The etiopathogenesis for Guillain-Barré syndrome (GBS) and Miller-Fisher syndrome (MFS), a variant of GBS, is well-documented in the literature. However, the association between MFS and an underlying herpes simplex virus type 1 (HSV-1) infection is very limited. We present a unique case of a 48-year-old man who developed diplopia, bilateral ptosis, and gait instability following an acute diarrheal illness and recurring cold sores. The patient was diagnosed with MFS precipitated by recurrent HSV-1 infection following a Campylobacter jejuni acute infection. The diagnosis of MFS was supported by a positive anti-GQ1b ganglioside immunoglobulin (Ig)G and abnormal MRI-enhancing lesions of the bilateral cranial nerves III and VI. Intravenous immunoglobulin and acyclovir produced a significant clinical response in the patient within the first 72 hours. Our case highlights the rare association between two pathogens and MFS and the importance of recognizing risk factors, symptomatology, and appropriate workup accompanying an atypical MFS case.
Prosthetic valve endocarditis (PVE) is a complication of valve replacement associated with high morbidity and mortality. Escherichia coli ( E. coli ) is rarely associated with infective endocarditis (IE), accounting for less than 1% of the cases reported. The low frequency is attributed to the organism’s low affinity to adhere to the endocardial endothelium. Risk factors that may play a role in developing IE by E. coli include age above 70, diabetes mellitus, a genitourinary source of infection, female sex, healthcare contact, implanted endovascular devices, and immunosuppression. We present a 70-year-old Hispanic woman who arrived with constitutional symptoms and persistent urinary complaints. She had diabetes mellitus, recurrent urinary tract infections, and native mitral valve IE treated with antibiotic therapy and tissue valve replacement. The valve was replaced with a mechanical valve a second time due to malfunctioning. The patient was found to have E. coli bacteremia and ultimately diagnosed with PVE. She was treated solely with ceftriaxone and gentamicin combination therapy resulting in complete resolution of valve vegetations. Our case represents the 11th report of this uncommon disease and illustrates its epidemiology and associated risk factors. We summarize the previous 10 cases reported and highlight the lack of prospective trial data to define optimal therapy for managing PVE caused by E. coli .
Cryptococcus species are commonly isolated in the excreta of birds, but zoonotic transmission has yet to be proven. We report a case of an immunocompetent man with meningitis caused by Cryptococcus neoformans var. grubii with significant exposure to a pet cockatoo highly suspicious for zoonotic transmission. Treatment with intravenous liposomal amphotericin B and oral flucytosine was initiated upon diagnosis, but diagnostic delay because of low suspicion contributed to neurological sequelae. Recognition of pet birds as potential sources of Cryptococcus species' zoonotic transmission is essential for prompt diagnosis and treatment.
Actinomyces species are opportunistic pathogens, difficult to isolate, and often accompanied by other pathogens. We report the case of an immunocompetent woman who presented with respiratory distress and was discovered to have a right-sided empyema requiring chest tube drainage. Streptococcus species and Actinomyces odontolyticus were isolated in pleural fluid cultures. Initial empiric broad-spectrum antibiotic therapy and chest tube placement failed to show clinical improvement. Upon isolation of Actinomyces, the treatment was streamlined to ampicillin/sulbactam while pleural drainage continued, producing significant clinical status improvement in the patient. Given the known co-pathogenicity of Actinomyces species and the difficulty in isolating Actinomyces, it is essential to consider antibiotic coverage for Actinomyces species in those with Streptococcus species empyema.
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