Search Results (83)

Background/Objectives: Edwardsiella tarda is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. Case presentation: We report a term neonate born via spontaneous vaginal delivery who developed systemic signs of infection within 18 h of life. Blood and cerebrospinal fluid (CSF) cultures grew Edwardsiella tarda. CSF analysis revealed severe meningoencephalitis. Maternal stool culture was also positive for E. tarda, suggesting vertical transmission. Despite initial systemic antibiotic therapy with ampicillin, gentamicin, and ceftriaxone, neuroimaging revealed progressive multifocal brain abscesses. The infant underwent a series of neurosurgical procedures, including bilateral drainage of abscesses, Rickham reservoir placement and ventriculoperitoneal shunting. A revised antibiotic regimen, including systemic meropenem and trimethoprim-sulfamethoxazole plus intrathecal gentamicin, was administered. At six months, the infant showed mild motor delay with lower limb hypertonia and was under close neurosurgical and developmental follow-up. Methods: We conducted a literature review of 12 published neonatal E. tarda infections, including our case. Results: Most infected infants presented within 72 h of life and exhibited CNS involvement. Mortality was 25%, and 44% of survivors experienced long-term neurologic sequelae. Conclusions: Edwardsiella tarda infection in neonates is rare but potentially devastating. Early suspicion, culture confirmation, aggressive antibiotic therapy, and multidisciplinary care, including neurosurgical management, are essential for improving outcomes. Full article

Background/Objectives: Listeria monocytogenes (Lm) is an extremely rare cause of brain abscesses, accounting for 1–10% of neurolisteriosis cases reported in the literature, associated with high mortality (approximately 23%). Data on diagnosis, management, and treatment is scarce. We report a case of listerial brain abscesses in an elderly patient in Italy who experienced progressively worsening bilateral ptosis. Methods: Diagnostic evaluation included neuroimaging, blood cultures, and microbiological investigations, followed by antimicrobial treatment according to available evidence. The isolated Lm strain underwent whole genome sequencing. Dietary history was also collected. Results: Positive early blood cultures were pivotal in identifying Lm as the aetiological agent. Neuroimaging revealed brain abscesses consistent with neurolisteriosis. The clinical course was complicated by pneumonia and opportunistic co-infecting pathogens, and despite adequate treatment according to the available literature, the outcome was fatal. Genomic characterisation revealed that the patient was infected with an strain belonged to the sequence type 206 and clonal complex 14, described as hypervirulent. The patient reported consuming several foods known to be associated with an increased risk of listeriosis. Conclusions: This case highlights the challenges involved in diagnosing and managing listerial brain abscesses, particularly in elderly patients. Even when the primary central nervous system infection is under control, the prognosis may be significantly impacted by comorbid conditions and hospital-related complications rather than the infection itself. Our findings underscore the need for improved preventive strategies and targeted risk communication regarding high-risk foods, particularly among elderly populations. Full article

Invasive Mucormycosis (IM) is an extremely rare infection with a high mortality rate, caused by a group of fungi classified as Mucorales moulds. Rhizomucor pusillus is a saprophitic, thermophilic, and angioinvasive microorganism that grows and lives at about 45 °C and is usually found in different environmental spaces such as soil, air, water, food, and other organic matter. These features predispose the infection to wide dissemination, especially in immunocompromised patients and most often in children after chemotherapy for hematological malignancies (HMs). Mucormycosis in patients with hematologic malignancies and neutropenia represents between 0.07% and 4.29% of the concomitant diseases. IM can develop into an infection in different sites, but its most common manifestation is pulmonary, followed by rhino-orbital–cerebral and disseminated forms. In recent years, an increased morbidity rate has been associated with the ongoing COVID-19 pandemic, as cited in the literature. There are many publications with COVID-19-associated mucormycosis (CAM) cases. The present treatment protocol includes extensive and radical surgical debridement and systemic antifungal therapy with Liposomal Amphotericin B (L-AmB), Posaconazole, and Isavuconazole, either combined or as monotherapy. Despite these new treatment modalities, the mortality rate remains over 50%. We present a rare case of a 3-year-old child with acute lymphoblastic leukemia (ALL) and systemic Rhizomucor pusillus infection, diagnosed on the occasion of lung and brain abscesses. The patient underwent lung and brain surgery and is recovering well with no further complications. The two-year follow-up period shows no signs of recurrence of the disease. Full article

A 30-year-old previously healthy man presented with fever and headache. HIV tests yielded negative results. Cerebrospinal fluid (CSF) analysis revealed pleocytosis (619/µL), elevated protein (210.3 mg/dL) and adenosine deaminase levels, and decreased glucose levels. A positive CSF culture for tuberculosis confirmed the patient had tuberculous meningitis (TBM). He was treated with methylprednisolone, isoniazid, rifampicin, pyrazinamide, and ethambutol (all highly sensitive). His compliance with medication was good. After six weeks of treatment, he was discharged in stable condition. Eight weeks after onset, he was readmitted with vertigo and right deafness. CSF examination showed worsened pleocytosis (819/µL) and protein levels (4296.1 mg/dL). Contrast-enhanced MRI revealed enhancement of meninges in the brainstem and spinal cord as well as the right vestibulocochlear nerve. No brain abscesses were observed. Based on these findings, a paradoxical reaction (PR) with vestibulocochlear neuritis following antituberculous therapy initiation was suspected. He received oral prednisolone, leading to rapid resolution of vestibulocochlear symptoms within two days. Although cranial nerve enhancement due to PR has been mentioned in the literature, specific imaging demonstrating it is scarce. This case highlights PR as a cause of cranial neuropathy in TBM and provides clear radiological evidence of direct inflammatory spread to the vestibulocochlear nerve, bridging a gap in the current literature. Full article

Background: Neurocysticercosis is a parasitic infection of the central nervous system caused by the larval stage of Taenia solium. This disease is endemic in some countries in Central and South America, South and South-East Asia, and sub-Saharan Africa. In North America, Europe, Japan, and Australia, only sporadic cases are documented. Moreover, reports of bacterial superinfection arising within neurocysticercotic lesions remain exceptionally scarce. Methods: We report a clinically severe and diagnostically challenging case of suspected neurocysticercosis with cerebral streptococcal superinfection in a 17-year-old Italian patient with Down syndrome and no history of travel to endemic regions. Results: The patient, with pre-existing epileptic encephalopathy, presented with progressive drowsiness and altered mental status, rapidly deteriorating to cardiorespiratory arrest. Neuroimaging demonstrated multiple ring-enhancing lesions, in conjunction with positive Taenia solium serology. Streptococcus spp. was identified in one neurosurgically drained lesion, consistent with secondary bacterial involvement in association with concurrent pneumonia. Combined antiparasitic therapy and targeted antimicrobial treatment resulted in sustained clinical and radiological improvement. Conclusions: In non-endemic settings, neurocysticercosis should remain within the differential diagnosis of unexplained epilepsy and multifocal CNS lesions. Although rare, bacterial superinfection warrants consideration in atypical presentations, particularly in individuals with concomitant infectious foci and underlying immune dysfunction such as that associated with Down syndrome. Full article

Objectives: The aim of this study was to identify factors that affect the clinical course, outcome, and duration of hospital stay in patients with a brain abscess. Methods: Eighty-four inpatients with a confirmed brain abscess were the subjects of this retrospective study. The impact of several factors on the length of hospital stay was evaluated and multiple linear regression analysis was used. Results: Several factors affecting the length of hospitalization were identified. These were older age and larger abscess diameter. Conclusions: Proper handling of preexisting infections and early consideration of CNS infection, especially in high-risk groups, may reduce the incidence of brain abscess and improve its prognosis. The factors affecting the length of hospitalization shown in this study should be considered upon admission to reduce patients’ unfavorable outcomes. Full article

Introduction: Brain abscess is defined as a suppurative collection resulting from hematogenous dissemination as an extension from otorhinolaryngologic infectious foci, or secondary to cranial trauma and neurosurgical procedures. Its evolution follows four histopathological stages, the most severe complication being intraventricular rupture, which is associated with extremely high mortality. Central nervous system infections caused by multidrug-resistant (MDR/XDR) Acinetobacter baumannii are rare but severe, significantly limiting therapeutic options due to the reduced penetration of the blood-brain barrier by active antimicrobial agents. Case report: We report the case of a 48-year-old patient with a history of hemorrhagic stroke treated surgically, who was admitted for fever, severe headache, and vomiting. On admission, lumbar puncture confirmed bacterial meningitis, with isolation of A. baumannii susceptible only to colistin. Brain magnetic resonance imaging revealed a postoperative cerebellar abscess. Initial empirical therapy consisted of meropenem and vancomycin, subsequently adjusted according to the susceptibility profile to cefiderocol, intravenous and intrathecal colistin, combined with ampicillin/sulbactam and minocycline. The clinical course was favorable with regard to meningitis, with partial regression of the cerebellar abscess. Follow-up lumbar punctures were sterile, and the patient’s neurological condition stabilized, allowing avoidance of neurosurgical drainage. Conclusions: Meningitis and brain abscess caused by MDRA. baumannii represent rare clinical entities with potentially severe outcomes. Intrathecal administration of colistin, in combination with systemic multidrug therapy, proved decisive in controlling the infection. An interdisciplinary approach and individualized antimicrobial regimens are essential to achieving a favorable prognosis in such complex cases. Full article

Background/Objectives: Streptococcus pyogenes (Group A Streptococcus, GAS) is a major human pathogen that causes a wide spectrum of diseases. While mild infections like pharyngitis and impetigo are common, severe and invasive infections, though less frequent, pose significant health risks, particularly in children. In recent years, the re-emergence of hypervirulent GAS strains has heightened global concern. Nowadays, the absence of universally accepted guidelines compels clinicians to rely on a combination of clinical judgment, microbiological data and available evidence to manage these infections effectively. Our aim was to assess the current management of invasive GAS (iGAS) infections in Italy and the variability in therapeutic and preventive approaches. Methods: A web-based current clinical practice survey about invasive and severe GAS infections was designed according to the Checklist for Reporting of Survey Studies (CROSS) methodology and circulated among the members of the Italian Society of Pediatric Infectious Diseases (SITIP). Results: The survey reveals that while many practices are commonly shared among clinicians, particularly regarding first-line therapies (penicillin or ceftriaxone depending on the infection site), significant uncertainties remain, particularly about the use of combined antibiotic regimens and supportive treatments. The use of combined antibiotic regimens was considered appropriate as first-line therapy for STSS, NF and brain abscesses. Clindamycin was the preferred agent for combination with beta-lactam for most infections, except for brain abscesses, where linezolid was favored. However, there was disagreement regarding the optimal timing for de-escalation to beta-lactam monotherapy. Responses varied widely concerning the indications and dosages for IVIG, as well as the use of corticosteroids. Conclusions: Addressing the burden of invasive GAS (iGAS) infections in children requires enhanced surveillance, early recognition, prompt treatment and preventive strategies. Further work to increase surveillance, e.g., developing national registries, and to standardize the management of the disease, e.g., developing country-specific guidelines, is essential to build solid evidence on the most effective approaches. Full article

Bacterial meningitis is one of the most serious infections. Salmonella meningitis is associated with a high prevalence of long-term adverse outcomes, often linked to acute complications and a broad range of potential neurological sequelae following the infection. Acute complications such as brain abscesses and chronic complications such as hearing loss and developmental delay. In this report, we present a case of a 2-month-old male patient with seizures, hypoactivity and respiratory symptoms, who was found to have Salmonella bacteremia complicated by Salmonella and Human Herpes Virus-6 (HHV-6) meningitis, as well as rhinovirus bronchiolitis, along with follow-up findings. The patient’s data, including demographics, presenting symptoms, physical examination findings, and whole exome sequence results, as well as investigations such as complete blood count (CBC), cerebrospinal fluid (CSF) analysis, liver enzyme levels, and imaging findings, were collected from the electronic medical record system using a case report form. In addition, immunological workups were performed, as serious Salmonella infections were more common in immunocompromised patients. In the literature, there was no clear correlation between Salmonella and HHV-6 meningitis, rhinovirus bronchiolitis, and the complications that developed in this infant. This case report provides valuable insights into the clinical spectrum and long-term outcomes of patients with Salmonella meningitis. Full article

Eikenella corrodens is a facultative anaerobic Gram-negative bacillus, part of the normal oropharyngeal flora, with opportunistic pathogenic potential particularly in immunocompromised hosts. The progression from localized intracranial infections such as cerebritis and subdural empyema to secondary bloodstream infection represents a rare but clinically significant pathway, especially in immuno-compromised patients. Here, we report a case of secondary E. corrodens bacteremia following left temporal cerebritis and ipsilateral subdural empyema in a 50-year-old man with advanced nasopharyngeal carcinoma treated with nivolumab. The patient presented neurological deficits and systemic inflammatory response, suggesting for a bacterial infection. Neuroimaging confirmed the intracranial infectious foci and blood cultures identified E. corrodens via MALDI-TOF MS and 16S rRNA gene sequencing. We discuss how cancer-associated immune dysregulation and immune checkpoint inhibition could modulate host susceptibility and clinical presentation of infection, potentially facilitating microbial dissemination across compromised blood–brain barriers. Additionally, we examine the cases of E. corrodens bacteremia secondary to CNS and head and neck infections. This case underscores the importance of heightened clinical vigilance for secondary bacteremia in oncologic patients with CNS infections and highlights the need for integrated microbiological and radiological assessment to optimize outcomes. Full article

Nocardia, an easily missed but potentially fatal opportunistic pathogen, can lead to serious infections like lung and brain abscesses. Intranasal inoculation (IN) is the traditional approach for constructing a Nocardia-induced pneumonia mice model, while it usually only results in limited local bacterial infection in the lungs. To comprehensively assess infection dynamics across distinct pulmonary inoculation routes in mice models, this study compared the pathogenicity of three different Nocardia farcinica pneumonia models established via IN, intratracheal aerosolization (ITA), and intratracheal instillation (ITI). C57BL/6J mice were infected with N. farcinica through IN, ITA and ITI with comparative analyses of bacterial distribution in lungs, survival rate, weight, bacterial load, inflammatory cytokines, histopathological characteristics and transcriptome differences. The findings suggest that ITA N. farcinica infections caused severer clinical symptoms, higher mortality, pulmonary bacterial load, levels of inflammatory cytokines in bronchoalveolar lavage fluid, and more significant histopathological damage to lungs than IN and ITI. Furthermore, ITA resulted in better lung bacterial distribution and delivery efficiency than ITI and IN. Transcriptome analysis of lungs from N. farcinica infected mice via IN, ITA and ITI revealed significant differential gene expression, whereas ITA route resulted in a larger fold change. ITA provides a more consistent and severe model of N. farcinica pneumonia in mice than IN and ITI, which can make the bacteria more evenly distributed in the lungs, leading to more severe pathological damage and higher mortality rates. In conclusion, ITA is an optimal route for developing animal models of N. farcinica pneumonia infections. Full article

Nocardia spp. is an environmental Gram-positive bacterium able to cause infections in humans, predominantly of an opportunistic nature. Nocardial brain abscesses are rare and result from dissemination from another primary lesion, mainly observed in immunocompromised hosts. The diagnosis of nocardiosis relies on direct examination and bacterial culture, but antimicrobial susceptibility testing (AST) remains controversial due to technical challenges, limited standardization, and a paucity of studies correlating in vitro susceptibility with clinical efficacy. Management is challenging and usually based on expert opinion, as robust evidence is limited. In this case report, we describe an immunocompromised patient with a Nocardia farcinica brain abscess who achieved clinical resolution following combination therapy that included ceftriaxone, despite in vitro resistance, illustrating the complexities in interpreting AST and guiding treatment decisions in rare infections. Full article

The paranasal sinuses are in close anatomical contact with the nasal and oral cavities, the orbit, the skull base, the brain, and important neurovascular structures, so complications of sinusitis can have serious and life-threatening consequences. Roughly, complications are divided into extracranial and intracranial. Of the extracranial complications, orbital complications are the most common. In addition to clinical examination and immediate referral to hospital, diagnostic imaging methods, particularly CT, are important in the diagnosis of complications. The treatment of complications of sinusitis is mainly multidisciplinary and may involve pediatricians, family physicians, emergency physicians, otorhinolaryngologists, neurologists, neurosurgeons, ophthalmologists, neuroradiologists, and infectious disease specialists. The cornerstone of treatment is early targeted antimicrobial therapy and surgery for abscess, visual impairment, or involvement of critical neurovascular structures. This paper reviews sinusitis complications and provides study material for physicians who manage this disease. Full article

For centuries, the most prevalent antler abnormalities observed worldwide have been attributed to trauma. However, detailed pathological investigation of these cases has not yet been carried out. In free-living fallow deer (Dama dama), we identified a chronic osteomyelitis-like condition—Pedunculitis Chronica Deformans (PCD)—using pathological and radiological diagnostics. We propose that inflammation during post-casting wound healing and consequent scar formation can trigger the development of PCD. In this study, we characterize the pathomorphology of PCD and introduce a scoring system to describe its severity. Furthermore, we describe the histoanatomy of the junction between the pedicle and the surrounding skin—an area essential for the integrity of the integument—which, when compromised, may predispose cervids to PCD. Our findings suggest that the most common antler abnormality results from a pathological fracture associated with PCD, which can be further complicated by fatal meningoencephalitis and brain abscesses. PCD-related lesions, while less frequently observed, can also be identified in roe deer (Capreolus capreolus) and red deer (Cervus elaphus), with species-specific differences. These findings overlap with cases reported in other cervid species, suggesting a more general disorder of antler formation. Describing this condition provides a basis for assessing its epidemiology and understanding its relevance to wildlife health. Full article

Brain abscesses are invasive infections of the central nervous system with a high level of treatment complexity especially in pediatric patients. Here, we describe a 3-month-old infant with multiple brain abscesses caused by methicillin-susceptible Staphylococcus aureus (MSSA). The patient was initially treated with empirical antibiotics (ceftriaxone, metronidazole, vancomycin). Upon MSSA identification, therapy was optimized by switching vancomycin to linezolid to improve tissue penetration. Therapeutic drug monitoring (TDM) was performed to check linezolid levels in the plasma and pus of the abscess, confirming drug penetration into brain tissue. A two-stage surgical drainage approach, consisting of repeated pus aspiration through an intracystic catheter, was then performed to achieve a significant reduction in abscess size. After nine weeks of antibiotic therapy, the patient was discharged in good clinical condition. This case highlights the role of linezolid for the treatment of complicated CNS infections and the importance of a multidisciplinary approach, combining TDM-based antibiotic therapy with timely and eventually repeated surgery, in order to effectively treat brain abscesses. Full article