Clin Microbiol Research Articles

Lessons from New Zealand's COVID-19 outbreak response

Lessons from New Zealand's COVID-19 outbreak response

Pulmonary COVID-19: Multimodality Imaging Examples.

The full digital presentation is available online.

NOCARDIOSIS PRESENTING LIKE A METASTATIC LUNG CANCER

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Nocardia is a gram-positive, weakly acid-fast, branching rod which is ubiquitous environmental saprophytes that cause localized or disseminated disease in both immunocompetent and immunocompromised patients. We present here a case of a 55-year-old male who was found to have right middle lobe lung abscess as well as right cerebellar abscess secondary to disseminated Nocardiosis from the pulmonary source. CASE PRESENTATION: A 55-year-old male with a past medical history of hypertension, hyperlipidemia, migraines, 30 pack-year smoking history, and emphysematous COPD presented to the hospital with 5 days of cough productive of clear sputum, headache and multiple episodes of emesis. He also reported 30 pounds weight loss over the last 1 year due to poor appetite. On presentation, he was hypoxic and tachypneic requiring 5 liters of oxygen by nasal cannula. Physical examination showed a cachectic male with decreased breath sounds bilaterally and crackles in the right lower lung field. The neurological exam showed nystagmus with right-sided gaze and square wave jerks as well as dysdiadochokinesia. Labs showed elevated WBC count at 17.6*10^3 with Neutrophilic pleocytosis. Chest CT showed right middle lobe lung mass, multiple bilateral pulmonary nodules as well as right lower lobe pneumonia. CT head showed right-sided cerebellar mass. Hence an emergent MRI was obtained to assess the mass which showed a large multiseptated cerebellar mass measuring 4.7 * 5.8 * 3.2 cm with mild vasogenic edema centered in the right cerebellar hemisphere crossing midline and producing severe stenosis of the fourth ventricle and resultant obstructive hydrocephalus. The patient was taken to the Operating room STAT and when the right cerebellum was entered a green-tinged fluid started draining which was sent for a culture that grew Nocardia cyriacigeorgica. The patient also had a bronchoscopic biopsy of the right-sided lung mass a day later which also grew the same organism. The patient was initially treated with Intravenous vancomycin, ceftriaxone and levofloxacin for broad-spectrum coverage for pneumonia and after the cultures grew Nocardia was switched to intravenous trimethoprim-sulfamethoxazole and meropenem after infectious disease consultation. However, he failed to respond to the therapy and was made comfort care and passed away. DISCUSSION: Disseminated disease with Nocardia involving brain and lung has been reported in both immunocompromised and immunocompetent patients. However, most of the cases reported in the literature are of elderly patients or immunocompromised patients. As the population of the United States is aging with many patients on immunomodulators it is imperative to raise awareness about disseminated nocardiosis CONCLUSIONS: Physicians must be aware that disseminated nocardiosis can mimic the presentation of metastatic lung carcinoma: early surgical intervention in brain abscess improves outcomes. Reference #1: Karan M, Vučković N, Vuleković P, Rotim A, Lasica N, Rasulić L. Acta Clin Croat. 2019 Sep;58(3):540-545. doi: 10.20471/acc.2019.58.03.20. Reference #2: Schlaberg R, Huard RC, Della-Latta P. Nocardia cyriacigeorgica, an emerging pathogen in the United States. J Clin Microbiol. 2008. Jan;46(1):265–73. 10.1128/JCM.00937-07 Reference #3: Lee GY, Daniel RT, Brophy BP, Reilly PL. Surgical treatment of nocardial brain abscesses. Neurosurgery. 2002. Sep;51(3):668–71, discussion 671–2. 10.1097/00006123-200209000-00010 DISCLOSURES: No relevant relationships by Fazal Raziq, source=Web Response No relevant relationships by Muhammad Usama, source=Web Response

Building a tuberculosis-free world while responding to the COVID-19 pandemic

Building a tuberculosis-free world while responding to the COVID-19 pandemic

DISSEMINATED PULMONARY HISTOPLASMOSIS IN AN IMMUNOCOMPETENT PREVIOUSLY HEALTHY INDIVIDUAL

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Histoplasmosis infection is clinically silent in over 99% of immunocompetent individuals in endemic areas. If symptoms occur most are non-specific and self-limited. However, disseminated histoplasmosis can develop in immunocompetent patients with devastating consequences including significant mortality. CASE PRESENTATION: A previously healthy 45-year-old man presented after 2-3 weeks of worsening dyspnea, non-productive cough, and 20lb weight loss. Outpatient work up showed concern for atypical pneumonia, necessitating treatment with three escalating oral antibiotics showing no improvement prompting admission. He was transferred from an outside hospital intubated progressing toward ARDS requiring vasopressor support. On imaging there was diffuse bilateral peribronchovascular consolidation, groundglass opacities with septal thickening, hepatosplenomegaly, and retroperitoneal lymphadenopathy. Testing included respiratory viral panel positive for rhinovirus, fungitell, fungal blood cultures, urine antigens for histoplasmosis and blastomyces, and bronchoscopy. He was placed on broad spectrum antibiotics and itraconazole. The following day his fungal regimen was advanced to amphotericin B. Three days later his urine histoplasmosis antigen returned positive followed by a positive fungitell and lastly bronchoscopy cultures grew histoplasmosis. He required a month long hospital stay with aggressive ventilator support requiring tracheostomy, severe fevers requiring external cooling, and significant ATN that all slowly improved. Work up for an underlying etiology for possible immunosuppression was unrevealing. He was discharged to an extended care facility where he was liberated from the ventilator within a few days of hospital discharge with later tracheostomy decannulation. He remains on itraconazole 9 months later. He has returned to his regular activities. Most recent imaging shows mild scarring and residual consolidative and nodular opacities. DISCUSSION: Initial generalized symptoms and the rarity of disseminated histoplasmosis in immunocompetent patients can cause it to be overlooked on the differential, leading to significant delays in care. Further delays can occur as testing typically takes multiple days to result and may require bronchoscopy. In this case, a broad differential was considered with a decisive plan of starting the patient on amphotericin days prior to test results likely significantly improving overall prognosis. CONCLUSIONS: Timely diagnosis and treatment of disseminated histoplasmosis requires a broad differential diagnosis coupled with a high level of clinical suspicion. Aggressive treatment may need to begin prior to definitive diagnosis in patients with significant disease burden. Reference #1: Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007;20(1):115-132. doi:10.1128/CMR.00027-06 Reference #2: Ling Q, Zhu W, Lu Q, Jin T, Ding S. Disseminated histoplasmosis in an immunocompetent patient from an endemic area: A case report. Medicine (Baltimore). 2018;97(29):e11486. doi:10.1097/MD.0000000000011486 DISCLOSURES: No relevant relationships by Benjamin Ramser, source=Web Response No relevant relationships by Joy Wang, source=Web Response No relevant relationships by Steven Young, source=Web Response

A multinational listeriosis outbreak and the importance of sharing genomic data

A multinational listeriosis outbreak and the importance of sharing genomic data

RAPIDLY PROGRESSIVE CARDIAC TAMPONADE AND BILATERAL PLEURAL EFFUSIONS IN THE SETTING OF MENINGOCOCCEMIA

SESSION TITLE: Medical Student/Resident Disorders of the Pleura Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Primary meningococcal pericarditis (PMP) is a rare form of purulent pericarditis that can occur in the event of N. Meningitidis bacteremia without meningitis or fulminant septicemia. This form of pericarditis can be infectious or immunologic and in either form, can cause life threatening tamponade (1). Here described is a case of rapidly evolving purulent pericarditis and pleural effusion in a patient with meningococcal bacteremia. CASE PRESENTATION: A 56 year old male with a history of HIV, and remote bacterial meningitis presented with pleuritic chest pain, worsened in the supine position, fevers, and diaphoresis. At the initial time of presentation ECG findings were consistent with pericarditis and bedside echo showed minimal pericardial effusion. The patient was evaluated and due to persistent hypotension, was admitted to the MICU. Hours after admission, the patient developed worsened chest pain, in the setting of continued hypotension. A bedside echo and CTPE showed increasing pericardial effusion with tamponade physiology, as well as small developing pleural effusions. Urgent pericardiocentesis was performed, 350mL of purulent fluid was obtained and a pericardial drain placed. Pericardial fluid cultures were negative, but blood cultures grew Neisseria meningitidis. Antibiotics were deescalated from piperacillin-tazobactam to ceftriaxone at that time. Serial bedside ultrasounds and showed a on hospital day three showed rapidly increasing pleural effusions despite pericardial drain placement. A right sided diagnostic thoracentesis was performed that was exudative by Lights Criteria and class 2 with a pH 7.45 and glucose 177. The following day, left sided thoracentesis was performed, and the patient had improvement in his hypoxia and symptomatology. He was discharged home to complete a 14 day course of ceftriaxone. DISCUSSION: The most common forms of invasive meningococcal disease are septicemia and meningitis. Approximately 10% of the population is a carrier of N. menigitidis, but invasive disease is relatively rare (2). Other sites of involvement are less common, but pericarditis has been reported in meningococcal bacteremia. This most often occurs in the presence of meningococcal meningitis or fulminant septicemia (3). This patient had no signs of meningitis or fulminant sepsis at the time of presentation. Rapid accumulation of purulent fluid causing cardiac tamponade has been described in PMP (4). CONCLUSIONS: Primary meningococcal pericarditis is a remarkably unusual presentation of meningococcal disease. Rapid progression to tamponade physiology can develop in these patients and monitoring for signs of pericarditis in patients with meningococcal disease should be implemented. Reference #1: Pericarditis as a complication of meningococcal meningitis. Morse JR, Oretsky MI, Hudson JA, Ann Intern Med. 1971;74(2):212. Reference #2: Update on meningococcal disease with emphasis on pathogenesis and clinical management. van Deuren M, Brandtzaeg P, van der Meer JW. Clin Microbiol Rev. 2000 Jan; 13(1):144-66. Reference #3: Zeidan A, Tariq S, Faltas B, Urban M, McGrody K. A case of primary meningococcal pericarditis caused by Neisseria meningitidis serotype Y with rapid evolution into cardiac tamponade. J Gen Intern Med. 2008;23(9):1532–1535. DISCLOSURES: No relevant relationships by Giovi Grasso-Knight, source=Web Response No relevant relationships by Matthew Schloop, source=Web Response No relevant relationships by Mouhamed Shatila, source=Web Response

TRACHEAL STENOSIS MIMICKERS: A CASE OF TRACHEAL MUCORMYCOSIS

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Mucormycosis is an invasive fungal infection most commonly seen in immunosuppressed individuals, especially those with hematologic malignancies and uncontrolled diabetes. Pulmonary mucormycosis is rare and carries high morbidity and mortality (1). We report a rare radiographic and pathologic presentation of tracheal mucormycosis in a female patient mimicking tracheal stenosis. CASE PRESENTATION: A 51-year-old woman with history of uncontrolled diabetes mellitus and hypertension presented with a month of progressive dyspnea in the setting of mediastinal lymphadenopathy and narrowing of the trachea seen on computed tomography imaging. This patient first presented to her primary care provider with one year of constitutional symptoms including weight loss, night sweats and worsening dyspnea that was initially concerning for malignancy. A computed tomography scan was obtained, and based on the findings of tracheal stenosis, she was referred for consideration of tracheal stenting. Bronchoscopy confirmed mid-tracheal narrowing with cobblestoning of the mucosa and bilateral white plaques. Pathology confirmed mucormycosis with acute inflammation and tissue invasion. She was initially treated with amphotericin but despite this, repeat bronchoscopy revealed increased distal tracheal stenosis. Micafungin was added to the regimen but there was no option for surgical intervention or stent due to inopportune location of narrowing and concern and failure of anastomosis. Since the addition of micafungin, the patient has clinically improved. Repeat bronchoscopy unfortunately continues to demonstrate ulceration and irritation, although stenosis was somewhat improved. At the time of this report, the patient is continuing with antifungal treatment. DISCUSSION: Tracheal mucormycosis remains a difficult diagnosis to make given the rarity of the disease as well as its nonspecific presentation. Our patient initially underwent workup for malignancy and only with computed tomography scan was found to have tracheal stenosis. In one review of tracheal mucormycosis cases, radiologic abnormalities appear in 94.6% of the patients, yet only 26% of the total patients received correct primary diagnosis of fungal pneumonia (2). It is important to pursue workup of concerning imaging findings, as in our patient, with bronchoscopy and biopsy in order to arrive at the correct diagnosis and initiate treatment as soon as possible. Without treatment, survival was reported to be only 3%, making early recognition of this disease entity critically important (3). CONCLUSIONS: Tracheal mucormycosis is a rare condition, yet deadly, if untreated. In immunocompromised patients with nonspecific findings and radiographic evidence of bronchopulmonary invasion, including tracheal stenosis, mucormycosis should remain on the differential and be evaluated using bronchoscopy and biopsy for histologic confirmation of pulmonary fungal invasion. Reference #1: Spellberg B, Edwards J, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18(3):556–559. Reference #2: He, Ruoxi, et al. “Report of 12 Cases with Tracheobronchial Mucormycosis and a Review.” The Clinical Respiratory Journal, vol. 12, no. 4, 2018, pp. 1651–1660., doi:10.1111/crj.12724. Reference #3: Rüping MJ, Heinz WJ, Kindo AJ, et al. Forty-one recent cases of invasive zygomycosis from a global clinical registry. J Antimicrob Chemother. 2010;65(2):296–302. DISCLOSURES: No relevant relationships by Amy Bellinghausen, source=Web Response Owner/Founder relationship with Restore3D Please note: $1-$1000 by George Cheng, source=Web Response, value=Ownership interest Consultant relationship with Medtronic Please note: $1001 - $5000 by George Cheng, source=Web Response, value=Consulting fee Consultant relationship with Boston Scientific Please note: $1001 - $5000 by George Cheng, source=Web Response, value=Consulting fee Consultant relationship with Intuitive Surgical Please note: $20001 - $100000 by George Cheng, source=Web Response, value=Grant/Research Support Consultant relationship with Pinnacle Biologics Please note: $1-$1000 by George Cheng, source=Web Response, value=Consulting fee No relevant relationships by Erica Lin, source=Web Response No relevant relationships by Russell Miller, source=Web Response No relevant relationships by Matthew Nobari, source=Web Response No relevant relationships by Alexandra Sykes, source=Web Response

TO CAVITATE OR NOT TO CAVITATE: ATYPICAL PRESENTATION OF A COMMON PATHOGEN

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: A patient with extensive cavitary lung disease and new diagnosis of Human Immunodeficiency Virus (HIV) infection who described clinical features suggestive of pneumocystis jiroveci (PCP) infection failed to improve with initial management. She was subsequently diagnosed with histoplasmosis after bronchoalveolar lavage (BAL) and transbronchial biopsy with a successful treatment response. CASE PRESENTATION: A 40 year-old woman with a past medical history of asthma and tobacco abuse presented with a two-week history of productive cough and pleuritic chest pain. She also reported a 40 pound unintentional weight loss over the past several months and denied hemoptysis. The patient was newly diagnosed with HIV (CD4 count of 41). Chest radiography showed extensive cavitary disease in the right upper lung lobe (RUL) and increased interstitial markings. Computed tomography showed multiple areas of peripheral soft tissue attenuation with central cavitation, the largest in the RUL measured at 7.4 cm, but no mediastinal or hilar lymphadenopathy. Her T-spot mycobacterium tuberculosis (TB) test was negative as were two expectorated sputum samples tested for TB by polymerase chain reaction. The patient underwent bronchoscopy with BAL. PCP smear from bronchial washings was positive, but the patient failed to improve after initial treatment with trimethoprim-sulfamethoxazole and steroids. Transbronchial lung biopsy (TBLB) of the right upper lobe showed lung parenchyma with fungal organisms in a background of necrosis and acute and chronic inflammation. The Grocott Methenamine Silver (GMS) stain of TBLB showed numerous budding yeast suggestive of Histoplasmosis. Fungal culture from BAL eventually grew Histoplasma capsulatum. The patient was treated with a two-week course of amphotericin B and transitioned to daily oral itraconazole for 12 months. DISCUSSION: Cavitary lesions in an immunocompromised patient should always prompt a search for an infectious cause. Although certain pathogens such as Staphylococcus aureus may cause cavitation during acute illness, cavitation due to infection is usually associated with chronic illnesses. Chronic infections most commonly associated with pulmonary cavitations are TB, Histoplasma, Aspergillus, Blastomyces, and Cryptococcus, among others. Cavitary lesions are a rare manifestation of PCP, and a solitary cavity is more common than multiple cavities. Fungal infections can be difficult to diagnose, given the poor sensitivity of culture, cross-reactivity of antigens and antibodies, and the modest sensitivity in BAL. As illustrated in our case, multiple tests may be needed to confirm the diagnosis. CONCLUSIONS: The presence of a cavitary lesion should lower the threshold for performing transbronchial biopsy in addition to BAL. Furthermore, this case calls to consider the interaction between different infectious processes as a contributing factor of such atypical presentation. Reference #1: Wheat J. Endemic mycoses in AIDS: a clinical review. Clin Microbiol Rev. 1995;8(1):146-59. Reference #2: Holt MR, Chan ED. Chronic Cavitary Infections Other than Tuberculosis: Clinical Aspects. J Thorac Imaging. 2018;33(5):322-333. Reference #3: Gallant JE, Ko AH. Cavitary pulmonary lesions in patients infected with human immunodeficiency virus. Clin Infect Dis. 1996;22(4):671-82. DISCLOSURES: No relevant relationships by JENNIFER CHIURCO, source=Web Response No relevant relationships by Jaime Palomino, source=Web Response No relevant relationships by Osman Perez, source=Web Response No relevant relationships by Hanyuan Shi, source=Web Response

A RARE CASE OF RHABDOMYOLYSIS AND ANURIC RENAL FAILURE IN A PATIENT WITH LEGIONNAIRES' DISEASE

SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Presented is a rare case of rhabdomyolysis and acute anuric renal failure caused by Legionnaires' disease CASE PRESENTATION: A 69 year old male truck driver with well-controlled HTN, HLD, and normal renal function at baseline presented with 3 days of progressive weakness and malaise. On exam, temperature 101.3F, respiratory rate 22, heart rate 122 and SpO2 92% on RA. Labs were remarkable for serum creatinine 5.1, CPK 53,734, and WBC 15K. Chest x-ray showed a right hilar consolidation. He was started on CAP coverage and fluids for rhabdomyolysis. Despite aggressive fluid resuscitation, over the next 48 hours the patient progressed to anuria with a creatinine of 10.1 and had increasing oxygen requirements to 10 L via simple facemask. Legionella urine antigen came back positive, and he had no other obvious causes of rhabdomyolysis. On day 3 he was started on hemodialysis, which resulted in down-trending CPK and decreased oxygen requirement to room air, but his anuria did not improve. He completed 10 days of azithromycin and was discharged on scheduled hemodialysis. DISCUSSION: Rhabdomyolysis and acute renal failure are known but serious complications of Legionella infection. Progression to anuria requiring dialysis is an extremely rare but very significant cause of morbidity in patients with Legionnaires’ disease. Our patient initially presented with no respiratory complaints, quickly developed anuria, and required continued hemodialysis despite resolution of his infection. CONCLUSIONS: Rhabdomyolysis and acute renal failure may be the presenting features of patients with Legionnaires' disease. Reference #1: Stout, J. E. and V. L. Yu (1997). "Legionellosis." N Engl J Med 337(10): 682-687. Reference #2: Soni, A. J. and A. Peter (2019). "Established association of legionella with rhabdomyolysis and renal failure: A review of the literature." Respir Med Case Rep 28: 100962. Reference #3: Fields, B. S., et al. (2002). "Legionella and Legionnaires' disease: 25 years of investigation." Clin Microbiol Rev 15(3): 506-526. DISCLOSURES: No relevant relationships by Alivia Adkins, source=Web Response No relevant relationships by Muthiah Muthiah, source=Web Response No relevant relationships by Robert Rudd, source=Web Response

MYCOBACTERIUM PORCINUM CAUSING A FALSE-POSITIVE QUANTIFERON TB-GOLD TEST

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Mycobacterium (M.) porcinum is a rapidly growing nontuberculous mycobacterium that is genetically related to M. Fortuitum. It has been detected in drinking water and fresh vegetables. In isolation, M. porcinum is considered to be commensal; however, true infections such as cellulitis, peritonitis, catheter-related infection and rarely pneumonitis have been reported secondary to M. Porcinum. We discuss the case of a 69 year old male who was infected with M. Porcinum and tested positive for Quantiferon TB-Gold (QFT). This case report brings to attention that despite the increased reliance on QFT for tuberculosis (TB) diagnosis, it is important to be mindful of its limitations and the possibility of an underlying non-tuberculous mycobacterium infection. CASE PRESENTATION: A 69-year-old male, with a history of COPD and long-term smoking presented with a persistent cough and shortness of breath for the past three months. He was treated for bronchitis without improvement. He denied any fever, chills, rigors or weight loss. CT scan of the chest showed a tree in bud appearance, raising concern for an atypical mycobacterial infection. Sputum for AFB stains were negative along with the Mycobacterium tuberculosis PCR assay. However, the QFT was positive. Further, after two weeks of incubation, AFB cultures were positive for M. Porcinum. The patient was subsequently started on rifampin, clarithromycin and amikacin with symptomatic improvement. DISCUSSION: The QFT gold is an ELISA measuring IFN-γ specific to M. tuberculosis peptides such as ESAT6, CFP-10, and TB7.7. These are present in M. tuberculosis but absent in BCG and other non-tuberculous mycobacterium. Unlike the tuberculin skin test, which measures a delayed hypersensitive reaction to the purified protein derivative present in M. tuberculosis and many atypical mycobacteria, the QFT gold test is an in vitro test that is more specific to M. tuberculosis. However, some tuberculous mycobacterium including M. Fortuitum and M. bovis also harbor ESAT 6, CFP 10, and TB7.7 and can produce falsely-positive QFT gold tests. As demonstrated in our patient, we consider M. porcinum to be a true pathogen. He had concomitant advanced COPD and showed evidence of a tree-in-bud appearance that is typically seen in an atypical Mycobacterium infection. After completing treatment with antibiotics, repeat sputum cultures have been negative. Infections from M. Porcinum have only been reported in a few case reports; however, false positive QFT tests secondary to M. porcinum have yet to be reported in literature. CONCLUSIONS: Although M. porcinum is usually considered commensal, it was regarded as a true pathogen in our patient, as evidenced by the tree in bud appearance on CT, positive M. Porcinum cultures, and a negative Mycobacterium tuberculosis PCR assay. Thus, we consider the QFT in our patient to be falsely-positive. Reference #1: Brown-Elliott BA, Wallace RJ, Tichindelean C, et al. Five-year outbreak of community- and hospital-acquired Mycobacterium porcinum related to public water supplies. J Clin Microbiol 2011;49:4231–8. DISCLOSURES: No relevant relationships by Joseph Leon, source=Web Response No relevant relationships by Mohan Rudrappa, source=Web Response No relevant relationships by Sanket Shah, source=Web Response No relevant relationships by Kunal Shah, source=Web Response

Tocilizumab versus the Covid19 tempest: All’s well that ends well or much ado about nothing?

Tocilizumab versus the Covid19 tempest: All’s well that ends well or much ado about nothing?

COVID-19: What do we know?

• Evidence regarding the provision of orthodontic care during the COVID-19 pandemic is examined.

Reply: Iron chelation may harm patients with COVID-19

Cavezzi A, Troiani E, Corrao S (2020) COVID-19: hemoglobin, iron, and hypoxia beyond inflammation. A narrative review. Clin Pract 10(2). https://doi.org/10.4081/cp.2020.1271 Garrick M, Ghio A (2020) Iron chelation may harm patients with COVID-19. Eur J Clin Pharmacol Herbert V, Jayatilleke E, Shaw S, Rosman A, Giardina P, Grady R et al (1997) Serum ferritin iron, a new test, measures human body iron stores unconfounded by inflammation. Stem Cells 15(4):291–296 Article Google Scholar Perricone C, Bartoloni E, Bursi R, Cafaro G, Guidelli G, Shoenfeld Y et al (2020) COVID-19 as part of the hyperferritinemic syndromes: the role of iron depletion therapy. Immunol Res 68(4):213–224 Article Google Scholar Edeas M, Saleh J, Peyssonnaux C (2020) Iron: Innocent bystander or vicious culprit in COVID-19 pathogenesis? Int J Infect Dis 97:303–305 Article Google Scholar Liu W, Zhang S, Nekhai S, Liu S (2020) Depriving iron supply to the virus represents a promising adjuvant therapeutic against viral survival. Curr Clin Microbiol Rep 7(2):13–19 Article Google Scholar Shi S, Lai M (2005) Viral and cellular proteins involved in coronavirus replication. Curr Top Microbiol Immunol 287:95–131 PubMed PubMed Central Google Scholar Juang H (2004) Modulation of iron on mitochondrial aconitase expression in human prostatic carcinoma cells. Mol Cell Biochem 265(1/2):185–194 Article Google Scholar Download references Spire Fylde Coast Hospital, St Walburgas Road, Blackpool, FY3 8BP, UK Anis Abobaker You can also search for this author in PubMed Google Scholar Correspondence to Anis Abobaker. The author declares that he has no conflict of interest. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions Abobaker, A. Reply: Iron chelation may harm patients with COVID-19. Eur J Clin Pharmacol (2020). https://doi.org/10.1007/s00228-020-02988-9 Download citation Received: 12 August 2020 Accepted: 27 August 2020 Published: 01 September 2020 DOI: https://doi.org/10.1007/s00228-020-02988-9

Usefulness of sonication procedure in mesh infection diagnosis associated with hernia repair.

The use of prosthetic meshes is a common practice in hernia repair surgery. However, infection can appear as an important complication where antibiotic selection must be directed by the etiology of the infection. In recent years, sonication has appeared as an important tool for the diagnosis of many biomaterial-associated infections. Here, we evaluated our experience with this methodology for the diagnosis of mesh infection. We retrospectively reviewed the microbiological records between 2015 and 2019 looking for sonicated meshes in the microbiology laboratory. All samples were processed according to the sonication protocol described by Esteban J et al. (J Clin Microbiol. 2008 Feb; 46 (2): 488-92). 26 samples were processed during the study period. 21 of them gave a positive result for culture (11 polymicrobial and 10 monomicrobial ones). Staphylococcus aureus and Candida albicans were the commonest monomicrobial isolates (4 cases each). There were five cases of mixed gut microbiota. The median (interquartile range) UFC count was > 100,000 (50,000- > 100,000) CFU/mL. Sonication is a useful technique for the diagnosis of mesh infection.

AGA Institute Rapid Review and Recommendations on the Role of Pre-Procedure SARS-CoV-2 Testing and Endoscopy

AGA Institute Rapid Review and Recommendations on the Role of Pre-Procedure SARS-CoV-2 Testing and Endoscopy

Corrigendum to “Isavuconazole is highly active in vitro against Candida species isolates but shows trailing effect” [Clin Microbiol Infect 24 (12) (December 2018) 1343.e1-1343.e4

Corrigendum to “Isavuconazole is highly active in vitro against Candida species isolates but shows trailing effect” [Clin Microbiol Infect 24 (12) (December 2018) 1343.e1-1343.e4

Genotyping SARS-CoV-2 through an interactive web application

Genotyping SARS-CoV-2 through an interactive web application

Computer Vision and Artificial Intelligence Are Emerging Diagnostic Tools for the Clinical Microbiologist.

Artificial intelligence (AI) is increasingly becoming an important component of clinical microbiology informatics. Researchers, microbiologists, laboratorians, and diagnosticians are interested in AI-based testing because these solutions have the potential to improve a test's turnaround time, quality, and cost. A study by Mathison et al. used computer vision AI (B. A. Mathison, J. L. Kohan, J. F. Walker, R. B. Smith, et al., J Clin Microbiol 58:e02053-19, 2020, https://doi.org/10.1128/JCM.02053-19), but additional opportunities for AI applications exist within the clinical microbiology laboratory. Large data sets within clinical microbiology that are amenable to the development of AI diagnostics include genomic information from isolated bacteria, metagenomic microbial findings from primary specimens, mass spectra captured from cultured bacterial isolates, and large digital images, which is the medium that Mathison et al. chose to use. AI in general and computer vision in specific are emerging tools that clinical microbiologists need to study, develop, and implement in order to improve clinical microbiology.

PC-FACS: COVID-19

PC-FACS (FastArticleCriticalSummaries forClinicians inPalliativeCare) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at pcfacs@aahpm.org.