Complicated Trichosporon asahii mastoiditis in immunocompetent child

Background Trichosporon asahii is an opportunistic fungus that causes infections in immunosuppressed patients. It is rarely seen in children and immunocompetent hosts. The mortality rates are still high despite early treatment with proper antifungal drugs. Trichosporon asahii mastoiditis in an immunocompetent child makes this case challenging. Case presentation This report presents a case of Trichosporon asahii mastoiditis which was complicated by transverse sinus thrombosis, in an otherwise healthy 21-month-old girl, and successfully treated with voriconazole. Trichosporon asahii was isolated, in three different occasions, from ear discharge of an immunocompetent healthy child, who presented with prolonged history of fever and received appropriate dosages of multiple types of antimicrobials as an outpatient but without improvement. After 48 h of starting the Voriconzole; post auricular swelling and ear discharge improved significantly. Conclusion A high index of clinical and microbiological suspicion is needed for optimal diagnosis of Trichosporon infection. Trichosporon asahii can also cause infection in immunocompetent individual even without previous history of hospitalization or intervention. We emphasize the importance of early pediatric infectious evaluation and intervention.

Meningitis and bacteremia caused by Haemophilus influenzae Type e in an immunocompetent child

Haemophilus influenzae infection is a well-known cause of serious invasive disease in adults and children. But incidence of the common serotypes are type b, f and a. There is very little information available on invasive disease of Haemophilus influenzae type e (Hie) in China, especially in children. We report a case of an immunocompetent child who was clinically diagnosed with bacterial meningitis with bacteremia caused by Hie. The literature on infection especially meningitis caused by Hie is reviewed.

Varicella Zoster Virus Meningitis with Absence of Rash in an Immunocompetent Child

Only a few cases in the literature have ever reported the reactivation of the varicella zoster virus (VZV) in children especially in the case of immunocompetent patients. It is an uncommon situation that may lead to several neurological complications. We report varicella zoster virus (VZV) meningitis in a 14-year-old healthy boy with no antecedent of rash. On his cerebrospinal fluid (CSF) examination, VZV DNA was detected. The rapid HIV test was negative. The treatment using acyclovir (20 mg/kg/8h) was effective, and the child’s clinical condition rapidly improved.

It is not always Tuberculosis! A case of pulmonary cryptococcosis in an immunocompetent child in Uganda

Pulmonary cryptococcosis is rare in immunocompetent individuals. Limited data exist regarding its occurrence in children, especially in developing countries. This case report describes an 8-year-old HIV-negative child with pulmonary cryptococco- sis, previously diagnosed and treated for tuberculosis twice without improvement. Fine needle aspiration biopsy confirmed the diagnosis of pulmonary cryptococcosis and serum cryptococcal antigen test was positive. The child improved on am- photericin and fluconazole treatment. Despite the limited diagnostic capacity in many resource-constrained settings like Uganda, this case report highlights the need to investigate other causes of pneumonia in immunocompetent children that are not improving on conventional antimicrobial treatments. Keywords: Pulmonary cryptococcosis; immunocompetent; children; Uganda.

Disseminated Blastomycosis Presenting as Oligoarthritis, Pneumonia, and Skin Disease in an Immunocompetent Child

Blastomyces species (spp) can cause clinical disease affecting nearly every organ system, including the skeletal system. However, isolated joint involvement without concurrent osteomyelitis is rare, especially in children. We present a pediatric case from a tertiary care center in urban Chicago of disseminated blastomycosis caused by Blastomyces dermatitidis presenting as oligoarthritis (in the absence of osteomyelitis), pneumonia, and skin involvement, with clinical improvement on IV amphotericin and oral azole treatment.