Preparedness Tested: Severe Cerebral Malaria Presenting as a High-Risk Person Under Investigation for Ebola Virus Disease at a US Hospital.

In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a "wet" person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded.This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry.

Translating and scaling the HHS Action Plan to Prevent Healthcare-associated Infections to the local level: experience of a Los Angeles Health System.

BACKGROUND: The US Department of Health and Human Services National Action Plan to Prevent Healthcare-associated Infections (HAIs) set 5-year national-level goals beginning in 2009 for reducing the most common and serious HAIs. Meeting these goals on the local level depended on generalizing and sustaining evidence-based infection prevention practices at the >5000 US community and federal acute care hospitals. OBJECTIVES: To describe the impact of the Federal and California State HAI Action Plans on UCLA Heath, an academic health system in Los Angeles, in planning and implementing HAI prevention activities and reducing HAI rates. METHODS: The Context-Input-Process-Product model and the systems functions and properties framework were applied to the evaluation of infection prevention and control activities at UCLA Health. RESULTS: Resource constraints, competing priorities, variation in care practices, provider engagement, and the expanding administrative burden of public reporting were some of the challenges to implementing and sustaining HAI prevention practices at the local level. Progress toward reducing targeted HAI rates in UCLA Health has paralleled the results observed on the state and national level, including declining infections associated with medical devices, surgical procedures, and multidrug-resistant organisms. CONCLUSIONS: In California, federal funding supporting the state HAI Action Plans and mandatory public reporting requirements spurred adoption, implementation, and evaluation of HAI prevention efforts and helped to drive collaborative performance improvement and research at the facility level.

Mucocutaneous leishmaniasis masquerading as Wegener granulomatosis.

A 43-year-old Brazilian female presented in 2001 with nasal stuffiness and sinusitis. A biopsy was consistent with limited Wegener's granulomatosis although antineutrophil cytoplasmic antibodies were negative. Her nasal inflammation progressed despite trials of prednisone, methotrexate, and azathioprine. A septal perforation developed and a repeat biopsy showed granulomatous inflammation. In 2006 the patient was referred to Division of Rheumatology, University of California, Los Angeles. The nose was grossly erythematous and a magnetic resonance imaging revealed nasal destruction and sinusitis. Palatine biopsies showed chronic inflammation. Cyclophosphamide at 150 mg/d resulted in markedly improved mucocutaneous lesions. The patient developed a leg and arm rash in 2007. A skin biopsy was positive for Leishmania braziliensis. The cyclophosphamide was discontinued and amphotericin B was initiated with transient benefit. Remission was achieved with pentavalent antimony. Despite multiple nasopharyngeal biopsies, for a 6-year span, mucocutaneous leishmaniasis masqueraded as Wegener's granulomatosis. Cyclophosphamide not only resulted in clinical improvement, due to reduced inflammatory response, but also allowed widespread cutaneous dissemination.

Transmission of mycobacterium tuberculosis via lung transplantation.

Organ donors are not routinely screened for tuberculosis (TB) in the United States. We investigated a case of pulmonary TB in a double-lung transplant recipient. We reviewed the donor's and recipient's records, and used molecular methods to compare the lung recipient's isolate with others from three sources: her hospital, the California state health department's genotyping database, and the donor's resident-nation of Guatemala. A respiratory specimen obtained from the lung recipient 1 day after transplantation grew Mycobacterium tuberculosis. Donor chest radiograph had a previously unnoticed pulmonary opacity that was present on post-transplant recipient chest radiographs and computed tomographs. The recipient's isolate was molecularly distinct from others at her hospital and in the state database, but was identical to two isolates from Guatemala. Tuberculosis was transmitted from lung donor to recipient. As organ transplantation becomes more common worldwide, similar cases could occur. Screening for TB in potential organ donors should be considered.