Neonatal listeriosis is an uncommon but potentially life-threatening cause of early-onset sepsis that can closely resemble hypoxic-ischemic encephalopathy. We present a term male infant delivered by cesarean section for nonreassuring fetal heart rate tracing who required resuscitation with positive pressure ventilation. Severe metabolic acidosis and low Apgar scores initially suggested perinatal asphyxia; however, a structured neurologic examination at 1 and 3 hours of life did not meet criteria for therapeutic hypothermia, and the infant subsequently developed fever, thrombocytopenia, persistent shock, and marked transaminitis. Blood and placental cultures grew Listeria monocytogenes, a gram-positive bacillus. The infant improved with ampicillin monotherapy and was discharged with a normal neurologic examination. This case illustrates the importance of maintaining a broad differential diagnosis, including infection, in neonates with a presumed diagnosis of perinatal asphyxia.
BACKGROUND Clostridioides difficile infection (CDI) frequently recurs and impacts quality of life, yet its relationship with mental illness remains understudied. METHODS Using the National Inpatient Sample (2018-2019), we calculated depression rates among adults with recurrent CDI (rCDI) and assessed the odds of codiagnosed depression compared to other chronic medical conditions. RESULTS Among 84,055 hospitalizations with rCDI, 21.5% had a codiagnosis of depression. In a population without CDI, depression prevalence was 14.2%. CDI patients had a 56% greater chance of having a diagnosis of depression compared with the general population (odds ratio [OR] 1.56, 95% confidence interval 1.5-1.6). When compared to those with common chronic medical comorbidities, patients with CDI had significantly higher odds of having depression than those with heart failure (OR 1.4), diabetes (OR 1.3), end-stage kidney disease (OR 1.5), and metastatic cancer (OR 1.9). Patients with fibromyalgia, multiple sclerosis, and alcohol-related disorders had higher rates of depression compared with those with CDI. CONCLUSION Patients with rCDI appear to have remarkably high depression rates, higher than those of patients with many other common chronic medical conditions. Further studies are needed to evaluate the causation of this potential association and to consider the benefit of implementing depression screening programs in this vulnerable population.
Retained intradural bullets are rare and may migrate within the thecal sac, potentially causing neurological deficits and creating diagnostic and surgical challenges. Most reported cases describe caudal migration. This case highlights a 19-year-old man who experienced preoperative cephalad migration of an intradural bullet following a gunshot injury to the lower back. Furthermore, we review previously reported cases of migratory spinal bullets, including treatment modalities and neurological outcomes.
