Subcutaneous Aspergillus nodule with cutaneous Enterococcus infection

ABSTRACT An 87-year-old woman presented with a subcutaneous nodule with overlying black and yellow scales on the surface located on the left forearm. Enterococcus faecalis grew up in bacterial culture using specimen from skin surface scale. And Aspergillus fumigatus was detected in the subcutaneous tissue culture. When suspecting a deep infection, not only the surface part but also the deeper part must be cultured, because we may mislead about the identity of the infectious organism only bacterial culture form skin surface.

Uveitis for the non-ophthalmologist

The uveitides are a heterogeneous group of diseases characterized by inflammation inside the eye. The uveitides are classified as infectious or non-infectious. The non-infectious uveitides, which are presumed to be immune mediated, can be further divided into those that are associated with a known systemic disease and those that are eye limited,—ie, not associated with a systemic disease. The ophthalmologist identifies the specific uveitic entity by medical history, clinical examination, and ocular imaging, as well as supplemental laboratory testing, if indicated. Treatment of the infectious uveitides is tailored to the particular infectious organism and may include regional and/or systemic medication. First line treatment for non-infectious uveitides is corticosteroids that can be administered topically, as regional injections or surgical implants, or systemically. Systemic immunosuppressive therapy is used in patients with severe disease who cannot tolerate corticosteroids, require chronic corticosteroids at >7.5 mg/day prednisone, or in whom the disease is known to respond better to immunosuppression. Management of many of these diseases is optimized by coordination between the ophthalmologist and rheumatologist or internist.

Thoracic Extrapulmonary Tuberculosis in the Millennial Era

Mycobacterium tuberculosis is one of the most pathogenic infectious organisms, usually known for causing cavitary lung infection. But this mycobacterium is also capable of causing masked involvement in any organ of the body. Its clinical manifestation can mimic other conditions according to the organ affected. Extrapulmonary infection is defined as any manifestation caused by tuberculosis in tissues outside the airway or the pulmonary parenchyma. Despite it being a well-known infectious organism throughout decades, tuberculosis continues to be causing great morbidity and mortality in this millennium. This chapter will discuss the clinical manifestations of extrapulmonary tuberculosis (EPTB), when the mycobacteria invade extrapulmonary tissues inside the thorax. We discuss and review the literature about the clinical manifestations, diagnosis and evaluation, and general treatment.

Childhood Infectious Encephalitis: An Overview of Clinical Features, Investigations, Treatment and Recent Patents

Background:: Infectious encephalitis is a serious and challenging condition to manage. This overview summarizes the current literature regarding the etiology, clinical manifestations, diagnosis, management and recent patents of acute childhood infectious encephalitis. Methods:: We used PubMed Clinical Queries and keywords of “encephalitis” AND “childhood” as a search engine, and patents were searched using the key term “encephalitis” in google.patents.com and patentsonline.com. Results:: Viral encephalitis is the most common cause of acute infectious encephalitis in children. In young children, the clinical manifestations can be non-specific. Provision of empiric antimicrobial therapy until a specific infectious organism has been identified, which in most cases includes acyclovir, is the cornerstone of therapy. Advanced investigation tools, including nucleic acid-based test panel and metagenomic next generation sequencing, improve diagnostic yield of identifying an infectious organism. Supportive therapy includes adequate airway and oxygenation, fluid and electrolyte balance, and cerebral perfusion pressure support and seizure control. Recent patents are related to diagnosis, treatment and prevention of acute infectious encephalitis. Conclusions:: Viral encephalitis is the most common cause of acute infectious encephalitis in children and is associated with significant morbidity. Recent advances in understanding the genetic basis and immunological correlation of infectious encephalitis may improve treatment. Third-tier diagnostic tests may be incorporated into clinical practice. Treatment is targeted at the infectious process but remains mostly supportive. Specific antimicrobial agents and vaccines development is ongoing.

E-Cigarette- and Vaping-Related Lung Injury (EVALI) at a Regional Hospital System in South Carolina

We report on four cases of severe lung injury and respiratory failure attributed to E-cigarette use that presented between July and August, 2019. The patients described were relatively healthy without clinically significant history of lung disease. Each developed severe acute respiratory distress shortly following E-cigarette use. In each case, the patients initially presented with considerable hypoxia and infectious-appearing pattern with elevated inflammatory markers on laboratory values. Imaging studies demonstrated a consistent pattern of widespread bilateral interstitial infiltrates with a medial distribution. All but one of the cases involved the admitted use of THC oil in E-cigarettes. There was rapid progression of illness requiring increased supplemental oxygen and in two cases, requiring urgent intubation and mechanical ventilation. No infectious organism was isolated in any case, and patients improved rapidly with the initiation of steroids. These are among the first cases reported in South Carolina and are consistent with similar cases that have been reported around the country.

Cephalosporins : An imperative antibiotic over the generations

Cephalosporins are the most commonly prescribed class of antibiotics, and its structure and pharmacology are similar to that of penicillin. It's a bactericidal, and its structure contains beta-lactam ring, as like of penicillin, which intervenes in bacterial cell wall synthesis. Cephalosporins are derived from the mold Acremonium (previously called as Cephalosporium). It was first discovered in 1945; scientists have been improving the structure of cephalosporins to make it more effective against a wider range of bacteria. Whenever the structure of cephalosporins modified, a new "generation" of cephalosporins are made. So far, there are five generations of cephalosporins available. They are prescribed against various organisms and infections. The cephalosporin antibiotics interfere with cell-wall synthesis of bacteria, leading to the breakdown of the infectious organism. To achieve this effect, the antibiotic must cross the bacterial cell wall and bind to the penicillin-binding proteins. Various generations of cephalosporins, mechanisms of resistance, pharmacokinetics, adverse reactions, and their clinical use were reviewed in this article. Most of the cephalosporins are available as parenteral, but the oral formulations are also available for certain drugs. Rather than learn all cephalosporins, it is reasonable for the clinician to be familiar with selected cephalosporins among the parenteral and oral formulations.

Bordetella infection

Bordetella are small Gram-negative coccobacilli, of which Bordetella pertussis is the most important human pathogen. Bordetella pertussis is the cause of whooping cough, which remains one of the 10 leading causes of death among children less than five years old. Transmission of this highly infectious organism is primarily by aerosolized droplets. The preferred diagnostic methods are polymerase chain reaction detection from nasopharyngeal samples and serology (IgG antibodies to pertussis toxin). Macrolide antibiotics are recommended if started within four weeks of illness onset. Preventing severe disease in young children remains the primary goal, hence schedules consist of a three-dose infant series and subsequent booster doses. Acellular vaccines enable immunization schedules to include adolescents and adults. Acellular pertussis vaccine given to pregnant women reduces the risk of pertussis in young infants. Antibiotic prophylaxis is given when there is an infant at risk of exposure.

Spectrum of neurovascular complications from central nervous system infections (viral, bacterial and fungal)

In the following pictorial review, common and uncommon neurovascular complications associated with a spectrum of viral, bacterial and fungal infections involving the central nervous system will be illustrated. These complications include cerebral vascular insult, venous thrombosis, vasculitis and aneurysm formation. They can occur as separate entities but are often inter-related. The imaging features of neurovascular complication related to infections can provide clues and aid diagnosis when considering the potential mode of infectious spread and the type of potential infectious organism involved. The radiological appearances vary from common features that are shared by several types of pathogens to typical characteristics of a type of infectious organism.

The Role of Ancillary Techniques in Pulmonary Cytopathology

Ancillary techniques play an essential role in pulmonary cytopathology. Immunoperoxidase and special stains are by far the most common ancillary techniques used in cytopathology; however, the role of molecular diagnosis is growing, especially in the fields of pulmonary oncology and infectious disease. In this article, we review the uses of ancillary techniques in lung tumor diagnosis, lung tumor classification, predictive marker determination, primary versus metastasis differential diagnosis, and infectious organism detection.

The Women and Children’s Infectious Diseases Center: An integrated approach to congenital infectious diseases

Congenital infectious diseases, transmitted during the course of pregnancy, are estimated to affect nearly one in every hundred births worldwide. These infections may be associated with fetal and infant adverse health outcomes, due to congenital malformations caused by in utero transmission of the infectious organism itself (as is the case with cytomegalovirus, toxoplasmosis, syphilis and Zika virus), or due to chronic infection in the infant (as is the case with human immunodeficiency virus [HIV] and hepatitis B and C). In addition, children who are exposed, yet uninfected, may still suffer from the consequences of exposure to infectious pathogens or to the drugs given to treat pregnant women and prevent in utero transmission (as may be the case with HIV infection).