An Unconventional Diagnostic Method for Cryptosporidial Enteritis in a Healthy Host: Never Call It Quits!

Cryptosporidial enteritis has a rising incidence in the USA, mostly affecting immunocompromised individuals and children. It has a self-limiting course in healthy hosts. Herein, we present a unique case of a healthy middle-aged female who presented with a 1-month history of voluminous watery diarrhea and acute blood loss anemia. Cryptosporidial enteritis was diagnosed based on endoscopy with biopsy-proven evidence of 2 jejunal peptic ulcers infected with Cryptosporidiumspp. that was originally missed on routine stool culture, ova and parasite tests. The patient was successfully treated with nitazoxanide,and eradication of the protozoan was also confirmed on repeat endoscopic biopsies of the ulcer that were carried out 6 months later. To our knowledge, this is the first case to be reported in the literature with infective colonization of peptic ulcers with Cryptosporidiumspp.with consequent systemic symptoms.

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Human Babesiosis in Europe

Pathogens ◽

10.3390/pathogens10091165 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1165

Author(s):

Anke Hildebrandt ◽

Annetta Zintl ◽

Estrella Montero ◽

Klaus-Peter Hunfeld ◽

Jeremy Gray

Keyword(s):

Clinical Management ◽

Diagnostic Tools ◽

Genetic Characteristics ◽

Susceptibility To Infection ◽

First Case ◽

The Usa ◽

Life Threatening ◽

History Of ◽

Etiological Agents ◽

Human Babesiosis

Babesiosis is attracting increasing attention as a worldwide emerging zoonosis. The first case of human babesiosis in Europe was described in the late 1950s and since then more than 60 cases have been reported in Europe. While the disease is relatively rare in Europe, it is significant because the majority of cases present as life-threatening fulminant infections, mainly in immunocompromised patients. Although appearing clinically similar to human babesiosis elsewhere, particularly in the USA, most European forms of the disease are distinct entities, especially concerning epidemiology, human susceptibility to infection and clinical management. This paper describes the history of the disease and reviews all published cases that have occurred in Europe with regard to the identity and genetic characteristics of the etiological agents, pathogenesis, aspects of epidemiology including the eco-epidemiology of the vectors, the clinical courses of infection, diagnostic tools and clinical management and treatment.

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A study on the antibiotic resistance of Shigella

Paediatrica Indonesiana ◽

10.14238/pi45.2.2005.49-54 ◽

2016 ◽

Vol 45 (2) ◽

pp. 49

Author(s):

Pramita G Dwipoerwantoro ◽

Sri P Pulungsih ◽

Nuraini I Susanti ◽

Hartaniah Sadikin ◽

Agus Firmansyah

Keyword(s):

Shigella Flexneri ◽

Clinical Manifestations ◽

Stool Culture ◽

Watery Diarrhea ◽

Persistent Diarrhea ◽

History Of ◽

Hospital Morbidity ◽

The Moment ◽

Bloody Stools ◽

Resistance Tests

Background The hospital morbidity caused by Shigella or dysen-tery ranges between 0.3 to 2.9%. Irrational use of antibiotics causesa persistent diarrhea and may lead to drug resistance.Objectives With various kinds of antibiotics available in Indone-sia at the moment, this study aimed to anticipate the kinds of anti-biotics appropriate for shigellosis and to evaluate the clinical spec-trum of dysentery in children in Indonesia.Method The study involved 50 children diagnosed with dysenteryor dysentery-like syndrome, aged 1 to 12 years, who came to fourdifferent hospitals in Jakarta, from November 2001 to April 2002.Parents were asked for their consent. Interviewers recorded de-tails of the children’s history of illness and the physical examina-tions. Stool culture and resistance tests were done.Results Fifty dysentery cases, comprising 30 males and 20 fe-males, 98% aged from 1 to 5 years, came to the four hospitalsduring the study period. Only 24 cases had positive Shigella cul-tures, of which 87% were Shigella flexneri and 17% were Shigellasonnei. The clinical manifestations of shigellosis were bloody stools(83%), mucus in the stool (75%), and watery diarrhea (96%). Fe-ver and tenesmus were absent in 67% and 92% of subjects, re-spectively. Almost 87% of shigellosis cases were resistant tocotrimoxazole; all were sensitive to colistin and most were sensi-tive to nalidixic acid.Conclusion This data suggests that colistin and nalidixic acid aredrugs of choice for dysentery syndrome. The clinical manifesta-tion of dysentery is not always accompanied by bloody stools butmostly incorporates watery diarrhea and mucus in the stool

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A Unique Case of Mycophenolate Induced Colitis after 10 Years of Use

Case Reports in Gastrointestinal Medicine ◽

10.1155/2016/3058407 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

Abhinav Goyal ◽

Moiz Salahuddin ◽

Yogesh Govil

Keyword(s):

Mycophenolate Mofetil ◽

Lupus Nephritis ◽

Side Effect ◽

Flexible Sigmoidoscopy ◽

Abdominal Distension ◽

Watery Diarrhea ◽

Common Side Effect ◽

Unique Case ◽

Gaseous Distension ◽

History Of

A 31-year-old female with a history of lupus nephritis on Hydroxychloroquine, Prednisone, and Mycophenolate Mofetil (MMF) for 10 years presented to the hospital for ankle swelling. On day four, she started to have severe, nonbloody, watery diarrhea with abdominal distension and tenderness. Stool PCR was negative forC. difficile.CT abdomen/pelvis showed gaseous distension of the colon without any obstruction. Flexible sigmoidoscopy revealed a normal looking mucosa. Histopathology showed crypt atrophy and increased crypt apoptosis, consistent with MMF colitis. The diarrhea resolved three days after stopping MMF. Although generally well tolerated, diarrhea is a common side effect of MMF. Most cases occur in the first six months of starting MMF. This case is unique because it describes MMF colitis in lupus after more than 10 years. Thus, MMF colitis should be considered as a differential in patients taking it, regardless of the duration of use.

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A unique case of multiple calvarial hemangiomas with one large symplastic hemangioma

BMC Neurology ◽

10.1186/s12883-021-02053-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Najwa Abdalkabeer A. Bantan ◽

Ahmed H. Abouissa ◽

Muhammad Saeed ◽

Mustafa Hassan Alwalily ◽

Kamal Bakour Balkhoyour ◽

...

Keyword(s):

Preoperative Embolization ◽

Unique Case ◽

First Case ◽

Lytic Lesions ◽

Level Of Consciousness ◽

Cavernous Hemangiomas ◽

History Of ◽

Surgical Field ◽

The Right ◽

Epileptic Fits

Abstract Background Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region. Case presentation A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment. The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up. Conclusions Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here.

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A rare case of severe gastroenteritis caused by Aeromonas hydrophila after colectomy in a patient with anti-Hu syndrome: a case report

BMC Infectious Diseases ◽

10.1186/s12879-021-06784-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael Greiner ◽

Alexia Anagnostopoulos ◽

Daniel Pohl ◽

Reinhard Zbinden ◽

Andrea Zbinden

Keyword(s):

Aeromonas Hydrophila ◽

Past History ◽

Opportunistic Pathogen ◽

Stool Culture ◽

Watery Diarrhea ◽

Culture Methods ◽

Case Presentation ◽

Severe Gastroenteritis ◽

History Of ◽

Stool Samples

Abstract Background Aeromonas hydrophila is a gram-negative facultative anaerobic coccobacillus, which is an environmental opportunistic pathogen. A. hydrophila are involved in several infectious diseases such as gastroenteritis, septicemia and wound infections. However, gastroenteritis caused by Aeromonas spp. are rare and the clinical relevance of Aeromonas species in stool specimens is still under debate. Case presentation Our case concerns a 32-year-old woman who presented at hospital with a worsening watery diarrhea and fever requiring intensive care. A cholera-like illness was diagnosed. The patient had a past history of an anti-Hu syndrome with a myenteric ganglionitis. A molecular multiplex RT-PCR (QIAstat-Dx Gastrointestinal Panel, QIAGEN) covering a broad spectrum of diverse gastrointestinal pathogens performed directly from the stool was negative but the stool culture revealed growth of A. hydrophila. Further investigations of the A. hydrophila strain in cell cultures revealed the presence of a cytotoxic enterotoxin. Conclusions Although A. hydrophila rarely causes gastroenteritis, Aeromonas spp. should be considered as a causative agent of severe gastroenteritis with a cholera-like presentation. This case highlights the need to perform culture methods from stool samples when PCR-based methods are negative and gastrointestinal infection is suspected.

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Anorectal lymphogranuloma venereum in a Melbourne man

Sexual Health ◽

10.1071/sh06029 ◽

2006 ◽

Vol 3 (3) ◽

pp. 189 ◽

Cited By ~ 13

Author(s):

Anna N. Morton ◽

Christopher K. Fairley ◽

Angelo M. Zaia ◽

Marcus Y. Chen

Keyword(s):

Anal Intercourse ◽

Lymphogranuloma Venereum ◽

First Case ◽

Insertive Anal Intercourse ◽

Recent Emergence ◽

The Usa ◽

Anal Swab ◽

History Of ◽

Sex With Men ◽

High Index Of Suspicion

We report the first case of anorectal lymphogranuloma venereum (LGV) in a man who has sex with men (MSM) in Australia in the setting of the recent emergence of LGV among MSM in Europe and the USA. A 33-year-old man presented with a 2 month history of mild external anal discomfort. He gave a history of unprotected receptive and insertive anal intercourse with one partner in Europe during the preceding 6 months. No symptoms suggested proctitis and examination revealed two small anal fissures. An anal swab was positive for Chlamydia trachomatis; investigation for other STIs including HIV were negative. On review 6 days later, he was investigated and treated presumptively for LGV. The LGV diagnosis was confirmed by identifying the L2 serovar of C. trachomatis using a genotype test on the original anal specimen. This case is in keeping with the more recent reports of LGV from Europe, and has demonstrated the need for a high index of suspicion for asymptomatic or minimally symptomatic anorectal LGV.

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Frequency and phenotype of headache in covid-19: a study of 2194 patients

Scientific Reports ◽

10.1038/s41598-021-94220-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

David García-Azorín ◽

Álvaro Sierra ◽

Javier Trigo ◽

Ana Alberdi ◽

María Blanco ◽

...

Keyword(s):

Reference Population ◽

Prior History ◽

Health Administration ◽

Castilla Y Leon ◽

First Case ◽

Headache Onset ◽

Severe Intensity ◽

History Of ◽

Systemic Symptoms ◽

Carlos Iii

AbstractTo estimate the frequency of headache in patients with confirmed COVID-19 and characterize the phenotype of headache attributed to COVID-19, comparing patients depending on the need of hospitalization and sex, an observational study was done. We systematically screened all eligible patients from a reference population of 261,431 between March 8 (first case) and April 11, 2020. A physician administered a survey assessing demographic and clinical data and the phenotype of the headache. During the study period, 2194 patients out of the population at risk were diagnosed with COVID-19. Headache was described by 514/2194 patients (23.4%, 95% CI 21.7–25.3%), including 383/1614 (23.7%) outpatients and 131/580 (22.6%) inpatients. The headache phenotype was studied in detail in 458 patients (mean age, 51 years; 72% female; prior history of headache, 49%). Headache was the most frequent first symptom of COVID-19. Median headache onset was within 24 h, median duration was 7 days and persisted after 1 month in 13% of patients. Pain was bilateral (80%), predominantly frontal (71%), with pressing quality (75%), of severe intensity. Systemic symptoms were present in 98% of patients. Headache frequency and phenotype was similar in patients with and without need for hospitalization and when comparing male and female patients, being more intense in females.Trial registration: This study was supported by the Institute of Health Carlos III (ISCIII), code 07.04.467804.74011 and Regional Health Administration, Gerencia Regional de Salud, Castilla y Leon (GRS: 2289/A/2020).

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First Clinical Case of Equine Parvovirus-Hepatitis-Related Theiler’s Disease in Asia

Viruses ◽

10.3390/v13101917 ◽

2021 ◽

Vol 13 (10) ◽

pp. 1917

Author(s):

Jungho Yoon ◽

Taemook Park ◽

Ahram Kim ◽

Jongyoung Park ◽

Byung-Joo Park ◽

...

Keyword(s):

Gastrointestinal Symptoms ◽

Blood Parameters ◽

Etiologic Agent ◽

Nested Polymerase Chain Reaction ◽

Abdominal Ultrasonography ◽

Viral Shedding ◽

First Case ◽

The Usa ◽

History Of ◽

Ns1 Gene

Equine parvovirus-hepatitis (EqPV-H) is a newly identified etiologic agent of Theiler’s disease (TD). We present a case of EqPV-H-related fulminant hepatitis in a 14-year-old thoroughbred mare in Korea. The mare had acute hepatopathy and gastrointestinal symptoms, with abnormal liver-related blood parameters. The horse was born in the USA and imported to Korea in 2017, with no history of administration of equine biological products after entry into Korea. The horse was diagnosed with EqPV-H-associated hepatitis after abdominal ultrasonography, laparotomy, and nested polymerase chain reaction (PCR) and in situ hybridization (ISH) assays. The serum, nasal swab, oral swab, and liver biopsy were positive for EqPV-H according to the PCR assay. Genetic analysis of the partial NS1 gene of EqPV-H showed a unique nucleotide substitution, distinct from that in previously deposited strains. EqPV-H DNA was found not only in hepatocytes but also in bile duct epithelium and Kupffer cells, particularly via ISH. To the best of our knowledge, this is the first case of EqPV-H-associated TD in Asia, providing the first clinical evidence for viral shedding from the mouth and nose, and identification of EqPV-H in the liver. This study contributes to a better understanding of the pathological features of EqPV-H-associated TD.

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A unique case of an alpha-fetoprotein-producing lung cancer with testicular metastasis

Canadian Urological Association Journal ◽

10.5489/cuaj.22 ◽

2012 ◽

Vol 6 (5) ◽

Author(s):

Jennifer M Willder ◽

Andrew M Thomson ◽

Kenneth M Grigor ◽

Grahame Howard ◽

Grant D Stewart

Keyword(s):

Lower Lobe ◽

Lung Lesion ◽

Alpha Fetoprotein ◽

Lung Tumour ◽

Unique Case ◽

First Case ◽

Overwhelming Evidence ◽

Metastatic Lung ◽

History Of ◽

Poorly Differentiated

Alpha-fetoprotein (AFP)-producing primary lung tumours are rare; we present the first case of an AFP-producing lung tumour with metastasis to testes. The patient, a 72-year-old man, presented with a history of flu-like symptoms and abdominal pain. On examination he had a hard, tender left scrotal mass. Imaging showed a 4.4-cm right lower lobe lung mass and the serum-AFP was raised (1189 ng/mL). Left orchidectomy excised a necrotic tumour. Microscopy showed complete hemorrhagic infarction and immunohistochemistry showed a lack of staining for AFP. Serum-AFP rose 3 days post-orchidectomy to 1466 ng/mL. The patient subsequently developed melaena and died. Autopsy revealed a 9 × 5-cm necrotic right lower lobe lung tumour. Immunohistochemistry showed the tumour cells reacted with a pan-cytokeratin antibody and less than 5% expressed AFP. Bilateral adrenal tumour deposits were also identified in addition to those in the bowel and spleen. The expression of AFP solely in the lung lesion and lack of expression in both testes, together with a rise in serum-AFP post-orchidectomy and the bilateral adrenal metastases, is overwhelming evidence for the reversal of the usual situation: a poorly differentiated AFP-secreting metastatic lung adenocarcinoma

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Clostridium sordelliias a Cause of Fatal Septic Shock in a Child with Hemolytic Uremic Syndrome

Case Reports in Pediatrics ◽

10.1155/2014/237674 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Rebekah Beyers ◽

Michael Baldwin ◽

Sevilay Dalabih ◽

Abdallah Dalabih

Keyword(s):

Septic Shock ◽

Hemolytic Uremic Syndrome ◽

Stool Culture ◽

Toxic Shock ◽

Unique Case ◽

Clostridium Sordellii ◽

First Case ◽

Uremic Syndrome ◽

Gynecologic Infection ◽

Severe Septic Shock

Clostridium sordelliiis a toxin producing ubiquitous gram-positive anaerobe, mainly associated with trauma, soft tissue skin infections, and gynecologic infection. We report a unique case of a new strain ofClostridium sordellii(not present in the Center for Disease Control (CDC) database) infection induced toxic shock syndrome in a previously healthy two-year-old male with colitis-related hemolytic uremic syndrome (HUS). The patient presented with dehydration, vomiting, and bloody diarrhea. He was transferred to the pediatric critical care unit (PICU) for initiation of peritoneal dialysis (PD). Due to increased edema and intolerance of PD, he was transitioned to hemodialysis through a femoral vascular catheter. He subsequently developed severe septic shock with persistent leukocytosis and hypotension, resulting in subsequent death. Stool culture confirmed Shiga toxin producingEscherichia coli 0157:H7. A blood culture was positively identified forClostridium sordellii.Clostridium sordelliis rarely reported in children; to our knowledge this is the first case described in a pediatric patient with HUS.

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