ABSTRACT
Mycobacterium fortuitum is a rare, opportunistic pathogen most frequently contracted through contact with a contaminated source. An immunocompetent 26-year-old female patient presented to our institution with an infected lumboperitoneal (LP) shunt presenting as continued nonhealing wounds. After multiple debridements, shunt revisions, and wound closure failures, infectious disease specialists were consulted. The wound cultures returned positive for M. fortuitum and the shunt was removed. Cerebrospinal fluid studies revealed significant pleocytosis with normal opening pressure, and the patient was diagnosed as having secondary meningitis. After shunt removal, the patient was treated with intravenous and oral antibiotics, resulting in infection resolution. Five months later, a new LP shunt was placed without infection recurrence. Although M. fortuitum was previously reported in neurosurgical patients with ventriculoperitoneal shunts, which are summarized here, to date this is the first case in the literature of M. fortuitum meningitis from an LP shunt. This case demonstrates the importance of clinicians considering uncommon and slow-growing pathogens, as well as consulting infectious disease specialists for patients with persistent, unexplained infections.
Subject(s)
Catheter-Related Infections/diagnosis , Cerebrospinal Fluid Shunts , Meningitis, Bacterial/diagnosis , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium fortuitum , Pseudotumor Cerebri/surgery , Adult , Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Catheter-Related Infections/therapy , Device Removal , Female , Humans , Imipenem/therapeutic use , Immunocompetence , Meningitis, Bacterial/therapy , Mycobacterium Infections, Nontuberculous/therapyABSTRACT
Nonmenstrual toxic shock syndrome (TSS) due to Staphylococcus aureus can lead to significant morbidity and mortality. While drotrecogin alfa (DA) has been employed in patients with Methicillin-resistant Staphylococcus aureus (MRSA) severe sepsis and septic shock, its utility in TSS remains unclear. The authors report a case of severe sepsis in the setting of MRSA-associated TSS that responded to treatment with DA. This case illustrates a potential role for DA in the treatment of toxic shock syndromes and emphasizes the importance of aggressive diagnostic and therapeutic modalities in approaching these conditions.
Subject(s)
Anti-Infective Agents/therapeutic use , Protein C/therapeutic use , Shock, Septic/drug therapy , Shock, Septic/microbiology , Staphylococcal Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Dermatitis, Exfoliative/microbiology , Female , Herniorrhaphy , Humans , Methicillin Resistance , Middle Aged , Recombinant Proteins/therapeutic use , Respiration, Artificial , Shock, Septic/therapy , Surgical Mesh , Surgical Wound Infection/microbiologyABSTRACT
OBJECTIVES: Acute flaccid paralysis (AFP) has recently emerged as a major central nervous system complication associated with West Nile virus (WNV) infection. The spectrum of clinical presentations of AFP in WNV infection and its sequelae have not been well-studied. METHODS: We describe three patients with AFP due to WNV infection and review the clinical presentations of 56 patients with this complication derived from published studies. RESULTS: Patients with AFP and WNV presented with a spectrum of illness ranging from single extremity paralysis to quadriparalysis with cranial nerve involvement. Patients commonly developed respiratory failure (54%) and bladder dysfunction (22%). While fever was nearly universal (92%), signs of meningismus were less common (17%). Cerebrospinal fluid (CSF) analysis generally revealed a modest pleocytosis, and imaging studies were not diagnositic. Persistent neurologic impairment occurred in all survivors; overall mortality rate was high (22%) and was associated with both the extent of paralysis and advanced age. CONCLUSION: AFP in the setting of WNV is associated with significant mortality and long-term morbidity.
