Background and clinical significance:Pasteurella spp. are Gram-negative coccobacilli, aerobic facultatively anaerobic, belonging to the Pasteurellaceae family. In humans, they are known to cause zoonotic diseases, which usually develop after dog or cat bites, licks or scratches. Case presentation: We present the case of a 61-year-old patient, with cardiovascular comorbidities, who presented to the Orthopedics Department, 38 days after knee replacement surgery, with recurrence of pain on walking, an antalgic gait with auxiliary support, and local signs of inflammation at the level of the left knee joint. The patient admitted to owning a dog who accidentally licked the post-surgical wound. The symptoms were suggestive of a post-surgical wound infection with extension to the periprosthetic area. A purulent discharge was collected from the wound during surgical debridement and sent to the microbiological laboratory for diagnosis, where Pasteurella canis was identified using MALDI-TOF MS. Antibiotic susceptibility testing (AST) was performed according to the EUCAST guidelines and empiric antibiotic treatment was started with Cefuroxime. During his future admissions to the Orthopedics and Infectious Diseases departments, two more samples were collected, in which Pasteurella canis was isolated, along with Klebsiella oxytoca (second sample), and Klebsiella oxytoca and Pseudomonas aeruginosa (third sample). Patient evolution was favorable due to the debridement of the wound and combined antibiotic treatment, with Ceftazidime and Gentamicin. Conclusions: Infections with Pasteurella canis are rare but slowly increasing due to more and more humans owning pets. The present case underlines the importance of interdisciplinary collaborations when rare pathogens are identified.

Objective: We describe a peculiar combination of West Nile virus (WNV) and SARS-CoV-2 infection, suggesting crucial clinical implications for diagnosis and management. Case report: We present a case of a 57-year-old woman with a past medical history of end-stage renal disease (ESRD), on chronic hemodialysis, and arterial hypertension. She was admitted to the hospital for a 5-day history of fever, headache, vomiting, psychomotor slowing, a diffuse tremor on the four limbs, and diarrhea. Evaluation revealed the presence of neutrophilic leukocytosis, hemoglobin level of 10.5g/dL, elevated C-reactive protein (60 mg/L), serum creatinine of 13.4 mg/dL with hyperkaliemia. Neurologic examination described the following findings: neck stiffness, confusion with motor aphasia, bradylalia, bradypsychia, global hyperreflexia, diffuse tremor, and unstable gait. Brain CT described a calcified temporo-lateral meningioma, CSF examination revealed colorless appearing, 560 leucocytes/3microL (97% lymphocytes), 848 mg/L proteins, glycorrhachia: 54 mg/dL (serum glucose: 101 mg/dL), and the multiplex Real-Time PCR test result was negative. On the second day of admission, the patient tested positive for COVID-19 and she was commenced on therapy with remdesivir, ceftriaxone, dexamethasone, and clexane. Adequate hemodialysis sessions were performed. On the eighth day of admission, the diagnosis of WNV infection was made based on the positive serological findings and the presence of IgM antibodies in the cerebrospinal fluid. After 15 days of hospitalization, the patient was discharged in good clinical condition, except for mild tremor in her limbs. Conclusions: Periodic epidemic bursts of WNV infection have been reported in Mures County, but present coinfection is rare; the severity and prognosis of the disease are unforeseeable.