The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising...The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising incidence of nosocomial manifestations underscores the importance of considering this organism in the differential diagnosis of hospital-acquired infections.We present a case of patient with septic arthritis of the shoulder who had been originally admitted for the management of acute-on-chronic congestive heart failure exacerbation and severe sepsis.On hospital day 1,joint aspiration cultures and Gram stain confirmed the presence of Citrobacter koseri,a pathogen not commonly associated with septic arthritis,and ceftriaxone was administered to target it.On hospital day 7,antibiotic was transitioned to levofloxacin,every other day for 4 weeks.The patient was discharged to an acute rehabilitation facility after a 14-day hospital stay.This case stresses the importance of maintaining a broad differential diagnosis for any patients who present with fever and joint inflammation or swelling,especially in a postoperative setting.展开更多
Rationale:Infectious keratopathy is an ocular emergency with the potential to cause irreversible blindness.Patient's concerns:A 63-year-old diabetic man presented with a 3-day history of painful red right eye.He h...Rationale:Infectious keratopathy is an ocular emergency with the potential to cause irreversible blindness.Patient's concerns:A 63-year-old diabetic man presented with a 3-day history of painful red right eye.He had a history of multiple ocular surgeries in the affected eye without recent ocular trauma.Diagnosis:Infective crystalline keratopathy secondary to Citrobacter koseri.Interventions:Topical corticosteroids were discontinued,and dual topical antibiotic therapy of moxifloxacin 5%and gentamycin 0.3%were applied.Outcomes:Twelve hours after the start of treatment,the crystalline nature of the infiltrate disappeared,with enlargement of the epithelial defect.The antibiotic regime was continued and the lesion healed within a week of presentation with residual scarring.Lessons:Infective crystalline keratopathy classically presents with intrastromal branching fern-like opacities and minimal anterior segment inflammation in an immunosuppressed eye.The mainstay of management is corticosteroid discontinuation and the administration of empirical antibiotics until the results of the culture and sensitivity are available.In Citrobacter-related cases,treatment may result in a suppurative appearance before healing of the lesion.展开更多
文摘The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising incidence of nosocomial manifestations underscores the importance of considering this organism in the differential diagnosis of hospital-acquired infections.We present a case of patient with septic arthritis of the shoulder who had been originally admitted for the management of acute-on-chronic congestive heart failure exacerbation and severe sepsis.On hospital day 1,joint aspiration cultures and Gram stain confirmed the presence of Citrobacter koseri,a pathogen not commonly associated with septic arthritis,and ceftriaxone was administered to target it.On hospital day 7,antibiotic was transitioned to levofloxacin,every other day for 4 weeks.The patient was discharged to an acute rehabilitation facility after a 14-day hospital stay.This case stresses the importance of maintaining a broad differential diagnosis for any patients who present with fever and joint inflammation or swelling,especially in a postoperative setting.
文摘Rationale:Infectious keratopathy is an ocular emergency with the potential to cause irreversible blindness.Patient's concerns:A 63-year-old diabetic man presented with a 3-day history of painful red right eye.He had a history of multiple ocular surgeries in the affected eye without recent ocular trauma.Diagnosis:Infective crystalline keratopathy secondary to Citrobacter koseri.Interventions:Topical corticosteroids were discontinued,and dual topical antibiotic therapy of moxifloxacin 5%and gentamycin 0.3%were applied.Outcomes:Twelve hours after the start of treatment,the crystalline nature of the infiltrate disappeared,with enlargement of the epithelial defect.The antibiotic regime was continued and the lesion healed within a week of presentation with residual scarring.Lessons:Infective crystalline keratopathy classically presents with intrastromal branching fern-like opacities and minimal anterior segment inflammation in an immunosuppressed eye.The mainstay of management is corticosteroid discontinuation and the administration of empirical antibiotics until the results of the culture and sensitivity are available.In Citrobacter-related cases,treatment may result in a suppurative appearance before healing of the lesion.
