Disseminated Cryptococcus neoformans infection involving multiple bones and lung in an immunocompetent patient: a case report.

BACKGROUND: Cryptococcal osteomyelitis is a rare and potentially serious condition, typically encountered in individuals with compromised immune systems. This case underscores the unusual occurrence of disseminated Cryptococcosis in an immunocompetent person, involving multiple bones and lungs, with Cryptococcus neoformans identified as the causative agent. CASE PRESENTATION: An Indonesian man, previously in good health, presented with a chief complaint of successive multiple bone pain lasting for more one month, without any prior history of trauma. Additionally, he reported a recent onset of fever. On physical examination, tenderness was observed in the left lateral chest wall and right iliac crest. Laboratory findings indicated mildly elevated inflammatory markers. A computed tomography (CT) scan of the chest revealed an ovoid solid nodule in the right lower lung and multifocal osteolytic lesions in the sternum, ribs, and humeral head. A magnetic resonance imaging (MRI) study of the sacrum showed multiple lesions in the bilateral iliac bone and the lower L4 vertebral body. Confirmation of Cryptococcal osteomyelitis involved a fine-needle biopsy and culture, identifying Cryptococcus neoformans in the aspirate. The patient responded positively to targeted antifungal treatments, leading to a gradual improvement in his condition. CONCLUSIONS: This case emphasizes the need to consider Cryptococcus neoformans osteomyelitis in immunocompetent patients with bone pain. A definitive diagnosis involves a fine-needle biopsy for pathology and culture, and prompt initiation of appropriate antifungal treatment has proven effective in preventing mortality.

Younger adults with mild-to-moderate COVID-19 exhibited more prevalent olfactory dysfunction in Taiwan.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is rapidly transmitted from person to person, causing global pandemic since December 2019. Instantly detecting COVID-19 is crucial for epidemic prevention. In this study, olfactory dysfunction is a significant symptom in mild to moderate COVID-19 patients but relatively rare in other respiratory viral infections. The Taiwan smell identification test (TWSIT) is a speedy and inexpensive option for accurately distinguishing anosmia that also quantifies the degree of anosmia. Using TWSIT in the outpatient clinic for early identifying the patients with mild to moderate COVID-19 can be promising. METHODS: Nineteen patients confirmed COVID-19 in central Taiwan were collected and divided into two groups: olfactory dysfunction and non-olfactory dysfunction. Demographic characteristics, laboratory findings, and the results of the olfactory test were compared between these two groups. FINDINGS: Thirteen (68.4%) of the 19 patients had olfactory dysfunction. The patients with olfactory dysfunction were younger than those without this symptom. The statistical difference in age distribution was significant between these two groups (IQR: 25.5-35.5 vs. IQR: 32.5-60.3; p-value: 0.012). There was no significant difference in gender, smoking history, comorbidities, travel history, respiratory tract infection symptoms, and laboratory findings between these two groups. CONCLUSION: This study demonstrated that young adults were prone to develop olfactory dysfunctions. In the flu season, olfactory dysfunction is considered a specific screening criterion for early detecting COVID-19 in the community. TWSIT can serve as a decent test for quantifying and qualifying olfactory dysfunction.

Clinical features, antifungal susceptibility, and outcome of Candida guilliermondii fungemia: An experience in a tertiary hospital in mid-Taiwan.

BACKGROUNDS: Candida guilliermondii is rarely isolated from clinical specimen. C. guilliermondii fungemia is seldom reported in the literature. The aims of this study were to report the clinical features, antifungal susceptibility, and outcomes of patients with C. guilliermondii fungemia. METHODS: From 2003 to 2015, we retrospectively analyzed the clinical and laboratory data of patients with C. guilliermondii fungemia in a tertiary hospital in mid-Taiwan. We performed a multivariable logistic regression analysis to identify the risk factors of mortality. The Sensititre YeastOne microtiter panel assessed the susceptibility of antifungal agents. RESULTS: In this study, we identified 36 patients with C. guilliermondii fungemia. The median age of patients was 50.5 years (range, 17 days to 96 year) and 20 cases (56%) were male. The incidence of C. guilliermondii fungemia was 0.05 per 1000 admissions. Malignancy was the most common co-morbidity, and 25 (69%) patients had central venous catheter in place. Thirty-day overall mortality was 16.7%. In multivariate logistical regression analysis, catheter retention was an independent risk factor of mortality. According to epidemiological cutoff values, most clinical isolates (21/22, 95.5%) belonged to the wild-type MIC distributions for amphotericin B and flucytosine; however, the isolates were less susceptible to fluconazole (68%) and echinocandins (77-91%). CONCLUSION: Despite the lower mortality rate associated with C. guilliermondii fungemia, the removal of a central venous catheter remained an independent factor influencing the outcome of patients. The clinical significance of less susceptibility of C. guilliermondii to triazoles and echinocandins remains to be elucidated.

Analysis of Deep Drawing Process for Stainless Steel Micro-Channel Array.

The stainless steel bipolar plate has received much attention due to the cost of graphite bipolar plates. Since the micro-channel of bipolar plates plays the role of fuel flow field, electric connector and fuel sealing, an investigation of the deep drawing process for stainless steel micro-channel arrays is reported in this work. The updated Lagrangian formulation, degenerated shell finite element analysis, and the r-minimum rule have been employed to study the relationship between punch load and stroke, distributions of stress and strain, thickness variations and depth variations of individual micro-channel sections. A micro-channel array is practically formed, with a width and depth of a single micro-channel of 0.75 mm and 0.5 mm, respectively. Fractures were usually observed in the fillet corner of the micro-channel bottom. According to the experimental results, more attention should be devoted to the fillet dimension design of punch and die. A larger die fillet can lead to better formability and a reduction of the punch load. In addition, the micro-channel thickness and the fillet radius have to be taken into consideration at the same time. Finally, the punch load estimated by the unmodified metal forming equation is higher than that of experiments.

Isolated tuberculous liver abscess in an immunocompetent adult patient: A case report and literature review.

Tuberculous liver abscess is a rare disease entity even in endemic areas of Mycobacterium tuberculosis. It is usually accompanied by pulmonary tuberculosis or enteric tuberculosis. Further, an isolated tuberculous liver abscess is extremely rare. The disease is diagnosed by laparotomy or postmortem autopsy in most cases, and some authors adopted a 9-month antituberculosis regimen. We herein report a case of an isolated tuberculous liver abscess that initially manifested as persistent fever and general malaise, which was diagnosed by liver biopsy and treated successfully with a 6-month antituberculosis regimen and percutaneous abscess drainage.

Infection in liver transplant recipients--analysis of 68 cases at teaching hospital in Taiwan.

BACKGROUND: In Taiwan, liver transplantation is a common treatment of end-stage liver diseases. Infection has a negative impact on the survival of these patients and their grafts. We evaluated the timing and frequency of infections, and the risk factors associated with infection and mortality in liver transplant recipients from Taiwan. METHODS: This retrospective study enrolled all adult patients who underwent orthotopic liver transplantation from January 2004 to November 2008 at a tertiary hospital in Taiwan. RESULTS: Sixty-eight patients were enrolled (male/female = 46/22) and average age was 51.3 years. Bacterial infection (26/68, 38.2%) was the most common infectious disease, with a rate of 0.3/1,000 person-days in the perioperative period, 0.27/1,000 person-days in the early operative period, and 0.38/1,000 person-days in the late-operative period. Operation-related complications increased the risk of bacterial infection. Biliary stricture was the most common operation-related complication, and this was associated with biliary tract infection (p < 0.001). The average time from first stent placement for biliary stricture by endoscopic retrograde cholangiography to biliary tract infection was 34.5 days. The overall mortality rate was 11.7%, and the mortality rate was 14% for patients with infections. CONCLUSIONS: Bacterial infection was the most common type of infection in liver transplant recipients. Surgery-related complication, especially biliary tract stricture was risk factor for infection. We suggest that the current recommendations about the timing of endoscopic retrograde cholangiography intervention be reevaluated.