The Tenacious Treponema: A Retrospective Examination of Syphilis Treatment Disparities in Washington, DC.

BACKGROUND: Since 2000, there have been rising rates of syphilis infections nationally with higher incidence among minorities and persons living with human immunodeficiency virus (HIV) (PLWH). The purpose of this study was to determine syphilis treatment adequacy and factors associated with treatment delay. METHODS: This was a retrospective academic-public health collaboration with the District of Columbia Department of Public Health reviewing surveillance data of all primary, secondary, and early latent syphilis cases diagnosed between January 1, 2015, and December 31, 2019. Data were analyzed using multivariable logistic regression to identify factors associated with delayed treatment >14 days from diagnosis. RESULTS: Among 1852 individuals diagnosed with early syphilis, 93% (1730/1852) were male; 48% (893/1852) were coinfected with HIV; 43% (n = 796/1852) were African American/Black, 27% (n = 492/1852) were White, and race/ethnicity was unknown for 17% (n = 318/1852) of cases. Among 679 PLWH for whom viral load (VL) was known, 41% (278/679) had a VL < 20 copies/mL, and 18% (123/679) had VL >10,000 copies/mL. Treatment adequacy overall was 96.5%. Median time to syphilis treatment was 6 days (interquartile range = 4-7). Factors associated with delay of treatment included refused/unknown race (adjusted odds ratio [aOR], 1.95; 95% confidence interval [CI], 1.00-3.79), and HIV VL > 10,000 copies/mL (aOR, 1.97; 95% CI, 1.08-3.58). CONCLUSIONS: The factors we identified associated with delayed treatment may reflect systemic factors contributing to the increased rates of infection among key populations. This highlights the importance of targeted public health efforts with the goal of reducing transmission of both HIV and syphilis.

A Case of Acute Extensive Viral Sinusitis Secondary to Acute Epstein Barr Virus.

Infectious mononucleosis (IM), the most common presentation of acute Epstein Barr virus (EBV) infection, typically presents with fever, pharyngitis and lymphadenopathy. We describe an unusual case of IM presenting as acute sinusitis. A 25 year-old male presented to the emergency department with worsening right frontal sinus pain along with fever, chills, and greenish nasal discharge for 3 weeks. Laboratory workup showed leukocytosis with high lymphocyte counts as well as transaminitis. Facial computerized tomography (CT) showed extensive right frontal, ethmoidal and maxillary sinusitis and antrochoanal polyp. The patient underwent endoscopy with drainage of purulent material and polyp removal. Unfortunately, cultures of the sample were not sent and bacterial infection could not be ruled out. Broad spectrum antibiotics were continued. Pathology of redundant tissue revealed large atypical lymphocytes with positive EBV-encoded RNA and lack of evidence of extranodal natural killer/T-cell (NK/T-cell) type lymphoma (ENKTCL). Tests for serum EBV IgM antibodies and EBV early Antigen antibodies were positive, indicating acute EBV infection. Lymphocytosis resolved along with significant clinical improvement at the 10-day follow up visit. Even though patient did receive antibiotics, multiple factors including isolated lymphocytosis, pathology positive for EBV with no neutrophilia were more suggestive of sinusitis caused by viral infection, EBV in this case. Lymphocytosis with fever and sore throat should prompt physicians to consider IM. There are no known reports in the literature of EBV as a causal organism for acute viral sinusitis. There are some studies relating EBV with ENKTCL. It is unknown whether this particular patient with a history of EBV sinusitis will be at high risk for nasal type lymphoma in the future. Further studies should be conducted to understand the pathogenesis and relationship between EBV and ENKTCL. LEARNING POINTS: Infectious mononucleosis (IM) can present with various atypical presentations. Consideration of IM should not be limited to people presenting with a triad of fever, lymphadenopathy and sore throat. Lymphocytosis with atypical symptoms should raise suspicion of infectious mononucleosis.No case has been reported of EBV as a causal organism for acute sinusitis. Association with EBV infection and chronic sinusitis or nasal polyp or extranodal NK/T cell lymphoma has been demonstrated but pathogenesis is poorly understood.Studies should be done on whether acute sinusitis secondary to EBV poses a risk for nasal type lymphoma.

Enterobacter cloacae as sole organism responsible for vertebral osteomyelitis/discitis and vertebral collapse in a patient with intravenous drug abuse.

Staphylococcus aureus is the most commonly isolated organism in osteomyelitis, while gram-negative bacteria (GNB) comprises only a minor portion. GNB osteomyelitis is usually seen in patients with bacteraemia, recent genitourinary infection, open fractures or trauma and is rarely seen in the spines. Our case is a man in his 30s with no significant risk factors except an extended history of intravenous drug use (IVDU), who presented with back pain and subsequently developed vertebral collapse. Bone culture grew Enterobacter cloacae, yet blood cultures were negative. To date, there are limited data on the prevalence of GNB osteomyelitis in IVDU and its association. Due to rising rates of IVDU, further research must be done into associated medical complications to provide comprehensive care. Moreover, the emergence of multidrug-resistant GNB strains limits the number of effective antibiotics and is expected to pose more serious public concerns in the future.

Delayed Onset of COVID-19 in an Immunosuppressed Patient.

We report on a case of delayed presentation of COVID-19 in a postpartum immunosuppressed patient with the confounding variable of cytomegalovirus viremia. This case highlights the importance of maintaining high suspicion for COVID-19 disease even with delayed onset of symptoms, as this diagnosis as important treatment and public health implications.

Exercise Training in "At-Risk" Black and White Women: A Comparative Cohort Analyses.

PURPOSE: Few data on the effect of exercise interventions in black women at risk for cardiovascular disease are available. METHODS: Women ≥18 yr of age without known cardiovascular disease with ≥1 coronary risk factor were enrolled in a community-based exercise program ≥3 d·wk for ≥30 min per session for 6 months. Exercise training intensity ~50% to 80% of functional capacity, using heart rate (HR) and/or rating of perceived exertion (RPE) as the primary intensity modulators. Preconditioning versus postconditioning quality of life assessments (depression and level of daytime sleepiness), dietary fat intake, Duke Activity Status Index score, changes in cardiovascular efficiency (systolic/diastolic blood pressure (SBP/DBP), HR, RPE during a standardized submaximal workload), and anthropometric measures, including body weight, body mass index, and waist circumference, were evaluated. RESULTS: Of 556 volunteers, 143 were excluded, leaving 413 women (222 white, 191 black; mean ± SD age, 61 ± 9 yr) who met compliance criteria. Both groups demonstrated significant (P < 0.05) postconditioning decreases in body mass index, waist circumference, resting SBP/DBP, and total and LDL cholesterol, and reductions in HR, SBP/DBP, and RPE at a fixed submaximal workload, and in fat screener, depression, and sleep scores. Duke Activity Status Index scores increased significantly (P < 0.0001) for both groups, signifying increases in self-reported functional capacity. Although 87 women (21%) experienced a musculoskeletal injury/discomfort during the program, there were no exercise-related cardiovascular events. CONCLUSIONS: A progressive moderate-to-vigorous exercise intervention without preliminary exercise testing elicited comparable improvements in coronary risk factors, anthropometric and quality of life measures, and cardiovascular efficiency in "at-risk" black and white women. These adaptations were achieved at exercise levels below those recommended in contemporary physical activity guidelines.

Estrogen depletion results in nanoscale morphology changes in dermal collagen.

Tissue cryo-sectioning combined with atomic force microscopy imaging reveals that the nanoscale morphology of dermal collagen fibrils, quantified using the metric of D-periodic spacing, changes under the condition of estrogen depletion. Specifically, a new subpopulation of fibrils with D-spacings in the region between 56 and 59 nm is present 2 years following ovariectomy in ovine dermal samples. In addition, the overall width of the distribution, both values above and below the mean, was found to be increased. The change in width due to an increase in lower values of D-spacings was previously reported for ovine bone; however, this report demonstrates that the effect is also present in non-mineralized collagen fibrils. A nonparametric Kolmogorov-Smirnov test of the cumulative density function indicates a statistical difference in the sham and OVX D-spacing distributions (P<0.01).