Concurrent Sphingomonas paucimobilis and Mycobacterium tuberculosis Meningitis in an Immunocompromised Patient: A Rare Case Report and Comprehensive Review of Literature.

Sphingomonas paucimobilis is a gram-negative bacillus that is widely distributed in the environment but rarely causes infections in humans. Meningitis caused by S. paucimobilis is an extremely rare clinical entity with very few reported cases in the literature. The clinical presentation and management of S. paucimobilis meningitis are not well established, and further research is needed to better understand this rare infection. Therefore, the goal of this study was to present probably the only case of meningitis caused by co-infection with S. paucimobilis and Mycobacterium tuberculosis and to describe the diagnostic and therapeutic challenges encountered, in correlation with the other very few reported cases of S. paucimobilis meningitis. A 64-year-old male farmer residing in a rural area was admitted with symptoms of severe headache, somnolence, and confusion. He had several comorbidities, including adrenal insufficiency, duodenal ulcer, and hypercholesterolemia. Lumbar puncture showed elevated leukocyte counts, glucose, and a marked rise of cerebrospinal fluid (CSF) proteins, indicating bacterial meningitis, which was confirmed by CSF culture that isolated S. paucimobilis and Mycobacterium tuberculosis. Antituberculosis therapy was initiated with isoniazid (300 mg/day), rifampicin (600 mg/day), pyrazinamide (2000 mg/day), and streptomycin (1 g/day). Ceftriaxone was introduced nine days later, after CSF culture grew S. paucimobilis, and was discharged without complications after 40 days of hospitalization. The literature search revealed a total of 12 published cases of S. paucimobilis meningitis in patients ranging from two months old to 66 years old. Among these cases, eight (66%) reported a favorable outcome, while two (17%) cases resulted in a poor outcome, and two (17%) were fatal. It was observed among the 13 identified cases (including ours) that the CSF white blood cell count had an average of 178.9 × 103/mm3, an average glucose level of 33.0 mg/dL, and an average protein count of 294.2 mg/dL. Most cases improved appropriately under antibiotic therapy with intravenous ceftriaxone, Meropenem, and Vancomycin. In conclusion, although extremely rare, S. paucimobilis meningitis has good outcomes even in immunocompromised patients with appropriate antibiotic therapy and close monitoring, while the diagnosis should not be excluded even in immunocompetent patients.

The Assessment of Multiplex PCR in Identifying Bacterial Infections in Patients Hospitalized with SARS-CoV-2 Infection: A Systematic Review.

Bacterial infection can occur in patients hospitalized with SARS-CoV-2 in various conditions, resulting in poorer outcomes, such as a higher death rate. This current systematic review was conducted in order to assess the efficiency of multiplex PCR in detecting bacterial infections in hospitalized COVID-19 patients, as well as to analyze the most common bacterial pathogens and other factors that interfere with this diagnosis. The research was conducted using four electronic databases (PubMed, Taylor&Francis, Web of Science, and Wiley Online Library). Out of 290 studies, nine were included in the systematic review. The results supported the use of multiplex PCR in detecting bacteria, considering its high sensitivity and specificity rates. The most common bacterial pathogens found were Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Haemophilus influenzae. The median age at admission was 61.5 years, and the majority of patients were men (70.3%), out of a total of 1553 patients. The proportion of ICU admission was very high, with a pooled proportion of 52.6% over the analyzed studies, and an average duration of hospitalization of 13 days. The mortality rate was proportionally high, as was the rate of ICU admission, with a pooled mortality of 24.9%. It was discovered that 65.2% of all patients used antibiotics before admission, with or without medical prescription. Antibiotic treatment should be considered consciously, considering the high risks of developing antibiotic resistance.

Clinical Presentation and Risk Factors of Infective Endocarditis in the Elderly: A Systematic Review.

Infective endocarditis (IE) is a bacterial infection with high morbidity and mortality rates, particularly among the elderly. This systematic review was conducted to determine the clinical characteristics of IE in older adults and the risk factors that could lead to adverse outcomes. The research employed three databases (PubMed, Wiley, and Web of Science), with a primary search for studies that have described cases of IE in patients older than 65 years. From a total of 555 articles, 10 were selected for inclusion in the current study, comprising a total of 2222 patients with a confirmed diagnosis of IE. The primary findings were an increased incidence of staphylococcal and streptococcal infections (33.4% and32.0%, respectively), an increased prevalence of comorbidities, namely, cardiovascular disease, diabetes, and cancer, and a significantly greater mortality risk than the younger group. Regarding mortality risks, the pooled odds ratio for cardiac disorders was OR = 3.81, septic shock OR = 8.22, renal complications OR = 3.75, and advancing age OR = 3.54 were most frequently mentioned. Taking into consideration the fact that the majority of the elderly population suffers from significant complications and is unable to undergo surgery due to an increased risk of complications after the procedure, it is imperative that effective treatment methods should be investigated.