspergillomas were localized to the right lower lobe. CONCLUSIONS: Chronic aspergillomas increase the risk of local tissue invasion which may result in potentially life-threatening hemoptysis. Fortunately, this patient’s hemoptysis spontaneously resolved and she subsequently remained asymptomatic. Such a presentation should be kept in mind when taking care of similar patients. Reference #1: Kumar N, Mishra M, Singhal A, Kaur J, Tripathi V. Aspergilloma coexisting with idiopathic pulmonary fibrosis: A rare occurrence. J Postgrad Med 2013;59:145-8 Reference #2: Moodley L, Pillay J, Dheda K. Aspergilloma and the surgeon. J Thorac Dis. 2014;6(3):202-9. Reference #3: Regis Gothard Bopaka, Hasna Jabri, Wiam El Khattabi, Hicham Afif European Respiratory Journal 2015 46: PA2650; DISCLOSURES: No relevant relationships by Nina Chan, source=Web Response No relevant relationships by Peter Sloane, source=Web Response