Current Epidemiology and Clinical Features of Cryptococcus Infection in Patients Without Human Immunodeficiency Virus: A Multicenter Study in 46 Hospitals in Australia and New Zealand.

BACKGROUND: Patients without human immunodeficiency virus (HIV) are increasingly recognized as being at risk for cryptococcosis. Knowledge of characteristics of cryptococcosis in these patients remains incomplete. METHODS: We conducted a retrospective study of cryptococcosis in 46 Australian and New Zealand hospitals to compare its frequency in patients with and without HIV and describe its characteristics in patients without HIV. Patients with cryptococcosis between January 2015 and December 2019 were included. RESULTS: Of 475 patients with cryptococcosis, 90% were without HIV (426 of 475) with marked predominance in both Cryptococcus neoformans (88.7%) and Cryptococcus gattii cases (94.3%). Most patients without HIV (60.8%) had a known immunocompromising condition: cancer (n = 91), organ transplantation (n = 81), or other immunocompromising condition (n = 97). Cryptococcosis presented as incidental imaging findings in 16.4% of patients (70 of 426). The serum cryptococcal antigen test was positive in 85.1% of tested patients (319 of 375); high titers independently predicted risk of central nervous system involvement. Lumbar puncture was performed in 167 patients to screen for asymptomatic meningitis, with a positivity rate of 13.2% where meningitis could have been predicted by a high serum cryptococcal antigen titer and/or fungemia in 95% of evaluable cases. One-year all-cause mortality was 20.9% in patients without HIV and 21.7% in patients with HIV (P = .89). CONCLUSIONS: Ninety percent of cryptococcosis cases occurred in patients without HIV (89% and 94% for C. neoformans and C. gattii, respectively). Emerging patient risk groups were evident. A high level of awareness is warranted to diagnose cryptococcosis in patients without HIV.

Eradication of post-lobectomy mucormycosis and bacterial empyema with intrapleural antimicrobial therapy in a patient with surgically resected Mycobacterium xenopi (non-tuberculous Mycobacteria) pulmonary infection.

Empyema thoracis is a collection of pus in the pleural space associated with pleural fibrin deposition. Treatment involves systemic antimicrobials, pleural drainage, intrapleural enzymes and sometimes decortication. Our case is a 57-year-old gentleman who developed chronic mucormycosis (Cunninghamella sp.) and bacterial (Enterococcus sp.) empyema in a high-risk post-lobectomy space in the setting of a non-expandable lung following non-tuberculous mycobacterial (NTM) infection. The patient did not tolerate antimicrobial therapy for progressive pulmonary NTM infection, and required lobectomy, complicated by polymicrobial empyema. He did not respond to systemic treatment and long-term intercostal catheter drainage and therefore intrapleural taurolidine-citrate, and enzyme therapy was used to help eradicate infection. Intrapleural antifungals and taurolidine-citrate in combination with long-term antifungal therapy may help eradicate infection in patients with fungal empyemas. Further studies investigating the safety of taurolidine-citrate in pleural catheters are needed.

Bali Belly: Salmonella senftenberg Found in an Infected Ovarian Endometrioma.

Salmonella is an extremely rare cause of an infected endometrioma. We present a case of a 30-year-old immunocompetent woman presenting with fevers and abdominal pain, on a background of prior endometriosis. Initial antibiotic treatment for pelvic inflammatory disease failed, and the patient progressed to septic shock requiring surgical evacuation of an infected ovarian endometrioma. Microbiological samples from stool, ovary, and peritoneal fluid revealed infection with Salmonella senftenberg. The likely diagnosis was Salmonella enterocolitis with bacterial translocation to an ovarian endometrioma.

Mycoplasma pneumoniae with para-infectious cerebral complications.

Mycoplasma pneumoniae infection most commonly manifests as a mild respiratory illness and headache. Pneumonia occurs in approximately 10% of patients with respiratory symptoms. M. pneumoniae infection can also cause neurological and other extrapulmonary complications. In this case report we describe a 33-year-old Caucasian man presenting with headache and raised intracranial pressure, found to be a para-infectious complication of M. pneumoniae infection. Nasopharyngeal PCR was highly useful in facilitating early diagnosis, as IgM antibodies were negative during the early stages of illness. Azithromycin is the preferred agent for M. pneumoniae treatment. The addition of M. pneumoniae PCR to hospitals' rapid respiratory viral PCR panels could promote early directed therapy and antimicrobial stewardship.

Predictors of chronic kidney disease and utility of risk prediction scores in HIV-positive individuals.

OBJECTIVE: The current study aimed to validate existing risk prediction scores and identify predictors of chronic kidney disease (CKD) in the setting of HIV. DESIGN AND METHODS: A retrospective cohort study of HIV-positive individuals (n = 748) with baseline estimated glomerular filtration rate (eGFR) more than 60 ml/min was conducted at the Alfred Hospital, Melbourne, Australia. Multivariable regression analysis was performed to determine factors associated with development of CKD, defined as two consecutive measurements of eGFR less than 60 ml/min. The performance of CKD risk scores proposed by the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group and Scherzer and colleagues were estimated by the area under the receiver operator curve (AUROC). RESULTS: CKD developed in 37 individuals (5.0%), at a median of 4.7 (interquartile range 2.2, 6.2) years. Older age [odds ratio (OR) 3.03, 95% confidence interval (CI): 1.20, 7.65, P = 0.02] and lower baseline eGFR (OR 10.39, 95% CI: 4.73, 22.83, P < 0.001) were associated with the development of CKD. Neither current, nor cumulative tenofovir disoproxil fumarate (TDF) use was associated with progression to CKD [current TDF hazard ratio (HR) 1.05, 95% CI: 0.54, 2.07, P = 0.88; cumulative TDF HR 1.03, 95% CI: 0.86, 1.24, P = 0.75]. The short D:A:D and Scherzer scores were well calibrated, with the short D:A:D score demonstrating superior discrimination (short D:A:D AUROC 0.85, Scherzer AUROC 0.78, P = 0.02). CONCLUSION: Older individuals and those with a lower baseline eGFR are at higher risk for CKD. Risk prediction tools may be useful in identifying those at greatest risk, who may benefit from aggressive management of risk factors.