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Vangara A, Gullapalli D, Depa JK, Kolagatla S, Ali M, Ganti SS. Beware of the Acute Respiratory Distress Syndrome in a Pulmonary Blastomycosis! J Investig Med High Impact Case Rep 2024; 12:23247096241233042. [PMID: 38375745 PMCID: PMC10880536 DOI: 10.1177/23247096241233042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
Blastomyces dermatitidis is a dimorphic fungus that can range from mild to severe disease presentation, including the acute respiratory distress syndrome (ARDS) based on the individual's immunity. Acute respiratory distress syndrome is an uncommon presentation having an incidence of about 10% to 15% but has a high mortality exceeding 90%. This is a case of a 50-year-old female with past medical history of asthma and type 2 diabetes mellitus who presented to the pulmonology clinic with worsening dyspnea for the last 2 months. She also had a lesion in the left lower back, which was draining purulent fluid. Chest radiographs showed bilateral infiltrates and was started empirically on vancomycin and piperacillin-tazobactam. Bronchoalveolar lavage was done and the cultures grew B dermatitidis. The patient was moved to a higher level of care and given amphotericin B. Unfortunately, the patient experienced septic shock, which later deteriorated into cardiac arrest, ultimately leading to their passing. The importance of early diagnosis of blastomycosis and timely treatment has been emphasized in this case report.
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Affiliation(s)
- Avinash Vangara
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Dedeepya Gullapalli
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Jayaram Krishna Depa
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Sandhya Kolagatla
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Whitesburg, KY, USA
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Ye Z, He J, Ji H, Xu H, Zhang Y, Zhou K, Liu H. Case report: isolated prevotella intermedia causing intracranial infection detected using metagenomic next generation sequencing. BMC Neurol 2023; 23:383. [PMID: 37872501 PMCID: PMC10591364 DOI: 10.1186/s12883-023-03374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/08/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Isolated Prevotella intermedia, a rare gram-negative, rod-shaped, anaerobic bacterium, is rarely detected in clinical practice. It has been associated with infections of the oral cavity and female genital tract, but has never been detected in cerebrospinal fluid (CSF) of patients in China. Accurate detection of causative pathogens is still an arduous task owing to the difficult conditions of anaerobic bacterial culture. Isolated Prevotella intermedia can be detected by metagenomic next generation sequencing (mNGS) of the CSF. Correct diagnosis and antibiotic treatment can help patients avoid life-threatening events. CASE PRESENTATION Herein, we describe the case of a 64-year-old Chinese woman who presented with typical features of meningoencephalitis. Routine CSF culture failed to identify the causative pathogen. Isolated Prevotella intermedia was detected by mNGS, and the patient was treated with antibacterial agents including ceftriaxone, vancomycin, moxifloxacin, meropenem, metronidazole, and linezolid. The patient underwent surgical treatment for abscess of left frontal parietal lobe, which was observed on magnetic resonance imaging (MRI) and was suspected to be caused by Prevotella intermedia. It was further confirmed that it was a secondary infection from the oral cavity, and the possible etiology might have been dental surgery. Treatment was rendered to the patient based on metagenomic test result, and her condition improved after two months. CONCLUSIONS This case highlights the role of mNGS in accurate diagnosis of patients with central nervous system infection. In particular, mNGS can be used to identify rare pathogens and confirm the diagnosis in patients with unknown etiology.
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Affiliation(s)
- Zhinan Ye
- Department of Neurology, Municipal Hospital Affiliated to the Medical School of Taizhou University, Taizhou, Zhejiang Province, China
| | - Jinfeng He
- Department of Neurology, Municipal Hospital Affiliated to the Medical School of Taizhou University, Taizhou, Zhejiang Province, China
| | - Hailong Ji
- Department of Neurosurgery, Municipal Hospital Affiliated to the Medical School of Taizhou University, No. 381 of East Zhongshan Road, Jiaojiang District, 318000, Taizhou, Zhejiang Province, China
| | - Hao Xu
- Department of Neurology, Municipal Hospital Affiliated to the Medical School of Taizhou University, Taizhou, Zhejiang Province, China
| | - Yaping Zhang
- Department of Neurology, Municipal Hospital Affiliated to the Medical School of Taizhou University, Taizhou, Zhejiang Province, China
| | - Kaiyu Zhou
- Department of Neurosurgery, Municipal Hospital Affiliated to the Medical School of Taizhou University, No. 381 of East Zhongshan Road, Jiaojiang District, 318000, Taizhou, Zhejiang Province, China.
| | - Hongwei Liu
- Department of Neurology, Taiyuan Central Hospital, Shanxi Medical University, No.5, Three lanes East Road, Taiyuan, 030000, Shanxi Province, China.
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Kazmer A, El-Baba R, Kontosis A, Borys E, Siddiqui M. Blastomycosis of the Central Nervous System. J Radiol Case Rep 2023; 17:13-21. [PMID: 38828027 PMCID: PMC11075853 DOI: 10.3941/jrcr.v17i12.5167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
The reported incidence of blastomycosis is increasing in certain regions of the United States. The diagnosis is primarily made via urine antigen testing, culture, or cytology smear. The differential diagnosis for blastomycosis includes pneumonia, tuberculosis, and non-infectious pulmonary disease. Clinical context and epidemiologic exposure play a crucial role in diagnosis. However, the differential can expand significantly if there is disseminated central nervous system involvement, especially if pulmonary manifestations are not seen. Imaging begins to play a vital role when differentiating disseminated blastomycosis from other etiologies such as malignancy. Herein we present a case of a 58-year-old male who presented with seizures and right sided gaze preference found to have disseminated central nervous system blastomycosis. In this article, we will discuss symptoms and imaging findings of disseminated blastomycosis to help guide diagnosis and management.
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Affiliation(s)
| | - Rami El-Baba
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA
| | - Andreas Kontosis
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, USA
| | - Ewa Borys
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, USA
| | - Mariah Siddiqui
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA
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Shaffer A, Johnson R, Guglielmi G, Naik A, Najafali D, Khan AA, Bellafiore FJ, Arnold PM, Hassaneen W. Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22406. [PMID: 36647253 PMCID: PMC9844530 DOI: 10.3171/case22406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/02/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Blastomyces dermatitidis is a fungus endemic to central and southern North America. While infection most commonly results in pneumonia, a small number of infections progress to systemic disease, which may include intracranial lesions. Progression to systemic disease is most common in immunocompromised patients, such as those with human immunodeficiency virus. OBSERVATIONS The authors present a 44-year-old immunocompetent male who presented following a tonic-clonic seizure. Initial workup revealed a 19-mm enhancing intracranial mass. There was avid uptake of fluorescein sodium, and an en bloc resection of the mass was performed. Histopathology revealed B. dermatitidis. Medical management included amphotericin B and azole therapy. Postoperative recovery was uneventful, and no focal neurological deficits were appreciated. LESSONS This case highlights the neurosurgical management of a rare intracranial fungal manifestation in an immunocompetent patient. A literature review was also performed to better understand the role of neurosurgery in fungal infections. There were limited cases of intracranial Blastomyces reported in immunocompetent patients, and neurosurgical management varied (no intervention, biopsy, resection) and was underreported. Too few cases are reported to suggest neurosurgical intervention for blastomycosis improves outcomes. Medical management was relatively standard with azole and amphotericin therapy.
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Affiliation(s)
- Annabelle Shaffer
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; and
| | | | | | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; and
| | - Daniel Najafali
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; and
| | - Amir A. Khan
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; and ,Infectious Diseases, and
| | | | - Paul M. Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; and ,Departments of Neurosurgery,
| | - Wael Hassaneen
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; and ,Departments of Neurosurgery,
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Pullen MF, Alpern JD, Bahr NC. Blastomycosis-Some Progress but Still Much to Learn. J Fungi (Basel) 2022; 8:jof8080824. [PMID: 36012812 PMCID: PMC9410313 DOI: 10.3390/jof8080824] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Blastomycosis, caused by Blastomyces spp., is an endemic mycosis capable of causing significant disease throughout the body. Higher rates of infection are seen in the Mississippi and Ohio River valleys, the Great Lakes region of the United States and Canada, much of Africa, and, to a lesser extent, in India and the Middle East. Limited reporting inhibits our true understanding of the geographic distribution of blastomycosis. An estimated 50% of those infected remain asymptomatic. Of those who present with symptomatic disease, pulmonary involvement is most common, while the most common extrapulmonary sites are the skin, bones, genitourinary system, and central nervous system. Itraconazole is the standard therapy for mild-moderate disease. Data for other azoles are limited. Amphotericin is used for severe disease, and corticosteroids are occasionally used in severe disease, but evidence for this practice is limited. Despite increasing incidence and geographic reach in recent years, there are still significant knowledge gaps in our understanding of blastomycosis. Here, we provide an updated review of the epidemiology, clinical presentations, and diagnostic and therapeutic approaches for this infection. We also discuss areas needing further research.
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Affiliation(s)
- Matthew F. Pullen
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jonathan D. Alpern
- Division of Infectious Diseases, HealthPartners, Bloomington, MN 55425, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Nathan C. Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Correspondence:
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Multiple Brain Abscesses of Odontogenic Origin. May Oral Microbiota Affect Their Development? A Review of the Current Literature. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the last few years, the role of oral microbiota in the setting of oral diseases such as caries, periodontal disease, oral cancer and systemic infections, including rheumatoid arthritis, cardiovascular disease and brain abscess (BA), has attracted the attention of physicians and researchers. Approximately 5–7% of all BAs have an odontogenic origin, representing an important pathological systemic condition with a high morbidity and mortality. A systematic search of two databases (Pubmed and Ovid EMBASE) was performed for studies published up to 5 January 2021, reporting multiple BAs attributed to an odontogenic origin. According to PRISMA guidelines, we included a total of 16 papers reporting multiple BAs due to odontogenic infections. The aim of this review is to investigate the treatment modality and the clinical outcome of patients with multiple BAs due to odontogenic infections, as well as to identify the most common pathogens involved in this pathological status and their role, in the oral microbiota, in the onset of oral infections. A multidisciplinary approach is essential in the management of multiple BAs. Further studies are required to understand better the role of microbiota in the development of multiple BAs.
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