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The present study describes the case of a 33-year-old male patient, who was diagnosed with concurrent infections of Rhodococcus hoagii (R. hoagii), Mycobacterium intracellulare (M. intracellulare), human immunodeficiency virus (HIV) and syphilis. This patient, a homeless farm laborer with no prior medical treatments, exhibited symptoms including persistent fever and cough, and was admitted to hospital. Treatment was initiated with a combination of anti-retroviral therapy with emtricitabine/tenofovir alafenamide/dolutegravir, and antibiotics (azithromycin, rifampicin, amikacin and ethambutol) targeted at both R. hoagii and M. intracellulare, alongside adjustments for drug-drug interactions due to rifampicin administration. Despite initial improvements and discharge after 21 days with scheduled outpatient follow-ups, the patient did not return for further treatment monitoring. The case presented herein underscores the challenges in managing complex infections in severely immunocompromised patients and highlights the need for integrated treatment approaches, careful drug management, and robust follow-up systems to ensure adherence and prevent relapse. In addition, the present case report contributes to the limited literature available on R. hoagii infections in HIV-infected individuals and highlights the need for early intervention and comprehensive management in similar clinical scenarios [ABSTRACT FROM AUTHOR]

Plasmodium falciparum (P. falciparum) malaria continues to pose a significant threat to public health worldwide, particularly in endemic areas. While the majority of cases can be effectively treated and cured, recurrences of P. falciparum malaria are not uncommon and can occur years following initial exposure. This phenomenon adds a new level of complexity to the management and prevention of the disease. The present study describes the compelling clinical case of a patient who contracted malaria despite not having been in an endemic region for over a decade. The patient had previously been infected and treated for the same disease. With low parasitemia, the patient was successfully treated with anti-malarial drugs; however, certain aspects of his medical history remained unclear. The present study also discusses the possibility that this case represents P. falciparum recrudescence or cryptic malaria, drawing on existing literature to contextualize the findings. The case presented herein highlights the need for continued vigilance in the diagnosis and treatment of P. falciparum malaria, particularly in instances of recurrence. Furthermore, it underscores the ongoing challenges posed by this persistent and insidious disease. [ABSTRACT FROM AUTHOR]

During the ongoing coronavirus disease 2019 (COVID-19) pandemic, a number of autoimmune diseases have been found to be associated with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection, with thrombocytopenia being the most common. The present study describes the case of a female patient who tested positive for SARS-CoV-2 infection from samples from two nasopharyngeal swabs examined using RT-PCR; she was admitted to hospital for severe anaemia. The woman also tested positive to direct antiglobulin test (DAT). In addition, the literature was reviewed for cases of anaemia concomitant to COVID-19 and only cases of autoimmune haemolytic anaemia (AIHA) with positive DAT were considered. A total of 38 cases of AIHA concomitant to COVID-19 were identified. In the cases reported in the literature, both warm AIHA and cold agglutinin disease were observed, with a marked prevalence of CAD. The majority of the cases identified in the literature, including the patient described herein, have had a full recovery from both COVID-19 and AIHA; however, as some of the patients visited the hospital for observation when their condition was already at an advanced and severe stage, effective therapy could not be administered and they consequently succumbed. On the whole, as autoimmune anaemia may be a consequence of SARS-CoV-2 infection, it should perhaps be considered among the haematological autoimmune disorders secondary to COVID-19, along with thrombocytopenia. [ABSTRACT FROM AUTHOR]

Laryngeal leishmaniasis represents an infrequent manifestation of mucosal leishmaniasis, and even rarer is the coexistence of mucosal and visceral relapse. The present study describes the case of the simultaneous occurrence of relapsing mucosal and visceral leishmaniasis in a patient infected with human immunodeficiency virus (HIV) who was under secondary prophylaxis with liposomal amphotericin B. The clinical manifestations, diagnostic approaches employed and the treatment regimen implemented are described herein. Furthermore, the present study discusses the implications of the co-infection between leishmaniasis and HIV on the host immune response and the management strategies employed for relapsing forms. Emphasizing the necessity for the prompt initiation of targeted treatment to enhance clinical outcomes, the present study underscores the critical importance of maintaining a heightened level of suspicion for laryngeal leishmaniasis relapse in individuals with HIV exhibiting persistent laryngeal symptoms. [ABSTRACT FROM AUTHOR]

Although legionellosis represents a widely underestimated disease for various reasons, the rate of Legionella pneumophila infections has increased steadily over the past 30 years. The present study describes the characteristics of patients hospitalized due to legionellosis. The present study retrospectively reviewed 10 cases of legionellosis during the defined period and documented the epidemiological and clinical characteristics of the patients, as well as the methods used for diagnosis and therapeutic management. The majority of the patients were male (80%) with a mean age of 55.8 years. The most common comorbidities were hypertension (40%) and tumors (20%). Fever was present in all the cases (100%) and the most frequent imaging finding was lung consolidation. Half of the cases exhibited hyponatremia, 40% of them had leukocytosis, and 50% of the patients presented elevated procalcitonin levels, as well as elevated levels of transaminases. In total, 2 patients (20%) required non-invasive oxygen support. All the cases presented a positive urinary antigen test for Legionella pneumophila serogroup 1. A total of 9 patients (90%) received levofloxacin-based therapy for a mean duration of 17.7 days. All the cases described herein were successfully discharged without any complications. On the whole, the present study demonstrates that a prompt clinical diagnosis along with early testing and treatment represent the cornerstone for positive outcomes in patients affected by Legionnaire's disease. [ABSTRACT FROM AUTHOR]

Stenotrophomonas maltophilia (S. maltophilia) is a difficult‑to‑treat bacteria. This glucose non‑fermenting, multidrug‑resistant Gram‑negative bacillus is known to cause a range of infections, such as skin manifestations and bacteraemia, with respiratory tract infections being the most common. Patients in intensive care units are often exposed to a higher risk of acquiring an infection caused by this pathogen. Although distinguishing between S. maltophilia infections and colonization can be challenging, pneumonia caused by S. maltophilia infection is becoming increasingly prevalent. Furthermore, S. maltophilia infections are often coupled with Pseudomonas aeruginosa infections, reinforcing the need to consider this bacterium as a potential cause of ventilator‑associated pneumonia (VAP). The present study describes the case of a 66‑year‑old male who was diagnosed with VAP due to S. maltophilia infection. This condition was effectively treated with trimethoprim/sulfamethoxazole. The case described herein underscores the importance of prompt recognition through heightened clinical suspicion, particularly in patients with VAP who are unresponsive to broad‑spectrum β‑lactam antibiotics. The early identification of S. maltophilia as the root cause of respiratory tract infections can make a significant difference to the outcomes of affected patients. [ABSTRACT FROM AUTHOR]

Acute and chronic bacterial prostatitis are considered infections which are cumbersome to treat, due to the limited available selection of effective antibiotics and the pharmacologically poor distribution in prostatic tissue. Furthermore, the emergence of novel antimicrobial resistance patterns, such as extended spectrum β‑lactamase (ESBL)‑producing Escherichia coli (E. coli) along with increasing fluoroquinolone resistance poses major clinical concerns in selecting the appropriate therapy to treat and eradicate the infection, particularly considering the outpatient setting. The present study describes the case of a healthy male affected by a first acute bacterial prostatitis episode due to ESBL‑producing E. coli. The patient was successfully treated with oral fosfomycin‑trometamol administration, achieving clinical success with microbiological eradication. The case described in the present study, along with the literature review, encourage and suggest the use of oral fosfomycin for the treat‑ ment of both acute and chronic prostatitis, particularly for outpatients and for those subjects who cannot be administered other antibiotics. [ABSTRACT FROM AUTHOR]

Almost 2 years have passed since the World Health Organization declared a pandemic state for severe acute respi‑ ratory syndrome coronavirus 2 infection. The pathogenesis of coronavirus disease 2019 (COVID‑19) consists of an initial viral phase responsible for early symptoms followed by an inflammatory phase, which is cytokine‑mediated, responsible for late‑onset symptoms, culminating in acute respiratory distress syndrome. Considering that IL‑6 plays a key‑role in the development and maintenance of inflammation, drugs targeting both IL‑6 and IL‑6 receptors have been evaluated. The present study reports the cases of four hospitalized patients with severe respiratory COVID‑19 treated with a single dose of sarilumab, a monoclonal anti‑IL‑6 antibody, along with standard of care medications and oxygen therapy. A few days following sarilumab administration, the clinical and biochem‑ ical conditions began to improve, until the discontinuation of O2 therapy and discharge. The present study demonstrates that sarilumab may represent a promising drug that may be used to treat the hyperinflammatory phase; however, further trials are required to determine whether it should be used combina‑ tion with other drugs or alone, and to better understand the pharmacokinetics and related side‑effects. [ABSTRACT FROM AUTHOR]

Heart infections are not limited to infectious endocarditis. In fact, prosthetic vascular graft infections are among the most severe complications associated with vascular and cardiac surgery. The risk of developing an infection on prosthetic material is estimated to be ~5%. The mortality rate associated with the infection is estimated to be ~10-25% within 30 days of infection and 50% after 1 year. The present article describes a case of a methicillin-sensitive Staphylococcus aureus (MSSA) infection on the prosthetic material following a heart Fontan procedure. To the best of our knowledge, only one other case of extracardiac prosthesis-related infection following Fontan surgery has been reported to date in adults. Prosthetic vascular graft infections (PVGIs) are a rare complication of heart surgery. However, PVGIs can seldomly occur and are burdened by a decreased survival rate. Therefore, physicians need to promptly suspect and recognize such cases. Further studies are required however, in order to determine the feasibility and long-term survival rates of a conservative therapeutic approach. [ABSTRACT FROM AUTHOR]

Patients with sickle cell disease (SCD) are more susceptible to severe coronavirus disease 2019 (COVID‑19) infection, in comparison with the general population, due to the possibility that the inflammatory state, along with hypoxia and hypercoagulability may increase the risk of developing acute SCD‑related complications. The present study reports the case of a 33‑year‑old female affected by SCD, who although vaccinated against COVID‑19, tested positive for SARS‑CoV‑2 and developed febrile pneumonia. During hospitalization, the patient complained about generalized intense pain, along with fever recurrence and increased inflammatory marker, procalcitonin and haemoglobin S levels. The patient was treated with an intravenous analgesic therapeutics cocktail in combination with red blood cell manual exchange procedure and broad‑spectrum antibiotic therapy, achieving the rapid resolution of pain and an improvement in the laboratory test results. From the case presented herein, it is thus suggested that patients with SCD and COVID‑19 infection need to be critically evaluated by clinicians, as such patients may develop severe outcomes, attributed to the overlap of two difficult to treat conditions. [ABSTRACT FROM AUTHOR]

Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) has been shown to increase the risk of thrombotic events due to a hypercoagulable state caused by several factors. The case of a 59-year-old woman affected by hypertension and metabolic disorders, treated for a COVID-19 infection who developed cardiac symptoms during the first days of hospitalization is reported. Electrocardiogram analysis and cardiac-ultrasound confirmed ST-segment elevation myocardial infarction (STEMI) diagnosis, thus the patient underwent percutaneous coronary intervention, which was successful. This case highlights a possible association between respiratory infection, particularly SARS-CoV-2 infection, and cardiovascular events, in particular Acute Coronary Syndrome. The association between these phenomena seems related to a range of factors, including a proinflammatory state and the hypoxemia. Moreover, the association amongst SARS-CoV-2 and cardiovascular diseases may be also linked to long-term sequelae. Thus, further studies are required to better understand the multifaceted and severe complications of this disease. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection usually affects the respiratory system; however, a number of atypical manifestations of this disease have also been reported, especially in children. The present study reports a case of a 12-year-old presenting with right unilateral parotitis and sialadenitis and SARS-CoV-2 infection. The young patient, after a 3-day history of fever, was brought to our clinic (Polyclinic University Hospital 'G. Rodolico', Catania, Italy) for the sudden onset of unilateral parotitis accompanied by sialadenitis and hyperaemia of the skin, which was tender to touch. The SARS-CoV-2 molecular swab was positive; the ultrasound of the affected region showed an increase in the volume of the parotid and sublingual gland and reactive lymph nodes compatible with parotitis and sialadenitis. This case suggests that, in the present Coronavirus disease 2019 pandemic, SARS-CoV-2 should be included in the differential diagnosis of parotitis and sialadenitis along with mumps and flue. Notably, a respiratory panel and serology for other potential causes are needed in case of parotitis-like disease. [ABSTRACT FROM AUTHOR]

The management of antiretroviral therapy is intricately associated with the evaluation of the viral genetic profile, a process in which infectious disease specialists play a pivotal role in both the selection and fine-tuning of treatment protocols. The V179D aminoacidic variation within the reverse transcriptase of the human immunodeficiency virus (HIV), while not considered among major mutations, carries the potential to exert a notable effect on resistance to antiretroviral agents. Notably, this influence extends specifically to the class of non-nucleoside reverse transcriptase inhibitors, suggesting that the presence of the V179D mutation may diminish the susceptibility of the virus to certain antiretroviral drugs within this classification. The present study describes the case of a patient which delineates the management trajectory of an HIV-positive individual, commencing from the initial diagnosis in November, 2017. A genotypic resistance test revealed the presence of the V179D mutation. Of note, notwithstanding the existence of this mutation, the patient underwent a transition to a cabotegravir and rilpivirine injectable combination regimen, resulting in a favorable treatment response characterized by comprehensive and sustained viral suppression, coupled with enhancements in the immunological profile. The case described herein underscores the critical significance of a tailored approach in the management of HIV, wherein therapeutic strategies are adeptly tailored to the unique exigencies of people living with HIV. [ABSTRACT FROM AUTHOR]

Listeria (L.) monocytogenes is a gram-positive, non-sporulating, facultatively anaerobic bacillus transmitted to humans through ingestion of contaminated foods. Listeriosis represents the third most common cause of death from foodborne illness, with a mortality rate of 20-30%, especially for patients affected by an invasive disease, which typically affects immunocompromised patients, pregnant women, the elderly, and neonates. It causes several clinical syndromes, of which meningitis, meningoencephalitis, and sepsis are the most challenging to deal with. Here, five cases of L. monocytogenes meningitis/meningoencephalitis affecting two previously healthy immunocompetent and three immunocompromised adult patients treated with ampicillin plus gentamicin are reported. In addition, all the patients described in this report received a low dose of intravenous dexamethasone; four of them made a full recovery. Additionally, a literature search was performed to better explain the appropriate clinical and therapeutic management approaches for these patients, highlighting the value of dexamethasone administration as part of the therapy. [ABSTRACT FROM AUTHOR]

Since late December 2019, severe acute respiratory syndrome coronavirus 2 has spread across the world, which resulted in the World Health Organization declaring a global pandemic. Coronavirus disease 2019 (COVID-19) presents a highly variable spectrum with regard to the severity of illness. Most infected individuals exhibit a mild to moderate illness (81%); however, 14% have a serious disease and 5% develop severe acute respiratory distress syndrome (ARDS), requiring intensive care support. The mortality rate of COVID-19 continues to rise across the world. Data regarding predictors of mortality in patients with COVID 19 are still scarce but are being actively investigated. The present multicenter retrospective observational study provides a complete description of the demographic and clinical characteristics, comorbidities and laboratory abnormalities in a population of 421 hospitalized patients recruited across eight infectious disease units in Southern Italy (Sicily) with the aim of identifying the baseline characteristics predisposing COVID-19 patients to critical illness or death. In this study, older age, pre-existing comorbidities and certain changes in laboratory markers (such as neutrophilia, lymphocytopenia and increased C-reactive protein levels) at the time of admission were associated with a higher risk of mortality. Male sex, on the other hand, was not significantly associated with increased risk of mortality. Symptoms such as fatigue, older age, a number of co-pathologies and use of continuous positive airway pressure were the most significant contributors in the estimation of clinical prognosis. Further research is required to better characterize the epidemiological features of COVID-19, to understand the related predictors of death and to develop new effective therapeutic strategies. [ABSTRACT FROM AUTHOR]

Among nucleos(t)ide analogue therapies for hepatitis B virus (HBV) treatment, entecavir (ETV) and tenofovir disoproxil fumarate (TDF)/tenofovir alafenamide are associated with the lowest rate of drug resistance. ETV is a drug requiring at least three substitutions in the reverse transcriptase (RT) domain to develop resistance, which is a rare occasion in treatment-naïve patients. However, pre-existing or acquired single mutations in the RT domain could lead to a virological breakthrough, after viral suppression. The present case report describes a 58-year-old female patient with hepatitis B virus (HBV) and high viral load who started HBV treatment with ETV. After 85 weeks of treatment, HBV-DNA declined to 0 IU/ml and remained undetectable for 3 years. However, after that period of time, the HBV-DNA rebounded, followed by the rise of liver enzymes (aspartate aminotransferase and alanine transaminase). Only the substitution M204I was detected in the HBV polymerase region. The patient was then switched to TDF treatment, achieving normalization of the liver enzymes and a decline in HBV-DNA levels. The present case report suggests that nucleoside-naïve patients should be cautiously monitored for resistance, even more than biochemically (transaminases, bilirubin) and virologically (HBV-DNA), even if complete HBV suppression is achieved. [ABSTRACT FROM AUTHOR]