Collapsing Glomerulopathy Leading To Rapidly Progressive Allograft Failure From Cytomegalovirus and SARS-CoV-2 Infection With Concomitant BK Virus Nephropathy.

We present a challenging clinical case of a 68-year-old female kidney transplant recipient who had a complicated posttransplant course marked by borderline T-cell-mediated rejection and BK virus nephropathy. The treatment for borderline rejection with steroids resulted in overimmunosuppression, and the patient acquired cytomegalovirus infection manifesting as colitis and SARS-CoV-2 infection. This progressed rapidly to collapsing glomerulopathy and allograft failure. This study also highlights the challenges in surveillance with donor-derived cell-free DNA in the setting of allograft injury by multiple viral infections.

Outcomes of Kidneys Transplanted From Hepatitis C Viremic Donors to Naive Recipients From an Appalachian Rural Kidney Transplant Program.

OBJECTIVES: Before the advent of direct-acting antiviral therapy for hepatitis C virus, a large proportion of kidneys from donors with hepatitis C viremia were discarded. Hepatitis C virus is now amenable to effective treatment with excellent seronegativity rates. In this study, we review the outcomes of hepatitis C viremic kidneys transplanted into hepatitis C-naive recipients. MATERIALS AND METHODS: In this retrospective observational study, we examined 6 deceased donor kidneys with hepatitis C viremia that were transplanted into hepatitis C-naive recipients between March 2020 and April 2021 at a single center. Because of health insurance constraints, patients were treated for hepatitis C virus with glecaprevir/pibrentasvir for 8 weeks following seroconversion posttransplant. Primary outcome measured was viral seroconversion; secondary outcomes included graft function, posttransplant complications, and all-cause mortality. RESULTS: On average, patients seroconverted 6 days (range, 4-10 d) after transplant and began treatment 26 days (range, 15-37 d) after seroconversion. An 8-week course of antiviral treatment was successful in preventing acute hepatitis C virus infection in all patients. Posttransplant median creatinine was 1.96 mg/dL (range, 1-4.55 mg/dL), whereas median estimated glomerular filtration rate was 41.33 mL/min/1.73 m2 (range, 17-85 mL/min/1.73 m2). Patient survival rate was 66.7%, and death-censored graft survival rate was 100%. Two patients died from unrelated reasons: 1 from acute respiratory failure secondary to SARS-CoV-2 infection and 1 from posttransplant lymphoproliferative disorder. Two patients developed allograft rejection posttransplant (1 developed antibody mediated rejection, 1 developed borderline T-cell-mediated cellular rejection). Other major complications included neutropenia, fungal rash, SARS-CoV-2 infection, cytomegalovirus, BK virus, and Epstein-Barr virus reactivation. CONCLUSIONS: Use of hepatitis C-viremic donor kidneys for transplant is a safe option and has great potential to increase the kidney donor pool, as long as high index of suspicion is maintained for allograft rejection and opportunistic infections.

Frecuencia de trastornos mentales y sus características sociodemográficas en pacientes con COVID-19 ingresados en un hospital psiquiátrico de Lima Metropolitana

Introducción. La descripción de las características y los diagnósticos de pacientes psiquiátricos con COVID-19 durante la pandemia ha sido poco descrito en el Perú. Objetivo. Describir la frecuencia de diagnósticos psiquiátricos y sus características sociodemográficas en pacientes con prueba antigénica positiva a COVID-19 en un hospital psiquiátrico peruano durante julio 2020 a julio 2021. Métodos. Se realizó un estudio descriptivo basado en la revisión de 100 historias clínicas de pacientes entre 18 y 70 años. Las variables estudiadas fueron el diagnóstico de ingreso y variables sociodemográficas como edad, sexo, nivel académico, ocupación, días de estancia. Resultados. Los diagnósticos más frecuentes fueron esquizofrenia, trastornos esquizotípicos y trastornos de ideas delirantes (49%) y los trastornos del humor (37%). El 66% pertenecía a los niveles socioeconómicos más bajos y el 60% eran pacientes continuadores. El mes de abril de 2021 presentó la mayor cantidad de ingresos (n=15). Conclusión. Durante un año de observación en tiempos de emergencia sanitaria por la COVID-19, ingresaron a un hospital psiquiátrico de referencia 100 pacientes con diagnóstico psiquiátrico que además tuvieron infección por SARS-CoV-2, la mayoría de estos pacientes tuvieron trastornos psicóticos.

Introduction. The description of the characteristics and diagnoses of psychiatric patients with COVID-19 during the pandemic has been poorly described in Peru. Objective. To describe the frequency of mental disorders and the associated sociodemographic characteristics of patients with a positive antigen test for COVID-19 in a peruvian psychiatric hospital from July 2020 to July 2021. Methods. For this descriptive study we analyzed 100 medical records of patients between 18 and 70 years old. The variables studied were the diagnosis according to ICD-10 and sociodemographic features such as age, gender, educational status, employment, days of admission. Results. The most common diagnoses were "Schizophrenia, schizotypal disorders and delusional disorders" (49%) and "mood disorders" (37%), 66% belonged to the lowest socioeconomic levels and 60% were recurrent patients. The month of April 2021 presented the highest number of admissions (n=15). Conclusion. In a year of observation during the COVID-19 outbreak, 100 patients with psychiatric diagnosis who also had SARS-CoV-2 infection were admitted to a reference psychiatric hospital, most of these patients had psychotic disorders.

Anaplasmosis-Induced Hemophagocytic Lymphohistiocytosis: A Case Report and Review of the Literature.

Cases of anaplasmosis have increased steadily and are appearing in states where it is less common. While symptoms are usually mild, in rare cases it can cause hemophagocytic lymphohistiocytosis. Here, we present a case of polymerase chain reaction-confirmed Anaplasma phagocytophilum with morulae on peripheral blood smear associated with biopsy-proven hemophagocytic lymphohistiocytosis.

First Report of Clivus Osteomyelitis Caused by Nocardia veterana in a Lung Transplant Recipient.

Nocardia species have been implicated as a cause of pulmonary, cutaneous, ocular, and disseminated central nervous system disease. Dissemination to the bones, commonly the spine, has also been described in the literature. However, isolated osteomyelitis of the skull base is rare. Additionally, advances in the use of molecular techniques have identified many new Nocardia species, including Nocardia veterana that was thought to be clinically insignificant when it was first identified. Here, we report the clinical features and treatment approach for a lung transplant patient who developed N. veterana clivus osteomyelitis secondary to sphenoid sinusitis. It is the first case of skull base osteomyelitis caused by this rare species of Nocardia.

A Report of Haemophilus influenzae Bacteremia With Acute Pelvic Inflammatory Disease.

Sexually-transmitted organisms that frequently originate from the flora of the lower genital tract are often implicated in pelvic inflammatory disease (PID). Haemophilus influenzae, a pathogen found primarily in the upper respiratory tract, has been rarely associated with PID. Here we report a case of a young woman with PID whose blood cultures grew H . influenzae biotype II, a reminder that the endometrium can be the source of systemic H. influenzae infection when no typical primary focus is found.

Asociación entre violencia íntima de pareja contra la mujer y desnutrición crónica entre los hijos de 5 años a menos: Análisis de la Encuesta Demográfica y de Salud Familiar del 2020 en Perú

Introducción: La asociación entre violencia íntima de pareja contra la mujer y la desnutrición crónica en los hijos no ha sido claramente establecida. En diversos marcos conceptuales que explican la desnutrición infantil, no se considera la violencia doméstica como una determinante. Objetivo: Evaluar la asociación entre violencia íntima de pareja contra la mujer y la desnutrición crónica en los hijos de 5 años o menos. Material y métodos: Realizamos un estudio de fuentes secundarias basada en la Encuesta Demográfica y de Salud Familiar 2020 del Perú. Estimamos la razón de momios cruda y ajustada con una regresión logística binaria que consideró como exposición a la violencia íntima de pareja y variable dependiente a la desnutrición crónica, además incluimos 16 covariables de interés seleccionadas a partir de la literatura pertinente. Resultados: Incluimos los datos de 8980 mujeres y sus respectivos hijos. La prevalencia de desnutrición crónica en los hijos de 5 años o menos fue de 10,7% (IC95%: 9,8 a 11,7). No encontramos asociación entre la desnutrición crónica en los hijos y la violencia emocional (ORa: 0,98, IC95%: 0,72 a 1,32), la física severa (ORa:1,02, IC95%: 0,62 a 1,68), y sexual (ORa: 0,94, IC95%: 0,50 a 1,77) contra las madres. Conclusiones: Estos resultados suman a la evidencia que apoya la ausencia de asociación entre los tres tipos de violencia íntima de pareja como factores de riesgo de la desnutrición crónica en los hijos de 5 años o menos y ponen de manifiesto la importancia de otras variables como el nivel educativo de la madre.

Introduction: The association between intimate intimate partner violence against women and chronic malnutrition in children has not been clearly established. Many conceptual frameworks of child malnutrition do not considered domestic violence as a determinant. Objective: To evaluate the association between intimate intimate partner violence against women and chronic malnutrition in children under 5 years of age. Methods: We conducted a study of secondary data based on the Demographic and Family Health Survey 2020 of Peru. We estimated the odds ratio crude and adjusted with a binary logistic regression that considered as exposure to intimate intimate partner violence and dependent variable to chronic malnutrition, also we included 16 covariates of interest selected from the relevant literature. Results: We included data from 8980 women and their children. The chronic malnutrition prevalence in children under 5 months of age was 10.7% (95% CI 9.8 to 11.7). We found no association between chronic malnutrition in children and emotional violence (aOR: 0.98, 95% CI: 0.72 to 1.32), severe physical violence (aOR: 1.02, 95% CI: 0.62 to 1.68), and sexual (aOR: 0.94, 95% CI: 0.50 to 1.77) against mothers. Conclusions: These results add to the evidence that supports the absence of association between the three types of intimate partner violence as risk factors of chronic malnutrition in children under 5 years of age and highlight the importance of other variables such as the mother's educational level.

Review of respiratory syncytial virus infection among older adults and transplant recipients.

Respiratory syncytial virus (RSV) is a common cause of pulmonary infection among children and has been increasingly recognized as an important respiratory pathogen in older adults and immunocompromised hosts. Among older adults, RSV can lead to exacerbations of underlying lung and cardiac disease. It is also associated with significant morbidity and mortality in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients and may be associated with acute rejection and chronic lung allograft dysfunction among lung transplant recipients (LTRs). Current treatment options for severe RSV disease are limited, and there is a paucity of guidance on RSV treatment among older adults. This narrative review provides a comprehensive overview of RSV disease in older adults, HSCT recipients, and SOT recipients. Nosocomial spread has been reported, thus highlighting the importance of infection prevention and control measures to prevent outbreaks. Antivirals, monoclonal antibodies for immunoprophylaxis, and vaccine development are underway; however, future research is still needed in these critical areas.

Heart failure exacerbation as only presenting sign of COVID-19.

With the increasing number of confirmed cases and accumulating clinical data, our understanding of COVID-19 continues to evolve. Here we describe the case of a patient who was initially admitted for decompensated heart failure with reduced ejection fraction (HFrEF). Only later in his course did he develop fever that led to testing for severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). Although we are aware of the common respiratory failure induced by SARS-COV-2, we have scant information that describes cardiac manifestations caused by this novel virus.

PBP-2 Negative Methicillin Resistant Staphylococcus schleiferi Bacteremia from a Prostate Abscess: An Unusual Occurrence.

Staphylococcus schleiferi subsp. schleiferi is a coagulase-negative Staphylococcus which has been described as a pathogen responsible for various nosocomial infections including bacteremia, brain abscess, and infection of intravenous pacemakers. Recently, such bacteria have been described to be found typically on skin and mucosal surfaces. It is also believed to be a part of the preaxillary human flora and more frequently found in men. It is very similar in its pathogenicity with Staphylococcus aureus group and expresses a fibronectin binding protein. Literature on this pathogen reveals that it commonly causes otitis among dogs because of its location in the auditory meatus of canines. Also, it has strong association with pyoderma in dogs. The prime concern with this organism is the antibiotic resistance and relapse even after appropriate treatment. Very rarely, if any, cases have been reported about prostatic abscess (PA) with this microbe. Our patient had a history of recurrent UTIs and subsequent PA resulting in S. schleiferi bacteremia in contrast to gram negative bacteremia commonly associated with UTI. This organism was found to be resistant to methicillin, in spite of being negative for PBP2, which is a rare phenomenon and needs further studies.