Infections in LVAD patients.

Infections in left ventricular assist device (LVAD) patients remain common. Differentiating into device related and non-device related infection is crucial. The incidence of non-device related infections seems to be more determined by the overall condition of the LVAD recipient. Device related infections can be treated by innovative surgical approaches or by transplant. Infection increases the risk of mortaility while on LVAD.

Solving the mystery: Hyalinized cyst wall containing organism-like structures in a lung transplant donor.

A 59-year-old man with non-ischemic cardiomyopathy underwent orthotopic heart transplantation. The donor, a 31-year-old male declared brain dead after a gunshot wound to the head, was considered high risk due to history of incarceration, illicit drug use, and sex with a HIV-positive partner. At organ procurement, the heart, kidneys, pancreas, and liver looked grossly normal. A small right lower lobe nodule was noticed, and lung biopsy was performed. Bronchoscopy showed purulent secretions in the right lower lobe. Images from pathology are presented. Lung biopsy confirmed the presence of hyalinized cyst wall containing organism-like structures. A combination of culture, microscopic morphology, and gene sequencing was used to identify the causative organism. The patient and all other organ recipients received appropriate antifungal prophylaxis and remain asymptomatic 6 months post-transplant.

Therapy of Mycobacterium abscessus Infections in Solid Organ Transplant Patients.

Mycobacterium abscessus complex (MABC), a rapidly growing Mycobacterium, is one of the most common causes of non-tuberculous mycobacteria (NTM) infections in the United States of America, and it has been associated with a wide spectrum of infections in immunocompetent and immunosuppressed individuals. Eradicating MABC is very challenging, even with prolonged combination therapies. The management of MABC infections in solid organ transplant (SOT) patients is usually complex given their net state of immunosuppression, associated comorbidities, and potential drug-drug interactions, among other things. In this manuscript, we discussed the antimicrobial management of pulmonary and extrapulmonary MABC infections. In addition, we reviewed promising novel therapies such as clofazimine, omadacycline, bedaquiline, and inhaled tigecycline that could join the existing antimicrobial armamentarium to fight this infection associated with significant morbidity and mortality. However, further studies are needed, especially among the immunocompromised host.

Nocardiosis in Solid Organ Transplant Recipients: 10-Year Single Center Experience and Review of Literature.

Solid organ transplant recipients (SOTRs) are at an increased risk of nocardiosis, a rare but life-threatening opportunistic infection. Universal PCP prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is used at our center, which is active in vitro against most species of the Nocardia genus and may have a role in preventing early infections. This is a single-center retrospective cohort study of nocardiosis in adult SOTRs at a large transplant center between January 2012 and June 2022, with comprehensive review of literature. Out of 6179 consecutive cases, 13 (0.2%) were diagnosed with nocardiosis. The patients were predominantly male (76.9%) and kidney transplant recipients (62%). Infection was diagnosed at median of 8.8 months (range, 3.7-98) after transplant. Patients were followed for a median of 457 days (range 8-3367). Overall mortality within one year after diagnosis was 46% (6/13), of which 17% (1/6) of deaths was attributable to Nocardia infection. No recurrence was reported. Nocardia infections were noted in a small proportion of our SOTRs and carried significant morbidity and mortality. TMP-SMX prophylaxis may be protective in some cases given low incidence of cases.

Sporadic leptospirosis case in Florida presenting as Weil`s disease.

Leptospirosis has been rarely reported in the United States and has been historically related to occupational exposure to infected animals, and contaminated environments. Over the past decade, there are indications that at-risk populations may be changing in the United States, to also include participants in freshwater sports and occasionally individuals living in economically disadvantaged urban inner- city environments. We present a case of Weil`s disease in a 39-year-old homeless man who had been released from prison two weeks prior and denied direct contact with infected animals or contaminated fresh water. Prison inmates and homeless patients are potentially at high risk of rat exposure and infection with Leptospira. A high index of suspicion is needed for diagnosis of leptospirosis in the absence of traditional risk factors. To our knowledge, this is the first case of leptospirosis associated with homelessness and incarceration in the United States. A literature review on leptospirosis cases in Florida over the past 60 years was performed.

Prosthetic joint infection caused by Candida lusitaniae: report of a unique case.

Background: Candida prosthetic joint infection (PJI) is a rare complication of total knee arthroplasty (TKA). The literature regarding its diagnosis and management is scarce. Case summary: We present the case of a 79-year-old woman with history of TKA and femoral intramedullary nailing, who developed PJI caused by Candida lusitaniae. A two-stage exchange arthroplasty was performed. She underwent implant removal, debridement and placement of temporary antibiotic impregnated spacer. Postoperatively, the patient received treatment with micafungin for 24 weeks. Eleven months after the first stage, the spacer was removed and a new knee prosthesis was placed. Complete eradication of infection was demonstrated by negative culture of cement spacer, synovial fluid and periprosthetic tissue. Histology of surgical samples was unremarkable. Empiric treatment with micafungin was given for 6 weeks after placement of the new prosthesis. At 6-month follow-up, there was no evidence of recurrent infection. Conclusion: To our knowledge, this is the first reported case of Candida lusitaniae PJI.

Primary Intramedullary Spinal Cord Lymphoma Presenting as a Cervical Ring-Enhancing Lesion in an AIDS Patient.

Primary intramedullary spinal cord lymphoma (PISCL) is rare and constitutes only 1% of central nervous system lymphomas. We report a case of PISCL in a 37-year-old man with advanced AIDS. To our knowledge, only 4 cases of PISCL in the setting of HIV/AIDS have been reported in the literature. Despite treatment, prognosis remains dismal.

C-reactive protein levels after cardiac arrest in patients treated with therapeutic hypothermia.

AIM: Prognostication of outcome after cardiac arrest (CA) is challenging. We assessed the prognostic value of daily blood levels of C-reactive protein (CRP), a cheap and widely available inflammatory biomarker, after CA. METHODS: We reviewed the data of all patients admitted to our intensive care unit (ICU) after CA between January 2009 and December 2011 and who survived for at least 24h. We collected demographic data, CA characteristics (initial rhythm; location of arrest; time to return of spontaneous circulation [ROSC]), occurrence of infection, ICU survival and neurological outcome at three months (good=cerebral performance category [CPC] 1-2; poor=CPC 3-5). CRP levels were measured daily from admission to day 3. RESULTS: A total of 130 patients were admitted after successful resuscitation from CA and survived more than 24h; 76 patients (58%) developed an infection and overall mortality was 56%. CRP levels increased from admission to day 3. CRP levels were higher in in-hospital than in out-of-hospital CA, especially on admission and day 1 (44.1 vs. 2.1 mgL(-1) and 74.5 vs. 29.5 mgL(-1), respectively; p<0.001), and in patients with non-shockable than in those with shockable rhythms. In a logistic regression model, high CRP levels on admission were independently associated with poor neurological outcome at 3 months. CONCLUSION: CRP levels increase in the days following successful resuscitation of CA. Higher CRP levels in patients with in-hospital CA, non-shockable rhythms and infection, suggest a greater inflammatory response in these patients. High CRP levels on admission may identify patients at high-risk of poor outcome and could be a target for future therapies.