Immunocompetent Patients Research Articles

Clinical Course, Antifungal Susceptibility, and Genomic Sequencing of Trichophyton indotineae.

Trichophyton indotineae is an emerging dermatophyte causing outbreaks of extensive tinea infections often unresponsive to terbinafine. This species has been detected worldwide and in multiple US states, yet detailed US data on infections with T indotineae are sparse and could improve treatment practices and medical understanding of transmission. To correlate clinical features of T indotineae infections with in vitro antifungal susceptibility testing results, squalene epoxidase gene sequence variations, and isolate relatedness using whole-genome sequencing. This retrospective cohort study of patients with T indotineae infections in New York City spanned May 2022 to May 2023. Patients with confirmed T indotineae infections were recruited from 6 New York City medical centers. Improvement or resolution at the last follow-up assessment. Among 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months). Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated terbinafine minimum inhibitory concentrations of 0.5 μg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates. The results of this case series suggest that disease severity, diagnostic delays, and lack of response to typically used doses and durations of antifungals for tinea were common in this primarily immunocompetent patient cohort with T indotineae, consistent with published data. Itraconazole was generally effective, and the acquisition of infection was likely in Bangladesh.

Host immunity involvement in the outcome of phage therapy against hypervirulent Klebsiella pneumoniae infections.

Highly encapsulated hypervirulent Klebsiella pneumoniae (hvKp) causes severe infections. Bacteriophage therapy, an antibiotic alternative, effectively treats bacterial infections. Phage φFK1979 encoding polysaccharide depolymerases can target and disarm the capsule of hvKp FK1979, showing promise against FK1979 infection. Resistant strains induced by φFK1979 are possibly eliminated by host immunity and new phage phiR3 targeting them. We constructed varied immunocompromised FK1979 infection mouse models to assess the therapy efficacy of φFK1979 alone or in combination with phiR3. Survival rates, bacterial loads, histopathology, inflammation, and immune cell distribution of mice were studied. Prompt and adequate administration of φFK1979, rather than phiR3, significantly improved survival rates in mice with different immune statuses. However, immunocompromised mice showed lower efficacy due to reduced tolerance to low-virulence φFK1979-resistant bacteria compared to immunocompetent mice. Adding phiR3 sequentially greatly enhanced therapy efficacy for them, leading to increased survival rates and notable improvements in pathology and inflammation. Immunocompetent mice exhibited the most favorable response to φFK1979 monotherapy, as their immune system cleared φFK1979-resistant bacteria while avoiding a robust response to phiR3 combating φFK1979-resistant bacteria. This study revealed host immunity involvement in the outcome of phage therapy against infections and introduced, for the first time, personalized phage therapy strategies for hvKp-infected mice with varying immune statuses.IMPORTANCEHypervirulent Klebsiella pneumoniae (hvKp), with high capsular polysaccharide production, can cause severe invasive infections. Capsule-targeting phage poses the potential to fight against hvKp. We previously elucidated that the capsule-targeting phage induces resistance in hvKp, while phage-resistant strains exhibit sensitivity to host innate immunity and new phages targeting them. This indicated that phage-resistant strains can be eliminated by the immune system in immunocompetent patients, whereas they may require treatment with phages targeting resistant bacteria in immunocompromised patients. HvKp can infect individuals with varying immune statuses, including both immunocompetent and immunocompromised/deficient patients. This study, for the first time, developed personalized phage therapy strategies for hvKp-infected mice with different immune statuses, optimizing phage therapy against hvKp infections. This research is expected to provide a theoretical foundation and novel insights for clinical phage therapy against hvKp infections, offering significant societal benefits and clinical value.

Sentinel lymph node biopsy versus observation in high-risk cutaneous squamous cell carcinoma in immunosuppressed and immunocompetent patients: An inverse probability of treatment weighting study.

The survival benefit of sentinel lymph node biopsy (SLNB) in immunocompetent and immunosuppressed patients with high-risk cutaneous squamous cell carcinoma (cSCC) has not been established. To determine whether SLNB improves disease-specific survival (DSS) in high-risk cSCC. Secondary objectives were to analyse disease-free survival, nodal recurrence-free survival and overall survival (OS). Multicentre, retrospective, observational cohort study comparing survival outcomes in immunosuppressed and immunocompetent patients treated with SLNB or watchful waiting. Inverse probability of treatment weighting was used to adjust for possible confounding effects. We studied 638 tumours in immunocompetent patients (SLNB n = 42, observation n = 596) and 173 tumours in immunosuppressed patients (SLNB n = 28, observation n = 145). Overall, SLNB was positive in 15.7% of tumours. SLNB was associated with a reduced risk of nodal recurrence (NR)(hazard ratio [HR], 0.05 [95% CI, 0.01-0.43]; p = 0.006), disease specific mortality (HR, 0.17 [95% CI, 0.04-0.72]; p = 0.016) and all-cause mortality (HR, 0.33 [95% CI, 0.15-0.71]; p = 0.004) only in immunocompetent patients. SLNB was associated with improvements in NR, DSS and OS in immunocompetent but not in immunosuppressed patients with high-risk cSCC.

Mini Review] Global Burden and Evolving Understanding of Hepatitis E Virus

Hepatitis E virus (HEV) is the leading cause of acute viral hepatitis worldwide, recognized as a significant global public health concern. Recent advancements in understanding the natural history of HEV infection have shed light on its epidemiology and clinical implications. The primary mode of HEV transmission is fecal-oral, occurring through contaminated water or food. Parenteral transmission, particularly through blood transfusions, was initially overlooked but has been increasingly recognized in both developing and industrialized countries. Acute HEV infection typically manifests as self-limiting jaundice, particularly in immunocompetent individuals. However, recent data suggest that acute infection can progress to a chronic form in various immunosuppressive conditions, including solid organ transplantation, hematological malignancies, and human immunodeficiency virus (HIV) infection. Chronic HEV can lead to cirrhosis, which may progress rapidly in some cases. Extrahepatic manifestations, particularly neurological complications, have also been reported. HEV remains underdiagnosed globally due to a lack of awareness among healthcare providers in many regions. Advances in serological and molecular assays have facilitated reliable diagnosis, both in immunocompetent and immunocompromised patients. Ribavirin monotherapy has proven effective in treating chronic HEV infection in immunosuppressed individuals and is currently widely recommended. However, its efficacy in acute HEV remains inconclusive. In 2011, an effective and well-tolerated HEV vaccine was developed and approved in China. This vaccine holds promise for high-risk populations, particularly individuals with cirrhosis and travelers to endemic regions.

Mohs micrographic surgery in immunosuppressed vs immunocompetent patients: Results of a prospective nationwide cohort study (REGESMOHS, Spanish registry of Mohs surgery).

Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.

Persistent Severe Headache After Removal of Fungus Ball From the Sphenoid Sinus: A Case Report.

Granulomatous invasive fungal sinusitis (GIFS) is a rare and life-threatening disease, whereas fungus ball (FB) is the most common form of noninvasive fungal sinusitis. Both GIFS and FB primarily develop in immunocompetent patients, with the former associated with higher mortality and morbidity. A chart review and review of the literature. We present the case of a 77-year-old woman with mixed fungal sinusitis who was successfully treated with voriconazole. GIFS and FB can coexist in extremely rare cases, known as mixed fungal sinusitis; however, the diagnosis and subsequent treatment of mixed fungal sinusitis can be delayed because of a lack of awareness of the underlying concept. Therefore, it is crucial for clinicians to recognize the concept of mixed fungal sinusitis.

Herpes Simplex Virus Dacryoadenitis Preceding Skin Vesicles.

Herpes simplex virus involvement of the orbit is rare. We report the case of an immunocompetent patient who presented with preseptal edema, erythema, decreased vision, and dacryoadenitis prior to the appearance of vesicular skin lesions and in the absence of corneal dendrites. The patient's clinical picture failed to improve on empiric therapy with intravenous antibiotics. The patient subsequently developed skin vesicles and a nucleic acid amplification swab of the ocular surface was positive for herpes simplex virus-1. The patient demonstrated rapid clinical improvement after initiation of oral antivirals. This is an unusual case of presumed herpes simplex virus dacryoadenitis preceding skin vesicles in an immunocompetent patient.

Refractory and disfiguring facial chromoblastomycosis caused by Exophiala spinifera responsive to posaconazole in an immunocompetent patient

Refractory and disfiguring facial chromoblastomycosis caused by <i>Exophiala spinifera</i> responsive to posaconazole in an immunocompetent patient

A man with diarrhea.

Respiratory syncytial virus (RSV) primarily affects infants and children and can manifest as upper airway dysfunction. Patients at the highest risk of increased morbidity and mortality from RSV include those who are immunosuppressed and the elderly. Patients with RSV hepatitis most commonly present with fever, abdominal pain, nausea, and vomiting; however, patients may present with jaundice and coagulopathies in a severe infection. We describe a first-of-its-kind case of an immunocompetent patient who developed RSV hepatitis after primary infection.

Bloodstream Infection Caused by Erysipelothrix rhusiopathiae in an Immunocompetent Patient

Erysipelothrix rhusiopathiae is a facultative anaerobe Gram-positive bacillus, which is considered a zoonotic pathogen. E. rhusiopathiae causes erysipeloid, mainly in occupational groups such as veterinarians, slaughterhouse workers, farmers, and fishermen. Two cutaneous forms (localised and generalised) and a septicaemic form have been described. Here, we report the isolation of a strain of E. rhusiopathiae from a 56-year-old immunocompetent obese male admitted to Fondazione IRCCS Policlinico San Matteo Pavia (Italy). Blood cultures were collected and Gram-positive bacilli were observed. E. rhusiopathiae grew and was identified. Antimicrobial susceptibility tests were performed and interpreted with EUCAST breakpoints (PK-PD). The strain was susceptible to all the antibiotics tested, while it was intrinsically resistant to vancomycin. The clinical diagnosis of E. rhusiopathiae can be challenging, due to the broad spectrum of symptoms and potential side effects, including serious systemic infections such as heart diseases. In the case described, bacteraemia caused by E. rhusiopathiae was detected in a immunocompetent patient. Bacteraemia caused by E. rhusiopathiae is rare in immunocompetent people and blood cultures were proven to be essential for the diagnosis and underdiagnosis of this pathogen, which is possible due to its resemblance to other clinical manifestations.

Incidence of Cryptosporidium: A Neglected Parasite in Immunocompetent Adults in Swabi

Objective: To highlight the increasing incidence of Cryptosporidium in immunocompetent adults and the resultant altered epidemiology. Methodology: This study was conducted over a period of one year, from 1st January 2023 to 1st of January, 2024 at Microbiology Laboratory MTI- GKMC/BKMC, Swabi. Modified Ziehl Neelsen staining was performed on the received stool samples from patients presenting with wide range of symptoms associated with Irritable Bowel Syndrome (IBS). Abdominal pain, recurrent episodes of diarrhea and weight loss were the main symptoms. Modified ZN stain being one of the most reliable, quick and cost effective methods for the detection of cysts of Cryptosporidium using 40X and oil immersion lens was used for diagnosis. Results: A total of 62 samples were received from immunocompetent patients in the said period out of which 34% were positive for the oocysts of Cryptosporidium species. Out of a total of 21 positive samples 62% were males and 38% were females. The age range of the patients spanned between 20 to 60 years. Conclusion: Knowing this high incidence 34% of Cryptosporidium spp. in the healthy adults, necessitates to prioritize steps for the prevention of this infection by implementation of public health measures.

Clinical characteristics and outcomes of Respiratory Syncytial Virus-associated ARF in immunocompetent patients: a seven-year experience at a tertiary hospital in France

BackgroundRespiratory syncytial virus (RSV) is widely recognized as a cause of acute respiratory failure in infants and immunocompromised patients. However, RSV can also contribute to acute respiratory failure in adults, particularly among the elderly population. The objective of this study was to analyze the clinical characteristics and outcomes of immunocompetent adults hospitalized for RSV infection. MethodsThis retrospective study included all immunocompetent adult patients consecutively admitted to a tertiary care hospital with RSV-related acute respiratory failure over a seven-year period (2016 – 2023). Diagnosis of RSV infection was made through nasal swabs or pulmonary samples, with multiplex reverse transcription polymerase chain reaction (RT-PCR). Patients were eligible for inclusion if they required supplemental oxygen therapy for at least 48hours. ResultsOne hundred and four patients met the inclusion criteria. Median age [IQR] was 77 years [67 – 85]. Ninety-seven patients had at least one comorbidity (97/104, 93%). At the time of RSV diagnosis, 67 patients (67/104, 64%) experienced acute decompensation of a pre-existing chronic comorbidity. Antibiotics were started in 80% (77/104) of patients; however, only 16 patients had a confirmed diagnosis of bacterial superinfection. Twenty-six patients needed ventilatory support (26/104, 25%) and 21 were admitted to the intensive care unit (21/104, 20%). The median duration of oxygen therapy [IQR] was 6 days [3 – 9], while the median hospital length of stay [IQR] was 11 days [6 – 15]. The overall mortality rate within one month of hospital admission was 13% (14/104). The sole variables associated with one-month mortality were age and maximum oxygen flow during hospitalisation. ConclusionRSV-associated acute respiratory failure affected elderly individuals with multiple comorbidities and was associated with prolonged hospitalization and a high mortality rate.

Antibiothérapie courte au cours de la pneumonie : PNEUMOSHORT

IntroductionPneumonia is one of the most common indications for antibiotic. Shortening the duration of antibiotic therapy should help reduce bacterial resistance. To date, three randomized control trials have shown non-inferiority of short courses of antibiotic therapy (3 days) compared with 7 days in non-severe pneumonia. The aim of this study was to assess this strategy in real life. MethodThis retrospective observational cohort study included all patients with pneumonia hospitalized in an internal medical ward from 11/01/2022 to 05/31/2023. We implemented the strategy based on early discontinuation of antibiotic therapy in patients with pneumonia who were clinically stable after 3 days of β-lactam treatment. ResultsAmong 49 patients included, median age was 72, median antibiotic duration was 4 days (IQR 3-6), and cure rate at D30 was 88 %. At day 30, we observed one death (2 %), four new antibiotic therapy (9 %), and two new hospitalisation (5 %), among five immunosuppressed patients. Among immunosuppressed patients (n=17; 35 %), failure rate was three times higher in case of short antibiotic courses (3/8; 38 %) than long antibiotic courses (1/7; 14 %). ConclusionStrategy based on early discontinuation of antibiotic therapy in immunocompetent patients with pneumonia who were clinically stable after 3 days of β-lactam treatment is safe, and easy to implement in a medical ward.

Kodamaea ohmeri: A rare yeast causing invasive infections in immunocompromised patients.

Kodamaea ohmeri is a rare, recognized pathogen that has previously been isolated from environmental sources. The patients commonly affected by this yeast include immunocompromised as well as immunocompetent patients having several associated risk factors. We report three cases in which K. ohmeri was isolated from blood using Bact T/ALERT. Identification was carried out by MALDI-TOF MS (Vitek-MS, BioMérieux, Marcy-l'Etoile, France) in addition to color characteristics on chromogenic media. The patients had diminished immune response on account of a multitude of comorbidities. K. ohmeri can be misidentified as Candida tropicalis, Candida albicans, or Candida hemolounii by conventional methods; correct and timely identification can be achieved by MALDI-TOF MS. Antifungal susceptibility breakpoints for K. ohmeri are currently not defined. An Echinocandin was added to the treatment regimen of all three of the cases. Identification of K. ohmeri using conventional methods is difficult and unusual yeasts should be carefully observed, especially upon prolonged incubation.

A Challenging Case of Primary Central Nervous System Lymphoma: Diagnostic Dilemmas and Therapeutic Insights

Introduction: Primary Central Nervous System Lymphoma (PCNSL) is a rare malignancy primarily located in the brain, spinal cord, leptomeninges, and eyes. The origin of PCNSL is uncertain, but it is thought to arise from lymphocytes within the central nervous system. Diagnosis and treatment can be complex, especially in immunocompetent patients. Case Report: A 65-year-old immunocompetent woman presented with symptoms including weight loss, severe weakness, and left hemiplegia. Initial brain MRI revealed an irregular mass with vasogenic edema in the right parietal lobe. Stereotactic biopsy confirmed large cell lymphoma (T-cell variant). The patient initially responded well to high-dose steroid treatment. Subsequent chemotherapy and radiotherapy were planned, but due to a positive PCR test, treatment was delayed. Discussion: PCNSL presents with non-specific symptoms, making early diagnosis challenging. Diagnostic tools such as MRI, PET-CT, and immunohistochemistry play crucial roles. Steroid use before biopsy should be cautious, as it may affect tissue necrosis and diagnosis accuracy. Prompt diagnostic and therapeutic measures are essential for improved outcomes. Conclusion: PCNSL is a rare and aggressive malignancy with a poor prognosis if left untreated. Early diagnosis and appropriate treatment, including chemotherapy and radiotherapy, are crucial for patient survival. Larger studies are needed to further understand and manage this challenging condition.

Surgical Management of Giant Condyloma Acuminata Involving Vulva, Perineum and Perianal Area

Condyloma acuminata (CA), also known as anogenital warts, are benign proliferative epidermal and/or mucosal lesions usually caused by Human Papilloma Virus (HPV) type 6 and 11. They initially manifest as variable sized and shaped soft papules or plaques on anogenital skin. However, they can grow as a large, bulky, lobulated growth. Lesions are commonly multiple and multifocal, affecting the vulva, perianal, vaginal and cervical regions. They represent the most common sexually transmitted disease (STD) and are highly contagious. Further, the incidence of CA is 5-7fold higher in Human Immunodeficiency virus (HIV) positive patients compared to immunocompetent patients. The HIV infection reduces the local immune control of HPV infection thus favours the proliferation of the HPV which results into large sized CA. The giant condyloma acuminata (GCA) and giant condyloma of Buschke-Löwenstein (GCBL) are uncommon variants of classical condyloma acuminata (CCA) which can reach the size of 10 to 30 cm. The treatment of CA should be individualized and based upon the extent of disease and treatment availability. The small CA which present as papules or plaques can be treated by Podophyllin, Imiquimod, electrosurgical ablation or cryotherapy. However, GCA require excision with cold knife, electrosurgery or CO2 laser. When the base of GCA is narrow, surgical excision with minimal skin loss allows primary closure of the wound, whereas when the base is broad and relatively fixed, one must keep the differential diagnoses of GCA versus GCBL which require wide excision and reconstruction of the tissue. This case report illustrates the surgical management of GCA with broad base in a 44-year-old female patient with HIV infection. She was treated by wide surgical excision followed by reconstruction of the defect with fascio-cutaneous V-Y advancement flaps. Histology confirmed the diagnosis of condyloma acuminatum. Six months following surgery, she had recurrence of a perianal wart that was cauterized. On further 12 month follow up there was no new recurrence of any condylomatous lesion.

Overlapping infections of Mycobacterium canariasense and Nocardia farcinica in an immunocompetent patient: A case report

BACKGROUND Infections by non-tuberculous mycobacteria (NTM) have become more common in recent years. Mycobacterium canariasense (M. canariasense ) was first reported as an opportunistic pathogen in 2004, but there have been very few case reports since then. Nocardia is a genus of aerobic and Gram-positive bacilli, and these species are also opportunistic pathogens and in the Mycobacteriales order. Conventional methods for diagnosis of NTM are inefficient. Metagenomic next-generation sequencing (mNGS) can rapidly detect many pathogenic microorganisms, even rare species. Most NTM and Nocardia infections occur in immunocompromised patients with atypical clinical symptoms. There are no previous reports of infection by M. canariasense and Nocardia farcinica (N. farcinica ), especially in immunocompetent patients. This case report describes an immunocompetent 52-year-old woman who had overlapping infections of M. canariasense , N. farcinica , and Candida parapsilosis (C. parapsilosis ) based on mNGS. CASE SUMMARY A 52-year-old woman presented with a productive cough and chest pain for 2 wk, and recurrent episodes of moderate-grade fever for 1 wk. She received antibiotics for 1 wk at a local hospital, and experienced defervescence, but the productive cough and chest pain persisted. We collected samples of a lung lesion and alveolar lavage fluid for mNGS. The lung tissue was positive for M. canariasense , N. farcinica , and C. parapsilosis , and the alveolar lavage fluid was positive for M. canariasense . The diagnosis was pneumonia, and application of appropriate antibiotic therapy cured the patient. CONCLUSION Etiological diagnosis is critical for patients with infectious diseases. mNGS can identify rare and novel pathogens, and does not require a priori knowledge.

Successful treatment of recurrent visceral leishmaniasis relapse in an immunocompetent adult female with functional hypopituitarism in Bangladesh.

Currently available treatment options are mostly effective in achieving long-term cure in visceral leishmaniasis (VL) patients. However, there have been reports of recurrence of this illness in both immunosuppressed and immunocompetent patients. We report the first case of recurrent VL relapse in a 19-year-old immunocompetent female with functional hypopituitarism (hypogonadotropic hypogonadism with central hypothyroidism) from Bangladesh, who has been treated three times previously with optimal dosage and duration- liposomal amphotericin B (LAmB) alone and in combination with miltefosine. We treated the patient successfully with a modified treatment regimen of 10 mg/kg body weight LAmB for two consecutive days along with oral miltefosine for seven days as loading dose. For secondary prophylaxis, the patient received 3 mg/kg body weight LAmB along with oral miltefosine for seven days monthly for five doses followed by hormonal replacement. The patient remained relapse free after 12 months of her treatment completion. In the absence of protective vaccines against Leishmania species and standard treatment regimen, this modified treatment regimen could help the management of recurrent relapse cases.

Preoperative Corticosteroids Reduce Diagnostic Accuracy of Stereotactic Biopsies in Primary Central Nervous System Lymphoma: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: Despite general acceptance that corticosteroid therapy (CST) should be withheld before biopsy for suspected primary central nervous system lymphoma (PCNSL), there remains conflicting evidence surrounding the precise impact of preoperative CST on the histopathological diagnosis. The objective of this systematic review and meta-analysis was to describe and quantify the effects of preoperative CST on the diagnostic accuracy of biopsies for PCNSL. METHODS: Primary articles were screened from Ovid MEDLINE, Embase, Web of Science, and Scopus databases. Meta-analysis was performed for immunocompetent patients with histologically confirmed PCNSL. Subgroup and regression analyses were performed to assess the effects of biopsy type, CST duration, dose, and preoperative taper on the diagnostic accuracy. In addition, the sensitivity of cerebrospinal fluid (CSF) analyses for PCNSL was assessed. RESULTS: Nineteen studies, comprising 1226 patients (45% female; mean age: 60.3 years), were included. Preoperative CST increased the risk of nondiagnostic biopsy with a relative risk (RR) of 2.1 (95% CI: 1.1-4.1). In the stereotactic biopsy subgroup, the RR for nondiagnostic biopsy was 3.0 (95% CI: 1.2-7.5). CST taper, duration, and dose did not significantly influence diagnostic biopsy rates. The sensitivity of CSF cytology, including flow cytometry, for PCNSL was 8.0% (95% CI: 6.0%-10.7%). CONCLUSION: Our results suggest that preoperative CST reduces the diagnostic yield of stereotactic biopsies for PCNSL. We found no evidence that tapering CST before biopsy improves diagnostic rates. CSF analysis currently has a poor sensitivity for the diagnosis of PCNSL.

Mycobacterium abscessus subsp. Bolletti-associated osteomyelitis of the lumbar vertebrae in immunocompetent patient

Introduction: Nontuberculous mycobacteria (NTM)-related Vertebral Osteomyelitis (VO) is a rare disease with challenging diagnosis and management. NTM-caused disease more often develops in vulnerable populations, affecting individuals who are immunocompromised or who have underlying health conditions. Methods: We report a case of Mycobacterium abscessus subsp. Bolletti-associated VO in a 60-year-old immunocompetent female patient. Results: The patient presented with chronic back pain and paresis of the legs. She underwent surgery - partial resection of L4 and L5 vertebral bodies, and vertebroplasty with allograft. Culture for Mycobacterium abscessus subspace Bolletti was positive from operation material, and treatment with multiagent antibacterial therapy was started. After 2 months of treatment, an asymptomatic m.psoas abscess was identified on control imaging. Repeated surgery with abscess drainage was applied, and treatment of M.abscessus infection was continued. After a 12-month course of treatment, the patient recovered successfully and could walk without support. During treatment, she experienced a lot of drug side effects including peripheral neuropathy. Conclusion: Sampling for Mycobacterium tuberculosis and NTM should be always considered in both, immunocompromised and immunocompetent patients presenting with clinical symptoms and imaging findings consistent with VO.