Disseminated histoplasmosis mimicking an acute appendicitis

Introduction: Histoplasmosis can present in a myriad of clinical manifestations, which often makes its diagnosis difficult and occasionally, deceptive. Case Report: We describe a case of a 33 years old gentleman who was clinically diagnosed as acute appendicitis at initial presentation in view of a one-week history of fever, right lower quadrant abdominal pain- and guarding at right iliac fossa. He had thrombocytopenia and lymphopenia on presentation. Mesenteric lymphadenitis and small bowel lesion were found intraoperatively, which was respectively biopsied and resected. Histopathological result confirms disseminated histoplasmosis. Retroviral screen was positive. He was treated with amphotericin B for one week, subsequently switched to oral itraconazole, followed by initiation of highly active antiretroviral therapy (HAART). Discussion: This case illustrates the various nature of histoplasmosis presentation. A high index of suspicion is needed to clinch the diagnosis and subsequently institute prompt treatment as disseminated disease can be fatal if left untreated in an immunosuppressed host

No coma, but expressive dysphasia with cerebellar signs: an unique presentation of cerebral malaria

Malarial infection is not uncommonly complicated by cerebral involvement and poses significant mortality and morbidity especially in children. Similar complications may be seen in the adult population. Cerebral malaria is defined as encephalopathy that presents with impaired consciousness, delirium, and/or seizures. Neurological deficits are commonly seen as sequelae of cerebral malaria rather than as presenting symptoms or signs. We present here a unique case of cerebral malaria with focal neurological deficits but without alteration in conscious level. Keeping rare presentations of common illnesses in mind, clinicians should consider the possibility of cerebral malaria in a patient with neurological deficits and a history of fever and travel in endemic areas

Acute pyelonephritis with candidemia caused by fluconazole resistant candida albicans

An increasing number of azole-resistant Candida albicans strains have arisen due to the evolution of acquired resistance and an epidemiological shift toward less vulnerable species. Here we highlight a case of acute pyelonephritis with candidemia caused by fluconazole-resistant Candida albicans in a patient with no previous exposure to antifungal

Rebound COVID-19 after Paxlovid in 2 related family members

On May 24, 2022, the CDC issued a healthcare advisory after reports of COVID-19 symptoms returning (COVID-19 rebound) in certain patients two to eight days after treatment with Paxlovid (Ritonavir-Boosted Nirmatrevir). We described two patients who experienced a rebound of COVID-19 after receiving Paxlovid treatment

Unmasking a hidden culprit: a case of 'diphtheritic' colitis

Pseudomembranous colitis, originally referred to as "diphtheritic colitis" by Finney in the late 1800s, has transformed from a fatal postoperative complication to a prevalent complication of antibiotic use that can lead to severe morbidity. This case report presents a complicated situation of a 71-year-old female patient diagnosed with colorectal carcinoma who developed pseudomembranous colitis after undergoing multiple rounds of antibiotics and chemotherapy. Despite treatment for acute infectious gastroenteritis, she exhibited no improvement. She was later diagnosed with pseudomembranous colitis after a colonoscopy revealing yellow raised lesions on edematous and erythematous mucosa. The patient was successfully treated with a 10-day oral vancomycin course without further relapse. Risk factors for pseudomembranous colitis include previous antibiotic use, treatment with proton pump inhibitors, nonsteroidal anti-inflammatory drugs, corticosteroids, and chemotherapy. Management of nosocomial diarrhea requires various diagnostic tests to determine the best course of action as Clostridium difficile infection, a common cause of pseudomembranous colitis, can cause a range of symptoms

Vibrio Cholerae O1 Ogawa bacteremia with Extraintestinal manifestation

O1 Ogawa Vibrio cholerae is rarely reported causing extraintestinal manifestation. Here, we report a case of O1 Ogawa Vibrio cholerae bacteremia with bullous cellulitis of the left leg. The patient acquired the infection through a small skin prick on her leg from contaminated soil that served as an environmental reservoir for Vibrio cholerae

Risk factors for severe outcomes in Extended-Spectrum Beta-Lactamase (ESBL) Bacteremia: a single-center study

Expanded-spectrum beta-lactamase (ESBL) bacteremia often leads to severe outcomes like mortality and treatment failure. This study aimed to identify risk factors in patients with ESBL bacteremia. A retrospective cohort analysis was conducted among patients aged 13 years and above who were admitted to Hospital Canselor Tuanku Muhriz (HCTM) due to ESBL bacteremia between the period of January 2015 and August 2019. Patients with polymicrobial bacteremia were excluded. The all-cause in HCTM mortality rate was 30.2%, while the infection-related mortality rate was 22.5%. The risk factors of all-cause in-hospital mortality include hypertension, diabetes mellitus, skin and soft tissue infections (SSTIs), urinary catheterisation and mechanical ventilation. The independent risk factor associated with mortality was mechanical ventilation (AOR 3.12; CI 1.06- 9.18; p = 0.04). No association found between appropriate empirical antibiotic treatment with mortality (p = 0.74), treatment success (p = 0.71) or length of hospital stay (p = 0.84). However, appropriate definitive treatment was associated with a lower mortality rate (p<0.01) and higher treatment success (p<0.01). Mechanical ventilation was the only independent risk factor significantly associated with mortality, while appropriate definitive treatment was associated with a lower mortality rate and higher treatment success

Chikungunya strikes the golden years - the unexpected visitor

Chikungunya, a viral infection transmitted by mosquitoes, has rapidly spread worldwide in recent years. While typically viewed as a self-limiting illness, this disease can trigger severe and debilitating symptoms, especially in elderly patients with underlying conditions. First described during an outbreak in southern Tanzania in 1952, it has now been identified in nearly 40 countries in Asia, Africa, Europe and, most recently, the Americas. Symptoms usually begin 4 to 8 days after a mosquito bite. However, they can appear anywhere from 2 to 12 days. Here, we present an intriguing case report of a senior citizen with multiple comorbidities, who experienced a week of acute onset of fever, excruciating joint pain involving both ankles and wrists, and macular rash more prominently on the lower limbs. With no history of recent travel or water activity and mainly home-bound, the patient's initial lab results revealed a viral picture with a white cell count of 6.8 x 109/L, a hemoglobin level of 12.5 g/dL, and a platelet count of 184 x 109/L. Extensive investigations for tropical infections like dengue and leptospirosis yielded negative results. Autoimmune screening was not significant. However, her Chikungunya IgM was positive, indicating recent chikungunya infection. This case report underscores the significance of considering chikungunya as a differential diagnosis in elderly patients with fever and joint pain. Moreover, it highlights an urgent need for further research on optimal management strategies for this disease in the aging population

Whole-genome sequence of a stenotrophomonas maltophilia isolate from tap water in an intensive care unit

Here, we present a 4,508,936-bp complete genome sequence of Stenotrophomonas maltophilia strain HW002Y, which was isolated from the tap water in an intensive care unit at Sultan Ahmad Shah Medical Centre at the International Islamic University of Malaysia (Kuantan, Pahang, Malaysia). Sequencing was performed using a Nanopore Flongle flow cell