Rhodococcus Empyema in an Immunocompetent Patient.

Rhodococcus (R.) equi is a gram-positive, facultative intracellular coccobacilli that most commonly causes pulmonary infections in animals and, rarely, in immunocompromised humans. Infected patients typically experience severe pulmonic infections such as necrotizing or cavitary pneumonia. We describe a rare case of R. equi that was isolated from an empyema in a 66-year-old immunocompetent patient experiencing recurrent pleural effusions requiring multiple interventions.

A Rare Presentation of Cryptococcal Meningitis in a Treatment-Naive Patient with Sarcoidosis.

Cryptococcus neoformans is an encapsulated, yeast-like fungus that commonly lives in the environment due to soil contamination by the faeces of birds, especially pigeons. Cryptococcus is an opportunistic fungal infection frequently diagnosed in immunocompromised patients with HIV, steroid use, malignancy, history of organ transplantation, or, rarely, sarcoidosis. There have been only a few reports of cryptococcus infection in sarcoidosis patients who were not on steroid treatment. Here, we highlight the importance of considering opportunistic fungal infection in asymptomatic treatment-naive sarcoidosis patients. We present a patient with a history of asymptomatic, treatment-naive sarcoidosis who presented with headache and was diagnosed with cryptococcal meningitis in the presence of an idiopathic T-cell lymphopenia. LEARNING POINTS: Cryptococcus is an opportunistic fungal infection commonly diagnosed in immunocompromised patients.Sarcoidosis is a multi-systemic disease characterized by the formation of granulomas in various organs, most commonly found in the lungs and mediastinal lymph nodes.

Lactobacillus paracasei endocarditis of bioprosthetic aortic valve presenting with recurrent embolic strokes.

INTRODUCTION: Lactobacillus prosthetic valve endocarditis is a rare infection caused by Lactobacillus bacteria. This bacterium is found in the normal flora of the human mouth, gastrointestinal tract and female genital tract. While there have been isolated cases of Lactobacillus bacteraemia and endocarditis, the infections are associated with comorbidities, immune deficiency, dental manipulation procedures and other medical history. This case of bioprosthetic valve endocarditis caused by Lactobacillus paracasei is unusual, as the patient was immune-competent and treated with pre-procedural antibiotics. CASE: We present a case of a 65-year-old male who underwent a dental extraction. He presented after 3 months of fever, chills and fatigue. On initial presentation, blood cultures were positive for alpha-haemolytic streptococcus bacteraemia. He was treated with IV penicillin and underwent aortic valve replacement with a bioprosthetic valve and excision of the mitral vegetation with repair of the mitral valve. Two years later, he had a tooth extraction after being treated properly with antibiotics. Three months later he presented with difficulty speaking, left leg weakness and increased drooling. All testing was normal. Three months later he presented with left side lower extremity weakness and expressive aphasia. He was diagnosed with bioprosthetic aortic valve endocarditis and was treated with IV penicillin and gentamicin for 6 weeks and then switched to oral penicillin. He remained stable. CONCLUSIONS: L. paracasei can potentially be a cause of complicated endocarditis in patients with prosthetic heart valves undergoing dental procedures. Timely culture-guided antibiotic therapy is critical and may obviate the need for valve surgery.

Cryptococcal sternal osteomyelitis in a healthy woman: a review of Cryptococcus neoformans.

Cryptococcus, an opportunistic yeast, known to afflict immune-compromised patients is often overlooked in immune-competent patients. This has led to increasing morbidity and mortality worldwide. We present a case of Cryptococcus causing sternal osteomyelitis in an immune-competent individual. Till date no case of Cryptococcus causing sternal osteomyelitis in an immune-competent patient has been reported in the English literature since 1946-2011. With the rising incidence of Cryptococcus infection it should be included among the list of infections causing osteomyelitis. Early detection and prompt treatment can decrease both morbidity and mortality.

Botulism toxemia following laparoscopic appendectomy.

We describe a case of botulism infection in a patient who had undergone laparoscopic appendectomy, an occurrence not previously described in the literature. This case exemplifies the need for coordination between clinical and public health personnel to ensure the immediate recognition and treatment of suspected botulism cases.