c Sphingomonas koreensis is an aerobic Gram-negative rod originally described in 2001 following isolation from natural mineral water in Korea. Here, we report a case study with Sphingomonas koreensis as the causative agent of meningitis. To our knowledge, this is the first documented case of Sphingomonas koreensis as a human pathogen. CASE REPORT In 1997, a 14-year-old female patient underwent surgery due to a syrinx in the cervical portion of her medulla. A cystoperitoneal shunt system was inserted, and the column was stabilized with pedicle screws and metal plates corresponding to T1-T2 and T11-T12.In 2003, she was diagnosed with secondary amenorrhea due to a pituitary adenoma. A transsphenoidal resection of the tumor was attempted in 2005, but bleeding resulted in the operation being unsuccessful.In November 2012, the patient was diagnosed with bacterial meningitis. The cerebrospinal fluid (CSF) showed the following: elevated leukocytes of 290 nucleated cells/l with 80% neutrophils, protein concentration at 0.7 g/liter, and CSF glucose concentration of 1.1 mmol/liter. No bacteria were observed in a concentrated Gram stain of the CSF, but Staphylococcus epidermidis and Staphylococcus warneri were isolated. After susceptibility testing of the two isolates, the patient received a 2-week course of intravenous ceftriaxone (4 g once daily). Twelve days after stopping the ceftriaxone treatment, the symptoms of meningitis returned. The CSF showed elevated leukocytes of 853 nucleated cells/l with 85% neutrophils, protein concentration at 0.6 g/liter, and CSF glucose concentration of 0.6 mmol/liter. Again, no bacteria were observed in a concentrated Gram stain, but S. epidermidis was cultured from the CSF and intravenous ceftriaxone was reinstituted. Initially, the clinical response was satisfactory; however, the symptoms recurred in January 2013. Following this recurrence, the decision was made to switch the treatment plan to intravenous meropenem (2 g three times a day) and intravenous vancomycin (1 g twice daily). Treatment with intravenous meropenem and vancomycin continued until the removal of the shunt system in February 2013. It should be noted that the peritoneal part of the shunt system could not be removed. The remaining part had no interaction with the central nervous system. Two weeks after surgical removal of the shunt, the patient was admitted to the Department of Infectious Diseases with a headache, stiff neck, and confusion. The CSF showed the following: elevated leukocytes of 335 nucleated cells/l with 70% neutrophils, protein concentration of 1.2 g/liter, and CSF glucose concentration of 0.6 mmol/liter. Treatment with intravenous meropenem (2 g three times a day) and vancomycin (1 g twice daily) was initiated, and temporary external lumbar drainage was performed. A magnetic resonance imaging scan showed a cranionasal fistula at the point of the previous transsphenoidal resection from 2005. Subsequently, a brain computed tomography showed two osseous defects in the sphenoid sinus. Blood cultures taken ...
The burden of Schistosoma haematobium-associated bladder cancer is very high in Africa; nevertheless the disease can pose considerable diagnostic challenges in low prevalence countries. We present the case of a 40-year-old HIV co-infected woman, originally from Mozambique, who had persisting haematuria for more than a year. Investigations revealed invasive S. haematobium-associated squamous cell bladder cancer. If her origin had been taken into account, the diagnosis might have been made earlier. Awareness of the disease prevalence among HIV co-infected patients from endemic areas and timely screening of such patients is important for the early diagnosis of schistosomiasis and related complications, such as S. haematobium-associated squamous cell bladder cancer.
The case presented here illustrates that interdisciplinary teamwork can be essential for the understanding of the COVID-19 disease presentation and enlightening of the pathophysiology. A 60-year-old woman without any comorbidities, apart from overweight, was found dead in her apartment after 14 days of home isolation due to suspicion of COVID-19. A forensic autopsy was performed. This revealed severely condensed, almost airless, firm lungs, and the cause of death was severe acute respiratory distress syndrome-associated with COVID-19 (SARS-CoV-2). In addition, SARS-CoV-2 was detected with reverse transcription polymerase chain reaction (RT-PCR) in cerebrospinal fluid, lung tissue, and tracheal sample and specific antibodies for SARS-CoV-2 were detected in cerebrospinal fluid and serum. Subsequent sequencing of the SARS-CoV-2 virus showed variation in nucleotides at 3 sites between SARS-CoV-2 isolates recovered from the tracheal sample, cerebrospinal fluid, and tissues from both lungs, and phylogenetic analysis revealed that the spinal fluid sample differed the most from the other 3 samples. This case supports the hypothesis that SARS-CoV-2 may be neuroinvasive and cause central nervous system infection.
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