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The occurrence of a multidrug-resistant tuberculous retropharyngeal abscess in an immunocompetent patient: A case report.

ABSTRACT: Retropharyngeal abscess is an uncommon location of tuberculosis (TB). In this report, we describe a multidrug-resistant tuberculous retropharyngeal abscess in a 21-year-old female patient who was treated for lymph node TB for one year. CT scan revealed a large retropharyngeal abscess that was aspirated intraorally under local anesthesia. The diagnosis of TB was retained by molecular and histological study. GeneXpert MTB/ RIF (Cepheid, Sunnyvale, CA, USA),performed on the pus, showed rifampicin resistance and a first- and second-line drug resistance test using Genotype MTBDRplus VER.2 and MTBDRsl VER.1 (Hain Lifescience GmbH, Nehren, Germany) showed TB highly resistant to rifampicin, isoniazid, and aminoglycosides. Treatment is primarily medical as it combines specific antituberculous antibiotics, and aspiration for drainage of the abscess. Our patient was put on long-term 2nd line anti-TB treatment.

SUBMITTER: Tiresse N

PROVIDER: S-EPMC8433240 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Brain Abscess Caused by <i>Nocardia brevicatena</i> in an Immunocompetent Patient: A Case Report.

Project description:Nocardia brain abscess is relatively rare and generally occurs in immunodeficient patients. Here, we present the first case of brain abscess due to Nocardia brevicatena in an immunocompetent patient, with unknown origin. In this case, a 49-year-old man was admitted to our hospital with limb twitching and complained of a history of intermittent headache. He was diagnosed with brain abscess through brain imaging and cured after craniotomy for abscess excision and targeted antibiotic treatment. Surgical specimens were sent for further detection. The causative organism was identified by weak acid-fast staining, culture and metagenomic next-generation sequencing (mNGS). We hope this case could provide a reference for incoming patients as well as their clinical management.

| S-EPMC9805727 | biostudies-literature

Immunocompetent patient with a brain abscess caused by Nocardia beijingensis in Latin America: A case report.

Project description:RationaleNocardia species are not commonly referred as primary infectious entities but rather as opportunistic pathogens. Infectious cases of Nocardia spp. in immunocompetent individuals are rare.Patient concernsAn immunocompetent 58-year-old patient presented with recurrent headaches.DiagnosisA brain abscess was found and surgically drained. Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and heat shock protein 65/16S-23S rRNA gene intergenic spacer genotyping from the sample revealed the etiological agent as Nocardia beijingensis.InterventionsMeropenem/amikacin/Trimethoprim-sulfamethoxazole were administered.OutcomesThe infection persisted leading to the patient's death.LessonsHere we present the first case of N. beijingensis infection of the central nervous system in an immunocompetent patient from Latin America. Further inquiry is needed to establish whether this species is more virulent than other Nocardia isolates.

| S-EPMC6426588 | biostudies-literature

Intracranial fusarium fungal abscess in an immunocompetent patient: case report and review of the literature.

Project description:Introduction Fusarium spp is an omnipresent fungal species that may lead to fatal infections in immunocompromised populations. Spontaneous intracranial infection by Fusarium spp in immunocompetent individuals is exceedingly rare. Case Report An immunocompetent 33-year-old Hispanic woman presented with persistent headaches and was found to have a contrast-enhancing mass in the left petrous apex and prepontine cistern. She underwent a subsequent craniotomy for biopsy and partial resection that revealed a Fusarium abscess. She had a left transient partial oculomotor palsy following the operation that resolved over the next few weeks. She was treated with long-term intravenous antifungal therapy and remained at her neurologic baseline 18 months following the intervention. Discussion To our knowledge, this is the first reported case of Fusarium spp brain abscess in an immunocompetent patient. Treatment options include surgical intervention and various antifungal medications. Conclusion This case demonstrates the rare potential of intracranial Fusarium infection in the immunocompetent host, as well as its successful treatment with surgical aspiration and antifungal therapy.

| S-EPMC4242827 | biostudies-other

Thoracic Spondylodiscitis Caused by Methicillin-resistant Staphylococcus aureus as a Superinfection of Pulmonary Tuberculous Granuloma in an Immunocompetent Patient: A Case Report.

Project description:Study Design Case report. Objective To describe a very rare case of an immunocompetent man who underwent surgery for thoracic spondylodiscitis caused by methicillin-resistant Staphylococcus aureus (MRSA) that developed as a superinfection of a pulmonary tuberculous granuloma. Methods Posterior decompression and pedicle screw vertebral fixation were followed by T5-T6 anterior somatotomy with implant of an expandable mesh and lateral plating as symptoms worsened. During the anterior approach, an atypical resection of the left lower lobe was also performed. Results A tuberculous granuloma was detected on histology. Ziehl-Neelsen stain confirmed the diagnosis. Culture also detected MRSA. Conclusions Early medical management is the first choice for spondylodiscitis to eradicate the infection and alleviate pain. Immobilization of the affected spine segments can protect the patient from vertebral collapse and from the appearance of neurologic deficits. Surgery is suggested if there are compressive effects on the spinal cord, spinal epidural abscess, vertebral collapse, and deformity. We decided to remove the abscess and to restore the anterior column using an anterior approach. Moreover, in this case, an anterior approach allowed us to identify the etiology of the lesion and to determine the best chemotherapy regimen.

| S-EPMC4369207 | biostudies-other

Differentiation of retropharyngeal calcific tendinitis and retropharyngeal abscess: a case series and review of the literature.

Project description:IntroductionRetropharyngeal calcific tendinitis (RCT) is a self-limiting aseptic inflammation of the tendon of the longus colli muscle, which can be clinically and radiologically misdiagnosed as abscess formation. This is a particular challenge for ENT specialists. However, articles about RCT are highly underrepresented in ENT journals and existing articles in ENT journals almost exclusively report overtreatment.MethodsThis study presents five patients, in which the diagnosis of RCT was delayed and of which one patient underwent incision and draining of a suspected retropharyngeal abscess under general anesthesia. In addition, the literature on the reported cases of RCT, between 1990 and 2020 was reviewed. For each case, epidemiological characteristics, complaints on presentation, symptoms, imaging and laboratory finding and treatment were summarized and compared to our own findings.ResultsIn all the five patients, the correct diagnosis was delayed. One patient underwent incision and draining of a suspected RA under general anesthesia. All patients received antibiotic treatment. The literature review revealed a total of 116 reported cases of RCT. A total of 99 CT scans and 72 MRI showed soft tissue swelling in 89.6% and calcifications in 91.4% of the cases, 6.9% received invasive treatment.ConclusionThis article emphasizes the importance of knowledge about RCT and its management to avoid invasive and potentially harmful treatment. The focus in establishing the correct diagnosis of RCT is the identification and correct interpretation of clinical symptoms together with the specific radiological findings.

| S-EPMC7410824 | biostudies-literature

Nocardia brain abscess in an immunocompetent patient.

Project description:Nocardia cerebral abscess is rare, constituting approximately 1-2% of all cerebral abscesses. Mortality for a cerebral abscess of Nocardia is three times higher than that of other bacterial cerebral abscesses, therefore, early diagnosis and therapy is important. Nocardia cerebral abscess is generally occur among immunocompromised patients, and critical infection in immunocompetent patients is extremely rare. We report on a case of a brain abscess by Nocardia farcinica in an immunocompetent patient who received treatment with surgery and antibiotics. This is the second case of a brain abscess caused by N. farcinica in an immunocompetent patient in Korea.

| S-EPMC3970313 | biostudies-literature

An aortic root abscess complicating a non-previous underlying heart disease infective endocarditis in an immunocompetent young patient: A case report.

Project description:Introductionand importance: Aortic infective endocarditis is a well described fatal disease that develops along the edges of the heart valves, although it can affect native and prosthetic valves, infection seldom affects a previously normal ones. Aortic root abscess as a complication of normal native aortic valve endocarditis is less recognized and described, it is a potentially fatal condition, which the diagnosis is based on clinical, biology, echocardiography and especially the intraoperative findings. Both native and prosthetic valve infection can be complicated by an aortic abscess, associated with a significant mortality rate, which often requires surgical intervention.Case reportWe report here a case of young man, with no major pathological history, non-systemic or valvular predisposing diseases, was admitted for the assessment of a prolonged fever with no obvious cause, and in whom an aortic abscess was suspected on an echocardiography and confirmed by transesophageal echocardiography and histopathology, complicating a negative blood culture infective endocarditis.ConclusionUp to date, the incidence of infective endocarditis continues to rise, with a significant rate of mortality and complications, however the physiopathology mechanism remain insufficiently studied.

| S-EPMC9289315 | biostudies-literature

Brain abscess caused by Tsukamurella tyrosinosolvens in an immunocompetent patient.

Project description:We describe a previously healthy patient with chronic otitis media complicated with cerebellar abscess caused by Tsukamurella tyrosinosolvens. The organism was identified based on conventional biochemical identification methods, PCR-restriction fragment length polymorphism analysis of the hsp65 gene, and 16S rRNA gene sequencing. The patient was treated successfully with debridements and prolonged antibiotic therapy.

| S-EPMC2681870 | biostudies-literature

Cutaneous disseminated sporotrichosis in immunocompetent patient: Case report and literature review.

Project description:Sporotrichosis is a global occurring implantation (subcutaneous) mycosis, caused by Sporothrix species, usually affecting the skin and the lymphatic vessels, from where it can disseminate. Nowadays, the vast majority of sporotrichosis infections in Brazil are caused by zoonotic transmission of S. brasiliensis which is the main etiologic agent. We report a cutaneous disseminated case of this disease, observed in an immunocompetent farmer living in southern Brazil, the Sporothrix schenckii-infection was successfully treated with itraconazole.

| S-EPMC9109117 | biostudies-literature

Tuberculous cold abscess of the chest wall: A clinical and surgical experience. Report of 16 cases(Case series).

Project description:Background:Tuberculosis is a public health problem in developing countries. Tuberculosis of the chest wall is rare and often presents as cold abscess (to differentiate from pyogenic abscess) or pseudotumoral mass whose diagnosis is difficult and often requires a surgical biopsy. Patients and methods:The medical series of 16 patients with cold chest wall abscess treated with surgery in association to anti-tubercular therapy were analysed retrospectively for the period of 7 years between January 2011 to December 2017 at Mohamed V Military Teaching Hospital - Rabat - Morocco. Results:The clinical examination provided a correct preoperative diagnosis of the abscess in all cases. Five patients had a past history of pulmonary tuberculosis and three patients had concomitant active infection. There were 6 cases on the left side, 9 cases on the right side and one case on the anterior chest wall. All patients underwent surgical drainage and debridement with specimens for bacteriology and histology. It was not necessary to resect ribs or sternum in all cases (sample costal or sternal curettage in one case each). Anti-tubercular treatment was routinely administered (6-9 months) with drug combinations of Isoniaside, Rifampicin, Pyrazinamide and Ethambutol. The evolution was favorable in all cases without complications or recurrences. Conclusion:Drainage of chest wall abscess and complete debridement provide adequate treatment. Post-operative anti-bacillary therapy should be combined with surgical procedures to minimize local complications and recurrence of infection.

| S-EPMC7029049 | biostudies-literature

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