Massive Cervical Lymphadenopathy Post-COVID-19 Vaccination.

The coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2. Rapid spread with rampant growth of cases and deaths brought forth an urgent need for novel therapies including vaccinations. The mRNA vaccines for COVID-19 disease have been implemented at an unprecedented scale in an effort to combat the unrelenting pandemic. Such a massive scale vaccination program is bound to coincide with adverse events related to treatment. We present a case of massive cervical lymphadenopathy in a 58-year-old male patient post-Moderna COVID-19 vaccination. Additional investigations did not identify malignancy and he was diagnosed with vaccine-related lymphadenopathy. Patient significantly improved with corticosteroid treatment within 2 days of admission. Lymphadenopathy is reported as the second most common local reaction to the Moderna vaccine. Promoting knowledge of this side effect, particularly in the setting widespread vaccination efforts, would allow for better management of cases, especially in relation to oncologic patients.

Role of SCCmec type in outcome of Staphylococcus aureus bacteremia in a single medical center.

Staphylococcus aureus virulence factors may determine infection presentation. Whether SCCmec type-associated factors play a role in S. aureus bacteremia is unclear. We conducted a prospective observation of adult inpatients with S. aureus bacteremia (1 November 2005 to 31 December 2006), performed SCCmec typing of methicillin-resistant S. aureus (MRSA) isolates, and stratified the results according to SCCmec type. We studied 253 patients. MRSA accounted for 163 (64.4%) cases. The illness severity index was similar in MRSA and methicillin-sensitive S. aureus (MSSA) cases. MRSA caused higher in-hospital mortality (23.9% versus 8.9%; P=0.003), longer bacteremia (4.7+/-6.5 days versus 2.7+/-2.9 days; P=0.01), but similar metastatic infection (14.7% versus 15.6%). Stratifying the results according to SCCmec type revealed significant differences. SCCmec type II caused highest mortality (33.3%) versus type IVa (13.5%), other MRSA (12.5%), and MSSA (8.9%). SCCmec IVa produced the highest metastatic infection (26.9% versus 9.1% [SCCmec II], 8.3% [other MRSA], and 15.6% [MSSA]). Persistent bacteremia (>or= 7 days) was similar in all SCCmec types (16.7 to 20.7%); each exceeded MSSA (6.7%; P=0.05). In multivariate analysis, SCCmec II was a predictor of mortality (odds ratio [OR]=3.73; 95% confidence interval [CI] = 1.81 to 7.66; P=0.009), SCCmec IVa was a predictor of metastatic infection (OR=3.52; CI=1.50 to 8.23; P=0.004), and MRSA (independent of SCCmec type) was a predictor of persistent bacteremia (OR=4.16; CI=1.47 to 11.73; P=0.007). These findings suggest that SCCmec-associated virulence factors play a role in the outcome of S. aureus bacteremia. Additional studies are needed to identify which virulence factors are the determinants of increased mortality with SCCmec type II and metastatic infection with SCCmec type IVa.

Staphylococcus aureus skin/soft-tissue infections: the impact of SCCmec type and Panton-Valentine leukocidin.

We assessed the role of Panton-Valentine leukocidin (PVL) and SCCmec type in community associated (CA) and healthcare associated (HC) Staphylococcus aureus (SA) skin/soft-tissue infections (STI). We prospectively monitored microbiology results (11 January 2005 to 6 January 2006), screened inpatients with SA in tissue samples or blood, and selected adults with STI. We recorded clinical/microbiological characteristics, and tested saved isolates for PVL genes (real time PCR) and SCCmec type (conventional multiplex PCR). We encountered 204 patients. MRSA strains that accounted for 70.5% CA and 66.0% HC cases, caused more abscesses (55.7% vs 29.7%; p =0.001) and were often PVL-positive (68.9% vs 4.8%; p <0.001). PVL-positive isolates caused more abscesses (72.9% vs 26.5%; p <0.001) but similar bacteremia (7.3% vs 7.1%). SCCmec IVa made up 95.8% of PVL-positive strains and accounted for 69.8% of the abscesses. SCCmec II caused higher mortality (14.8% vs 0-3.1%; p = 0.02). PVL was a predictor of abscesses (p <0.001). Predictors of bacteremia were age > or = 65 y (p =0.004), necrotizing infection (p =0.014), and head/neck location (p =0.05). These findings suggest that SCCmec type and PVL status influence STI manifestations and contribute to MRSA-MSSA differences. PVL is implicated in abscess formation but not bacteremia. Bacteremia is likely related to host condition and/or other virulence factors that were not studied.