ABSTRACT
Introduction: Achromobacter xylosoxidans is a rare pathogenthat causes opportunistic and rarely, nosocomial infectionsin immune-compromised patients, with high mortality. Weencountered a rare presentation of recurrent A.xylosoxidansinfection in an immune-competent individual.Case Report: A 40-year-old lady presented with a rightscapular swelling for 1 week. She had mild pain and lowgrade fever. She had no comorbidities apart from a pastlaparoscopic cholecystectomy for cholelithiasis. Monthslater, she was diagnosed with multiple liver abscesses, withA.xylosoxidans as the causative organism gown in culture. Shewas asymptomatic for 2 years thereafter. The right scapularswelling was diffuse, non-tender and non-erythematous.Conclusion: A.xylosoxidans rarely causes liver abscesses,although there have been few reports of similar cases in patientsfollowing cholecystectomy, similar to the case in discussion,indicating a possible association between cholecystectomyand A.xylosoxidans infection, even in immune-competentpatients. Infection may be recurrent, and may requireprolonged antibiotic therapy and close surveillance.
ABSTRACT
Aspergillosis in the central nervous system (CNS) is a very rare disease in immune-competent patients. There was a case of a healthy man without a history of immune-compromised disease who had invasive aspergillosis with unusual radiologic findings. A 48-year-old healthy man with diabetes mellitus, presented with complaints of blurred vision that persisted for one month. Brain magnetic resonance imaging (MRI) showed multiple nodular enhancing lesions on the right cerebral hemisphere. The diffusion image appeared in a high-signal intensity in these areas. Cerebrospinal fluid examination did not show any infection signs. An open biopsy was done and intraoperative findings showed grayish inflammatory and necrotic tissue without a definitive mass lesion. The pathologic result was a brain abscess caused by fungal infection, morphologically aspergillus. Antifungal agents (Amphotericin B, Ambisome and Voriconazole) were used for treatment for 3 months. The visual symptoms improved. There was no recurrence or abscess pocket, but the remaining focal enhanced lesions were visible in the right temporal and occipital area at a one year follow-up MRI. This immune-competent patient showed multiple enhancing CNS aspergillosis in the cerebral hemisphere, which had a good outcome with antifungal agents.
Subject(s)
Humans , Abscess , Amphotericin B , Antifungal Agents , Aspergillosis , Aspergillus , Biopsy , Brain , Brain Abscess , Central Nervous System , Cerebrum , Diabetes Mellitus , Diffusion , Follow-Up Studies , Magnetic Resonance Imaging , Rare Diseases , Recurrence , Vision, OcularABSTRACT
El género Aspergillus es ubicuo en la naturaleza y de distribución universal. Por esta razón, el contacto con este hongo incluye hospederos inmunocompetentes e inmunosuprimidos. La vía aérea es la forma más frecuente de adquirir este hongo y sus manifestaciones clínicas y localización topográfica se relacionan con la interacción del hongo y la capacidad inmunológica del hospedero. La principal manifestación clínica de este hongo es a nivel respiratorio, con un impacto muy importante en mortalidad y morbilidad, especialmente en el paciente inmunosuprimido. Los pacientes con tumores hematológicos, trasplantes de corazón, pulmón y con sida son más susceptibles de presentar invasión tisular y vascular por este hongo, que en tales casos se manifiesta como Aspergilosis Invasora (AI). La AI ofrece dificultades diagnósticas en el hospedero inmunosuprimido por lo que en este grupo de pacientes el uso de métodos de diagnóstico no invasores permite guiar el abordaje terapéutico. En la actualidad se dispone de medicamentos antifúngicos del grupo de los azoles (voriconazol) y de las equinocandinas (caspofungina) que han mejorado el resultado de la AI. En este artículo se actualiza la literatura en cuanto al diagnóstico y tratamiento de la AI.
The genus Aspergillus is ubiquitous in nature and has universal distribution; for this reason contact with this fungus includes immunocompetent and non-immunocompetent hosts. The most common form of acquiring this fungus is through air, and its clinical manifestations and topographic location correspond to the interaction of the fungus and its host's immune capacity. The main clinical manifestation of this fungus is a breathing condition and has a very significant impact on mortality and morbidity, especially in non-immunocompetent patients. Patients with haematological malignancies, heart or lung transplant surgeries, and AIDS are the most susceptible to present tissue and vascular invasion by this fungus in the form of invasive aspergillosis (IA). The IA presents diagnostic difficulties in non-immunocompetent hosts; therefore using non-invasive diagnosis methods for this group of patients offers therapeutic approach guidance. Antifungal drugs such as azoles (voriconazole) and echinocandins (caspofungin), that have improved the AI group results, are available nowadays. This article updates the literature on AI diagnosis and treatment.