COVID-19 in the Immunocompromised Host, Including People with Human Immunodeficiency Virus.

This review describes the incidence, epidemiology, and risk factors for mortality of COVID-19 in immunocompromised patients, including persons with human immunodeficiency virus. It describes various preventive measures, including vaccines and their effectiveness and the role of monoclonal antibodies for pre-exposure prophylaxis. It also reviews the different treatment options for immunocompromised individuals, including antivirals, monoclonal antibodies, and immunomodulators. Lastly, it describes the impact of COVID-19 on transplantation and continuity care of this population.

A case report of Nocardia spp. infective endocarditis in an injection drug user.

BACKGROUND: Nocardia-related endocarditis is rare. Intravenous drug use with nonsterile injection practices is a potential risk factor for nocardia infection. Disseminated nocardiosis with endovascular involvement is rarely reported in immunocompetent individuals. CASE PRESENTATION: A 54-year-old male was diagnosed with infective endocarditis due to Nocardia asteroides with septic emboli in the brain and spleen. The use of a matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) rapid diagnostic system was beneficial in identifying the causative organism. He was empirically treated with combination therapy consisting of three antibiotics. Antimicrobial susceptibility testing indicated that all three antibiotics had favorable minimum inhibitory concentrations (MICs). Due to his clinical status, he was not a surgical candidate. Patient passed away after discharge to hospice. CONCLUSIONS: This case demonstrates unique challenges in the identification, diagnosis, and management of Nocardia-related infective endocarditis. A detailed history of injection practices should guide clinicians in assessing the risk for environmental pathogens. Valvular surgery and combination antibiotic therapy should be recommended for all eligible patients to improve the chances of survival.

CMV Infection in Hematopoietic Stem Cell Transplantation: Prevention and Treatment Strategies.

PURPOSE OF REVIEW: Cytomegalovirus (CMV) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (Allo-HSCT). New strategies and methods for prevention and management of CMV infection are urgently needed. We aim to review the new developments in diagnostics, prevention, and management strategies of CMV infection in Allo-HSCT recipients. RECENT FINDINGS: The approval of the novel anti-CMV drug letermovir in 2017 has led to an increase in the use of antiviral prophylaxis as a preferred approach for prevention in many centers. Real-world studies have shown efficacy similar to the clinical trial. CMV-specific T cell-mediated immunity assays identify patients with immune reconstitution and predict disease progression. Phase 2 trials of maribavir have shown its efficacy as preemptive therapy and treatment of resistant and refractory CMV infections. Adoptive T cell therapy is an emerging option for treatment of refractory and resistant CMV. Of the different CMV vaccine trials, PepVax has shown promising results in a phase 1 trial. SUMMARY: CMV cell-mediated immunity assays have potential to be used as an adjunctive test to develop individualized management plan by identifying the patients who develop immune reconstitution; however, further prospective interventional studies are needed. Maribavir and adoptive T cell therapy are promising new therapies for treatment of CMV infections. CMV vaccine trials for prevention are also under way.

Cutaneous infection caused by paraconiothyrium cyclothyrioides in a renal transplant recipient.

Infections because of Coelomycetes are being diagnosed more frequently, ranging from superficial cutaneous to disseminated infections. An increasing incidence of infections because of emerging environmental fungi are being reported in immunocompromised patients because of exposure to soil, plants, and water. We report a case of cutaneous infection because of Paraconiothyrium cyclothyrioides, a Coelomycetous fungi, including literature review on reported cases and discuss suggested treatment options.

Ecthyma gangrenosum without bacteremia in a 54-year-old woman with heart transplant.

Ecthyma gangrenosum is a cutaneous manifestation of severe systemic pseudomonas infection and is commonly associated with bacteremia. It is common in immunocompromised patients with underlying neutropenia or leukopenia. We report a patient with heart transplant who developed a single lesion of ecthyma gangrenosum in the absence of bacteremia with a review of reported cases in solid organ transplant patients.

Ehrlichiosis in a recent kidney transplant recipient: The repellent that did not repel! A case report and literature review of ehrlichiosis in solid organ transplant patients.

Ehrlichiosis has been infrequently reported in immunosuppressed patients such as solid organ transplants (SOT). We report a case of Ehrlichia chaffeensis infection in an immunosuppressed woman four months after deceased donor kidney transplantation. The diagnosis was confirmed by PCR testing in serum, and the patient responded promptly to treatment with doxycycline. To supplement our Case Report, a literature review encompassing 1995 to present was also performed using PubMed as the search vehicle. Search terms that were utilized include: ehrlichiosis, HME, E chaffeensis, kidney transplant(ation), renal transplant(ation), solid organ transplant(ation), and immunosuppression. The diagnosis of ehrlichiosis can be challenging in SOT patients since ehrlichiosis is not a classic opportunistic infection in SOT. Transplant physicians must have a high clinical suspicion for the diagnosis in patients with an acute febrile illness accompanied by headache, worsening cytopenias, and transaminitis who live in endemic areas, especially if they have tick exposure.

Quantification of Hepatitis B Surface Antigen: Is there a Role in HIV-Hepatitis B Virus Coinfection?

Hepatitis B surface antigen (HBsAg) level plays an important role in conjunction with other markers such as hepatitis B envelope antigen (HBeAg) and hepatitis B virus (HBV) deoxyribonucleic acid levels to predict disease activity in chronic Hepatitis B (CHB). Quantification of HBsAg is useful in differentiating carriers from active hepatitis in HBeAg negative patients, and current guidelines recommend monitoring of pegylated interferon alpha treatment in CHB infection. However, there are only few studies about the role of quantitative HBsAg (qHBsAg) monitoring in HIV-HBV coinfected patients. Studies have shown that tenofovir based antiretroviral therapy regimen leads to a very slow decline in HBsAg levels and a predicted time of 10-42 years to lose the HBsAg, in majority of patients. Rapid drop in HBsAg levels and gain in CD4 within the 1st year of treatment and low baseline HBsAg level are associated with faster seroconversion. The reported rate of HBsAg loss in this population is < 15%. In this review, we discuss utility of qHBsAg in monitoring disease activity and treatment in HIV-HBV coinfected population.