Cervical lymphadenitis from Mycobacterium avium complex.

We present an instructive case of cervical lymphadenitis in a young man without a history of HIV infection. The patient developed spontaneous left-sided neck swelling that progressed over 4 months. CT imaging demonstrated a necrotic left-sided neck mass within the cervical lymph node chain. He was initially prescribed azithromycin and rifampin for presumed cat scratch disease with improvement but incomplete resolution of symptoms. Blood cultures ordered 2 months later grew Mycobacterium avium complex (MAC) and the patient had an excellent clinical response to MAC therapy. Here, we review the case, including presentation and management, and describe the implications for the immune status of the host and long-term considerations for treatment.

Eliminating hepatitis B vaccination disparities for West African immigrants.

BACKGROUND: Hepatitis B virus (HBV) infection is endemic in West Africa. There has been a significant increase in the Bronx West African (WA) community. To achieve HBV elimination, vaccination of non-immune individuals is important. Unfortunately, vaccine uptake in immigrant populations is at this time very limited. METHODS: An educational program was conducted by medical providers of WA origin in collaboration with local faith-based organizations, after which free HBV screening was offered. Non-immune individuals were initially recommended to contact their medical provider or referred to the Department of Health for vaccination. Beginning in 2021, the program offered vaccination. A questionnaire including reasons for vaccination in the program was offered. FINDINGS: Among the first500 individuals screened,34.6 % required vaccination. Among those screened before program vaccine availability, 72.2 % initiated the vaccination series,with38.2 % obtainingit at an outside setting and34 % returning when available through the program.Among patients screened after program vaccineavailability, 92.1 % initiated the series.Of those receiving vaccination in the program and completing the questionnaire,70.7 % had access to care but chose vaccination by the program because of the trust instilled by WA personnel. INTERPRETATION: Our findings demonstrate the effectiveness of integrating vaccination into an HBV screening program for an immigrant population. It emphasizes the importance of timeliness and cultural sensitivity.

Candida auris in skilled nursing facilities.

Candida auris is a fungal organism resistant to several classes of antifungals. Since its identification in 2009, it has gained worldwide attention in healthcare for its virulence and resistance to commonly used antifungal therapeutics. Although its origin and mechanisms of transmission are not fully elucidated, it is widely recognized as a high priority healthcare-associated pathogen. Infection control efforts in skilled nursing facilities have been very challenging due to the tendency of C. auris to persist in the environment and colonize residents. In this narrative review, we discuss the epidemiology and infection prevention of C. auris in skilled nursing facilities. We also identify challenges in the diagnosis and management of both symptomatic infections and asymptomatic colonization.

Missed diagnosis of septic arthritis due to invasive pneumococcal disease.

A 61-year-old woman with severe gout, chronic kidney disease, type II diabetes, and heart failure with reduced ejection fraction was admitted with acute onset bilateral hand swelling and pain following a trauma. She was managed for a severe gout flare, but her symptoms, leukocytosis, and inflammatory markers did not improve. Six days into the hospital course, she developed fevers. Blood cultures grew Streptococcus pneumoniae. Intravenous antibiotics were started, and the patient underwent multiple incision and debridements of the bilateral hands with improvement in symptoms and clinical status. Septic arthritis secondary to S. pneumoniae is uncommon. We highlight this case to recognize that septic arthritis should always be considered when a patient presents with a painful, erythematous joint. Pneumococcal vaccination reduces the incidence of invasive pneumococcal disease, and should be prioritized for those at high risk for invasive disease and who are immunocompromised.

Identification and confirmation of an exonic splicing enhancer variation in exon 5 of the Alzheimer disease associated PICALM gene.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by memory and cognitive impairment and is the leading cause of dementia in the elderly. A number of genome wide association studies and subsequent replication studies have been published recently on late onset AD (LOAD). These studies identified several new susceptibility genes including phosphatidylinositol-binding clathrin assembly protein (PICALM) on chromosome 11. The aim of our study was to examine the entire coding sequence of PICALM to determine if the association could be explained by any previously undetected sequence variation. Therefore, we sequenced 48 cases and 48 controls homozygous for the risk allele in the signal SNP rs3851179. We did not find any new variants; however, rs592297, a known coding synonymous SNP that is part of an exonic splice enhancer region in exon 5, is in strong linkage disequilibrium with rs3851179 and should be examined for functional significance in Alzheimer pathophysiology.