ASM case reports最新文献

{"title":"Toxoplasmosis-associated hemophagocytic lymphohistiocytosis during tumor-infiltrating lymphocyte therapy.","authors":"Tariq Odeh, Priscilla Quach, Amin Mostofizadeh, Julia D Hankins, Robert Hamilton-Seth, Chelsea Gorsline","doi":"10.1128/asmcr.00070-26","DOIUrl":"10.1128/asmcr.00070-26","url":null,"abstract":"<p><strong>Background: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome triggered by infections, malignancies, or autoimmune disorders. Tumor-infiltrating lymphocyte (TIL) therapy requires lymphodepleting chemotherapy and interleukin-2, producing profound immunosuppression. While HLH-like syndromes have been characterized after chimeric antigen receptor T-cell therapy, HLH has not been reported in the setting of TIL therapy. <i>Toxoplasma gondii</i> is a recognized but uncommon parasitic trigger of secondary HLH.</p><p><strong>Case summary: </strong>A 68-year-old male with metastatic melanoma undergoing TIL therapy presented with altered mental status. He had chronic lymphopenia and reported gastrointestinal intolerance to trimethoprim-sulfamethoxazole, documented as a sulfonamide allergy without formal testing, limiting prophylaxis to inhaled pentamidine, which has no anti-<i>Toxoplasma</i> activity. On admission, he was febrile (39.3°C) with pancytopenia, hypofibrinogenemia (44 mg/dL [normal 200-400]), hyperferritinemia (>30,000 ng/mL [normal 30-300]), hypertriglyceridemia (410 mg/dL [normal 150]), and elevated soluble CD25 (6,979.4 pg/mL [normal 175.3-858.2]); HScore was 283 (>99% probability of HLH). Bone marrow biopsy revealed bradyzoites, tachyzoites, pseudocysts, and hemophagocytosis. Disseminated toxoplasmosis was confirmed by positive serum <i>Toxoplasma</i> IgG, negative IgM, and cerebrospinal fluid <i>Toxoplasma</i> PCR of 13,700 copies/mL (reference: not detected), with brain MRI demonstrating targetoid enhancing lesions. Treatment with pyrimethamine, sulfadiazine, and leucovorin was initiated, but the patient continued to deteriorate and transitioned to comfort measures.</p><p><strong>Conclusion: </strong>This represents the first toxoplasmosis-associated HLH during TIL therapy. It underscores the importance of distinguishing drug intolerance from true allergy, ensuring <i>Toxoplasma</i>-active prophylaxis in profoundly immunosuppressed patients, and recognizing that HIV-derived CD4 thresholds may not apply to non-HIV immunocompromised populations.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of multidrug-resistant tuberculosis with bedaquiline, pretomanid, linezolid, and moxifloxacin following near-total gastrectomy.","authors":"Ihab Weheba, Sarah K Brode, Melissa Richard-Greenblatt, Natasha F Sabur","doi":"10.1128/asmcr.00027-26","DOIUrl":"10.1128/asmcr.00027-26","url":null,"abstract":"<p><strong>Background: </strong>Patients with a history of gastrectomy are at increased risk of developing pulmonary tuberculosis due to nutritional deficiencies and potential immune impairment. Altered gastrointestinal anatomy can affect oral drug absorption and treatment pharmacokinetics, making management of drug-resistant tuberculosis in this population challenging.</p><p><strong>Case summary: </strong>We describe a case of a woman with a history of gastric adenocarcinoma treated with chemotherapy, followed by near-total gastrectomy and Roux-en-Y reconstruction, who subsequently developed multidrug-resistant pulmonary tuberculosis. A biopsy of a pulmonary nodule was sent for culture and grew <i>Mycobacterium tuberculosis</i> complex. Phenotypic drug susceptibility testing could not be performed due to poor growth; however, a line probe assay performed on the isolate identified resistance to rifampin and isoniazid. The patient was treated with the all-oral bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) regimen. Due to concerns regarding impaired drug absorption following gastrectomy, therapeutic drug monitoring was performed to guide dosing. Therapeutic drug levels were ultimately achieved, and sputum culture conversion occurred after 5 weeks of effective therapy. The patient successfully completed the 26-week regimen with sustained microbiologic cure.</p><p><strong>Conclusion: </strong>This case demonstrates successful use of the all-oral BPaLM regimen in a patient with prior gastrectomy when supported by therapeutic drug monitoring. Evaluating drug exposure may help optimize treatment outcomes in patients at risk for drug malabsorption.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Babesiosis at ultra-low parasitemia presenting as secondary hemophagocytic lymphohistiocytosis in a patient on B cell-depleting therapy.","authors":"Nadia Toumeh, Bismarck S Bisono Garcia, Felicity C Norrie, Matthew J Thoendel, Nischal Ranganath","doi":"10.1128/asmcr.00066-26","DOIUrl":"10.1128/asmcr.00066-26","url":null,"abstract":"<p><strong>Background: </strong><i>Babesia microti</i>, a parasite transmitted by the <i>Ixodes scapularis</i> tick, can cause infections ranging in presentation from asymptomatic to fulminant, life-threatening disease. Ocrelizumab, an anti-CD20 B-lymphocyte monoclonal antibody used to treat multiple sclerosis, increases the risk of severe or relapsing infections with tick-borne pathogens. In rare cases, babesiosis may trigger hemophagocytic lymphohistiocytosis (HLH).</p><p><strong>Case summary: </strong>We report a case of babesiosis manifesting in a subacute fashion with secondary HLH in a 51-year-old female on B cell-depleting therapy. She presented in December with generalized weakness and fever and was found to have pancytopenia, transaminitis, and hyperinflammatory markers consistent with HLH. A microbial cell-free DNA next-generation sequencing test detected <i>Babesia microti</i>, with subsequent confirmation by blood PCR and smear demonstrating <0.01% parasitemia. The patient improved following treatment with atovaquone and azithromycin, along with corticosteroids for HLH.</p><p><strong>Conclusion: </strong>This case highlights the heterogeneity of babesiosis and its potential to present with minimal parasitemia, yet severe systemic inflammation in immunocompromised hosts. Additionally, this case underscores the importance of maintaining a broad differential in patients on B cell-depleting agents who present with new pancytopenia and systemic inflammatory symptoms. Early utilization of microbial cell-free DNA next-generation sequencing tests may aid in timely diagnosis and treatment.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Listerial rhombencephalitis diagnosed by repeat blood culture despite negative CSF PCR: a case report.","authors":"Simona Arientová, Radmila Galušková, Lenka Ceprová, Michal Jareš, Michal Holub","doi":"10.1128/asmcr.00063-26","DOIUrl":"10.1128/asmcr.00063-26","url":null,"abstract":"<p><strong>Background: </strong>Rhombencephalitis is a rare inflammatory disorder of the brainstem and cerebellum, most commonly associated with autoimmune, paraneoplastic, or vascular etiologies. <i>Listeria monocytogenes</i> is an uncommon but potentially severe infectious cause, and diagnosis may be challenging due to the limited sensitivity of cerebrospinal fluid testing.</p><p><strong>Case summary: </strong>An adult patient presented with subacute, progressive brainstem symptoms. Neurological examination and magnetic resonance imaging findings were consistent with rhombencephalitis. Cerebrospinal fluid analysis demonstrated inflammatory changes; however, PCR testing for <i>L. monocytogenes</i> was negative. Additional cerebrospinal fluid findings included moderately elevated interleukin-6 and chemokine CXCL13 levels and detectable Epstein-Barr virus DNA. Blood cultures subsequently yielded <i>L. monocytogenes</i>, confirming the diagnosis. Targeted antimicrobial therapy was initiated, and adjunctive corticosteroids were administered because of severe neurological involvement. The patient showed clinical stabilization and neurological improvement during follow-up.</p><p><strong>Conclusion: </strong>This case demonstrates that listerial rhombencephalitis may occur even with negative cerebrospinal fluid PCR results and highlights the importance of empiric therapy covering <i>Listeria</i> until an alternative etiology is confirmed. Marked inflammatory and immunological cerebrospinal fluid abnormalities may accompany severe disease and should prompt careful clinical assessment.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of <i>Plasmodium falciparum</i> malaria by 16S rDNA testing in pericardial fluid from a blood antigen and microscopy negative patient.","authors":"Joseph J Zeppa, Andrew K Kapoor, Deborah Yamamura, Mark Loeb, Antoine Corbeil, Julianne V Kus","doi":"10.1128/asmcr.00216-25","DOIUrl":"10.1128/asmcr.00216-25","url":null,"abstract":"<p><strong>Background: </strong>Malaria is typically diagnosed using rapid antigen tests and microscopy. This case describes an unusual presentation of <i>Plasmodium falciparum</i>, initially detected via 16S rDNA testing of pericardial fluid identifying apicoplast DNA-a finding not previously reported in the literature.</p><p><strong>Case summary: </strong>A septuagenarian Nigerian man visiting Canada presented with shortness of breath, tachycardia, tachypnea, anemia, and a pericardial effusion. Pericardiocentesis yielded serosanguineous fluid, and imaging revealed multifocal opacities. Blood and fluid cultures were negative for bacterial organisms. After briefly leaving the hospital against medical advice, he returned in respiratory distress and required intubation for acute respiratory distress syndrome. He received empiric antibiotics for rickettsial infection (due to positive serology) and presumed sepsis. Further workup, including pericardial fluid 16S rDNA PCR and sequencing, identified <i>P. falciparum</i> apicoplast DNA. This was confirmed by malaria antigen and <i>Plasmodium</i>-specific PCR testing of the fluid alongside PCR of whole blood, though microscopy and antigen tests remained negative. Hemozoin-like structures were also identifiable in the pericardial fluid. He was treated with a 3-day course of atovaquone-proguanil for malaria, with subsequent clinical improvement. He remains well on follow-up.</p><p><strong>Conclusion: </strong>This case underscores an uncommon presentation of <i>P. falciparum</i> and, though not a standard or recommended diagnostic tool for malaria, in this case, 16S rDNA analysis aided in the diagnosis. Clinicians should maintain malaria in the differential for patients from endemic regions. Multidisciplinary collaboration was essential in achieving the diagnosis.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergence of <i>SCCmec</i> variants causing false-negative MRSA results by Xpert SA Nasal Complete: a need for culture back-up?","authors":"Amy L Leber, Sophonie J Oyeniran, Jonatan Lehtinen, Huanyu Wang","doi":"10.1128/asmcr.00069-26","DOIUrl":"10.1128/asmcr.00069-26","url":null,"abstract":"<p><strong>Background: </strong><i>Staphylococcus aureus</i> (SA) is a major human pathogen and an important cause of healthcare-associated infections. Hospital-acquired methicillin-resistant <i>S. aureus</i> (MRSA) is associated with increased morbidity and mortality. Screening for nasal carriage of SA followed by decolonization has been shown to reduce healthcare-associated MRSA transmission and infection. Nucleic acid amplification assays (NAATs) are widely used for MRSA screening and are associated with shorter turnaround times, fewer isolation days, reduced MRSA-related infections, and improved clinical outcomes and cost savings.</p><p><strong>Case summary: </strong>Two patients underwent preoperative nasal screening using Xpert SA Nasal Complete, and corresponding culture results were discordant with the molecular results. In both cases, the Xpert SA assay reported \"SA detected and MRSA not detected,\" whereas culture and antimicrobial susceptibility testing (AST) demonstrated the presence of MRSA. Additional testing supported the culture-based identification of MRSA. Whole-genome sequencing and molecular typing revealed that both MRSA isolates harbored <i>SCCmec</i> variants that were not detected by the Xpert assay, leading to false-negative (FN) MRSA results.</p><p><strong>Conclusion: </strong>While NAATs remain highly sensitive and reliable tools for MRSA screening and the overall risk of FN MRSA detection may be low, our cases highlight the importance of ongoing surveillance of local MRSA epidemiology and understanding the genetic inclusivity of the molecular assays used for detection. In high-risk or targeted patients, consideration of reflex culture may be warranted.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection and genomic characterization of a travel-associated ECSA lineage chikungunya virus infection in Mexico.","authors":"Daniel Canul Canul, K Jacqueline Ciau-Carrillo, J Reyes Canche Pech, Cesar Cañas-Alamilla, Jesús Kú-Cachón, Ana Osorio-Medrano, Maria E Lopez-Novelo, Igrid García González, James Earnest, Daniel Limonta, Norma Pavia-Ruz, Pablo Manrique-Saide, Fabián Correa-Morales, Guadalupe Ayora Talavera, Laura Conde-Ferraez, Azael Che-Mendoza, Jorge Palacio-Vargas, Rafael Valdez-Vázquez, Julissa Guzman-Hernandez, Carlos Frederico Campelo de Albuquerque E Melo, Gonzalo Vazquez-Prokopec, Tetyana I Vasylyeva, Marina Escalera-Zamudio, Miguel A Garcia-Knight, Henry Puerta-Guardo","doi":"10.1128/asmcr.00035-26","DOIUrl":"10.1128/asmcr.00035-26","url":null,"abstract":"<p><strong>Background: </strong>In 2013, chikungunya virus (CHIKV), a re-emerging <i>Aedes</i>-borne virus, was introduced into the Americas. This led to synchronous epidemics across the region associated mainly with the Asian lineage, which eventually subsided. Resurgent outbreaks have been recorded since, principally in South America, largely driven by the East-Central-South-African (ECSA) lineage. In 2025, more than 300,000 CHIKV suspected cases were reported in Brazil and Cuba.</p><p><strong>Case summary: </strong>In November 2025, a healthy adult male traveling from Cuba arrived in Merida, Mexico, and shortly after presented febrile symptoms consistent with an arboviral infection. CHIKV infection was diagnosed by RT-qPCR. Though the infection was mild, the patient developed a rash on the abdomen and neck that persisted for up to a month, with further inflammation of the joints of the left leg. Phylogenetic analysis of the viral genome indicated placement within the ECSA lineage, clustering with other contemporaneous virus genomes sampled from Brazil that belong to a recently described clade II within the country, in which viral genomes from Cuba also cluster.</p><p><strong>Conclusion: </strong>We identify a travel-associated ECSA lineage CHIKV case in Mexico. This viral lineage has not previously been detected in the country. This finding highlights the risk for subsequent local transmission and is consistent with reports of the presence of this lineage in Cuba. Ten years since the last CHIKV epidemic in Mexico, strengthened surveillance is required to anticipate potential local outbreaks within the region.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case study of Powassan virus encephalitis in an immunocompromised host.","authors":"Myriam Shehata, Gracen Betts, Sarah Chung, Anne Piantadosi, Sujit Suchindran, Daniel O Espinoza, Matthew H Collins","doi":"10.1128/asmcr.00044-26","DOIUrl":"10.1128/asmcr.00044-26","url":null,"abstract":"<p><strong>Background: </strong>Powassan virus (POWV) is a tick-borne, neurotropic arbovirus endemic to Canada and the United States and is transmitted by Ixodes ticks, which also carry Lyme disease. It is an increasingly recognized cause of neuro-invasive infection in humans, for which treatment is supportive. Prognosis in POWV encephalitis is variable, ranging from complete recovery to death. As with other arboviral encephalitides, the mainstay of diagnosis is serological testing. However, molecular diagnostics play an increasingly important role, particularly in the case of immunocompromised hosts.</p><p><strong>Case summary: </strong>A 47-year-old woman with rheumatoid arthritis taking methotrexate experienced a tick bite, followed by target-shaped rash. She was clinically diagnosed with Lyme disease and started on doxycycline therapy. She then developed headache, ataxia, dysarthria, and diplopia. An extensive infectious workup was notable for positive Powassan virus IgM confirmed with neutralizing antibody testing several weeks later. CSF Powassan virus PCR was negative. She was treated empirically for neuroborreliosis and later with pulse-dose steroids and intravenous immunoglobulin (IVIG). She ultimately recovered after a 10-day hospitalization and 5 days of inpatient rehabilitation.</p><p><strong>Conclusion: </strong>Physicians should be aware of POWV, an underrecognized cause of encephalitis, and of the complexities in diagnostic testing. Notably, cross-reactive serologies are common in arboviral infection. Serological testing remains first line in diagnosis but requires confirmatory testing typically performed at reference laboratories.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Mycobacterium bovis</i> BCG infection of the brain following intravesical BCG treatment.","authors":"Sierra Amaya, Steven N Schwartz, James E Kirby, Hemant Varma","doi":"10.1128/asmcr.00186-25","DOIUrl":"10.1128/asmcr.00186-25","url":null,"abstract":"<p><strong>Background: </strong>Intravesical Bacille Calmette-Guerin (BCG) therapy with live-attenuated form of <i>Mycobacterium bovis</i> (<i>M. bovis</i>) is used as a treatment of early-stage bladder cancers. Documented adverse reactions are usually local and time limited, with severe central nervous system (CNS) complications being exceedingly rare. We report an 88-year-old patient with papillary urothelial carcinoma who presented with recurring neurological complications for over a year after treatment with intravesical BCG therapy.</p><p><strong>Case summary: </strong>MRI at initial presentation revealed a dural-based left frontoparietal mass. Histological examination of the resected tissue revealed granulation tissue, necrosis, and lymphohistiocytic inflammation. Stains for organisms and cultures were negative, as was broad-range PCR. Two additional CNS resections performed followed detection of new lesions on follow-up. A mycobacterial culture from abscess fluid from the last resection recovered <i>M. tuberculosis</i> complex that, on region of detection signature pattern analysis, was identified as <i>M. bovis</i> BCG.</p><p><strong>Conclusion: </strong>This case represents one of the rare documented reports of an <i>M. bovis</i> BCG CNS infection resulting from intravesical BCG treatment. BCG infection should be considered in the differential of CNS infections in patients with a history of BCG treatment so early life-saving therapy can be instituted.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First UK use of bacteriophage therapy with DAIR for chronic <i>Staphylococcus aureus</i> prosthetic joint infection.","authors":"A Scobie, T Ferry, D Roulston, S Subbarao, T Thai, G Trafford, A Cudmore, J Miles, K Crick, S H Chin, R Lester, S Warren, N Karunaharan, P-J Ceyssens, M Merabishvili, S Djebara, J-P Pirnay, T Azamgarhi","doi":"10.1128/asmcr.00082-26","DOIUrl":"10.1128/asmcr.00082-26","url":null,"abstract":"<p><strong>Background: </strong>Chronic <i>Staphylococcus aureus</i> prosthetic joint infection (PJI) remains difficult to manage when surgical revision and long-term antibiotics are not feasible. Bacteriophage therapy is emerging as a potential adjunct, though experience in orthopedic infections, particularly in the United Kingdom, is limited.</p><p><strong>Case summary: </strong>We report the first UK case of intra-articular bacteriophage therapy administered alongside debridement, antibiotics, and implant retention (DAIR) for chronic methicillin-sensitive <i>Staphylococcus aureus</i> knee PJI. An 81-year-old man with multiple comorbidities developed persistent infection following revision knee arthroplasty, with recurrent sinus formation despite multiple surgical washouts and prolonged suppressive antibiotics. Major revision surgery and amputation were not viable options. Following a multidisciplinary review through the UK Clinical Phage Network, targeted phage therapy was pursued as salvage treatment. Phage susceptibility testing identified an active lytic phage (ISP). The patient underwent open DAIR with intra-articular phage administration, adjunctive local antibiotics, short-course intravenous antimicrobials, and subsequent oral suppressive therapy. Two further intra-articular phage doses were administered postoperatively. Initial sinus closure occurred, but recurrence developed within 4 weeks. At 18 months, symptoms were partially improved with better mobility and reduced inflammation, though one sinus tract persisted. No significant adverse effects were observed. Whole-genome sequencing of pretreatment isolates demonstrated a predominantly ST5 <i>S. aureus genotype</i> with conserved biofilm-associated virulence genes and limited antimicrobial resistance in addition to clonal diversification consistent with chronic biofilm infection.</p><p><strong>Conclusion: </strong>This case demonstrates the feasibility and safety of intra-articular phage therapy during DAIR in a UK setting but highlights biological, logistical, and pharmacological factors that may limit efficacy in advanced chronic PJI.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}