Community-Acquired Pneumonia Caused by Unusual Pathogens
Keywords:
pulmonary tuberculosis; histoplasmosis; Shewanella putrefaciens; atypical pneumonias.Abstract
Introduction: Pulmonary tuberculosis and deep mycoses can coexist with other atypical pathogens such as Shewanella putrefaciens, which is uncommon and generally affects people who live in coastal environments and consume raw fish and shellfish.
Objective: To describe the diagnostic and therapeutic processes of a complex case of community-acquired pneumonia involving suspected tuberculosis, confirmed histoplasmosis, and isolation of Shewanella putrefaciens.
Case Report: A 52-year-old female tourism worker with a history of hypothyroidism, who lived near the sea and ate raw fish and shellfish almost daily, presented with fever, cough, malaise, sweating, hoarseness, and anorexia. She was tested for COVID-19 in her province, which was positive, and was treated with antibiotics and steroids, with partial improvement. The chest X-ray showed reticulonodular infiltrate and several acid-fast bacilli (AFB) negative sputum samples; however, antituberculosis treatment was initiated without improvement, so the patient was transferred to the Institute of Tropical Medicine, where a bronchoalveolar lavage and thoracentesis with sample collection were performed. The patient's condition deteriorated, and she was subsequently transferred to Hermanos Ameijeiras Clinical Surgical Hospital, where antifungal and broad-spectrum antibiotic treatment was started due to suspected atypical or nosocomial infection. The bronchoalveolar lavage results showed Shewanella putrefaciens and a positive antigen for Histoplasma capsulatum. The patient's condition worsened, and she died four days later from sudden death.
Conclusions: When tuberculosis is suspected, it is essential to search for opportunistic pathogens, with particular attention to clinical and epidemiological factors.
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