A curious case of Lyme carditis in an urban hospital.

Lyme carditis (LC), a manifestation of early disseminated Lyme disease, most commonly presents with cardiac conduction abnormalities. It is a transient condition with good prognosis but in extremely rare cases may be life-threatening. We describe a 42-year-old man who presented with progressively worsening generalized weakness, presyncope and dyspnea on exertion for 2 weeks after sustaining a tick bite. He subsequently developed a 'bull's eye rash' on his flank 2 days before his presentation. He was found to have symptomatic third-degree AV conduction blockade with a ventricular escape rhythm resulting in a brief cardiac arrest. Intravenous (IV) ceftriaxone was commenced empirically and a temporary transvenous pacemaker was placed. In a few days he showed dramatic, rapid improvement; the pacemaker was removed, and the patient was discharged on oral doxycycline to complete a 24-day course. This case is unique due to its occurrence in an urban hospital where such cases are uncommon. Cardiac arrest, although brief in this case, is a rare occurrence. Lyme carditis was a surprise diagnosis in our hospital due to the patient's geographical dislocation during the COVID-19 pandemic.

Chryseobacterium indologenes, an Emerging Bacteria: A Case Report and Review of Literature.

Chryseobacterium indologenes are aerobic, Gram negative, nonfermentative rods that are intrinsically multi-drug resistant. Reported infections include bacteremia, pneumonia, meningitis, myositis, keratitis, and indwelling devices. We present the clinical course of a 52-year-old African male with a medical history of end stage renal disease (ESRD) in hemodialysis with multiple episodes of central line-associated bloodstream infections (CLABSI) presenting with symptoms of chills, malaise, and localized erythema on insertion site of permacath. Blood cultures obtained from catheter showed C. indologenes. Successful response was obtained with piperacillin/tazobactam based on sensitivity and removal of indwelling catheter. Given the increase in the number of cases reported in the literature, guidelines for the management of this pathogen should be considered.

The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients.

Current guidelines suggest that HIV-infected patients should receive chemoprophylaxis against Pneumocystis jirovecii pneumonia (PJP) if they have a cluster determinant 4 (CD4) count <200 cells/mm3 or oropharyngeal candidiasis. Persons with CD4 percentage (CD4%) below 14% should also be considered for prophylaxis. Discordance between CD4 count and CD4% occurs in 16% to 25% of HIV-infected patients. Provider compliance with current PJP prophylaxis guidelines when such discordance is present was assessed. Electronic medical records of 429 HIV-infected individuals who had CD4 count and CD4% measured at our clinic were reviewed. CD4 count and percentage discordance was seen in 57 (13%) of 429. Patients with CD4 count >200 but CD4% <14 were significantly less likely to be prescribed PJP prophylaxis compared with those who had CD4 count <200 and CD4% >14 (29% versus 86%; odds ratio = 0.064, 95% confidence interval: 0.0168-0.2436; P < .0001). We emphasize monitoring both the absolute CD4 count and percentage to appropriately guide PJP primary and secondary prophylaxis.

PJP granuloma in an Immune competent host: Case report and literature review.

PJP (Pneumocystis jirovecii) is a fungal agent by taxonomy. Ones considered a protozoan, it is now recognized as fungi based on ribosomal RNA and other gene sequence homologies, the composition of their cell walls, and structure of key enzymes. This organism generally affects immunocompromised hosts with a CD4 count <200 or <15%.Review of literature does support a rare occurrence of PJP infections in immunocompetent hosts.PJP can occur at normal CD 4 levels.

Emphysematous urinoma as a complication of emphysematous pyelitis in a healthy adult male.

Emphysematous pyelitis and urinomas are independently rare conditions. The former is a severe necrotizing infection involving the renal collecting system, the latter an encapsulated collection of urine in the perinephric or paraureteral space. An unusual case of emphysematous urinoma complicating emphysematous pyelitis in a healthy male adult is presented in this study.

Fatal dual infection with Salmonella and Mycobacterium avium complex infection in a patient with advanced acquired immunodeficiency syndrome: a case report.

Non-typhoid Salmonella and Mycobacterium avium complex infections are part of the constellation of infections seen with increasing frequency in patients with acquired immuned deficiency syndrome. The incidence has reduced significantly since highly active antiretroviral therapy era, but their critical nature is unchanged. The co-existence of these infections and the accompanied increased mortality is presented in this case report.