An unusual case of Candida parapsilosis endocarditis of the native tricuspid valve secondary to a tunneled dialysis catheter.

Candida endocarditis is a severe disease associated with high mortality rates. Candida parapsilosis is frequently identified as the causative pathogen in intravenous drug users and is commonly associated with nosocomial infections, primarily due to its ability to form biofilms on catheters or other foreign bodies. Here, we present a rare case of Candida parapsilosis endocarditis affecting the native tricuspid valve in a 35-year-old male patient with end-stage chronic kidney disease (Stage V), who had a suspected fungal infection related to the left cervical catheter. The patient received treatment with caspofungin and underwent excision of a verrucous tumor on the tricuspid valve. Despite encountering postoperative complications, the patient was discharged on fluconazole treatment and scheduled for follow-up. Candida endocarditis poses a clinical challenge that necessitates a multidisciplinary approach and tailored management due to its infrequent occurrence and higher mortality rate compared to bacterial endocarditis.

La endocarditis por Candida es una enfermedad grave asociada con tasas de mortalidad elevadas. Candida parapsilosis se identifica con frecuencia como un patógeno que afecta usuarios de drogas intravenosas y está comúnmente relacionada con infecciones nosocomiales, principalmente debido a su capacidad para formar biopelículas en catéteres u otros cuerpos extraños. Se presenta un caso inusual de endocarditis por Candida parapsilosis que afecta la válvula tricúspide nativa en un paciente masculino de 35 años con enfermedad renal crónica en etapa terminal (Etapa V), quien tenía una sospecha de infección fúngica relacionada con el catéter cervical izquierdo. El paciente recibió tratamiento con caspofungina y se sometió a la extirpación de un tumor verrugoso en la válvula tricúspide. A pesar de enfrentar complicaciones posoperatorias, el paciente fue dado de alta con tratamiento de fluconazol y se programó un seguimiento. La endocarditis por Candida presenta un desafío clínico que requiere un enfoque multidisciplinario y un manejo personalizado debido a su ocurrencia infrecuente y una tasa de mortalidad más alta en comparación con la endocarditis bacteriana.

Field-based screening of selected oral antibiotics in Belize.

INTRODUCTION: The presence of poor quality antibiotics on the market has contributed to the antibiotics resistance and global threat to public health. Antibiotic resistance is now a global concern. One area to address this issue is by evaluating the quality of antibiotics accessible to the public. The purpose of this study was to test and compare (with corresponding pharmacopeia) the quality of common oral antibiotics available in the country of Belize with a view to providing base-line data on the testing of medications imported to the country for public consumption. The study focused only on level 2 field-based screening quality assurance on three Key Access Antibiotics from the World Health Organization (WHO) Model List of Essential Medicines. METHODS: Five brands of antibiotic tablets/capsules with denoted pharmacopeia imported into the country of Belize were tested for quality at The University of Belize pharmacy laboratory. A sample of 30 tablets/capsules each of the selected antibiotic brand were used for study. Visual inspection and weight variation were done for each sample while Monsanto type tablet hardness tester, Roche@Tablet Friability Test Apparatus (single drum), and Ajanta@ Tablet Disintegration Test Apparatus (double basket) were conducted on selected antibiotics. Results were recorded and compared with corresponding pharmacopoeia references. RESULTS: Most of the samples collected passed performed tests. Only a few samples from both BP and USP antibiotics failed in visual inspection and weight variation tests. All antibiotics tested conformed to their corresponding pharmacopeia reference in terms of friability and disintegration time. CONCLUSION: Most of the selected antibiotics passed performed tests when compared with their pharmacopeia. Only a few samples from both BP and USP antibiotics failed the tests conducted. There is need for regular quality assurance tests on all medications imported to Belize especially antibiotics.

Concurrent Hearing, Genetic, and Cytomegalovirus Screening in Newborns, Taiwan.

OBJECTIVE: To evaluate the feasibility and potential benefits of incorporating genetic and cytomegalovirus (CMV) screenings into the current newborn hearing screening (NHS) programs. STUDY DESIGN: Newborns were recruited prospectively from a tertiary hospital and a maternity clinic between May 2016 and December 2016 and were subjected to hearing screening, CMV screening, and genetic screening for 4 common mutations in deafness genes (p.V37I and c.235delC of GJB2 gene, c.919-2A>G of SLC26A4 gene, and the mitochondrial m.1555A>G). Infants with homozygous nuclear mutations or homoplasmic/heteroplasmic mitochondrial mutation (referred to as "conclusively positive genotypes") and those who tested positive for CMV received diagnostic audiologic evaluations. RESULTS: Of the total 1716 newborns enrolled, we identified 20 (1.2%) newborns with conclusively positive genotypes on genetic screening, comprising 15 newborns (0.9%) with GJB2 p.V37I/p.V37I and 5 newborns (0.3%) with m.1555A>G. Three (0.2%) newborns tested positive on CMV screening. Twelve of the 20 newborns (60%) with conclusively positive genotypes and all 3 newborns who tested positive for CMV (100%) passed NHS at birth. Diagnostic audiologic evaluations conducted at 3 months confirmed hearing impairment in 6 of the 20 infants (30%) with conclusively positive genotypes. CONCLUSIONS: This study confirms the feasibility of performing hearing, genetic, and CMV screenings concurrently in newborns and provides evidence that the incorporation of these screening tests could potentially identify an additional subgroup of infants with impaired hearing that might not be detected by the NHS programs.