The diagnostic dilemma for atypical presentation of progressive human Mpox.

BACKGROUND: Human mpox has increasingly been reported worldwide since May 2022, with higher incidence in men who have sex with men (MSM) and persons living with HIV (PLHIV) with presentation typical for generalized macules and papules. CASE PRESENTATION: We are describing a case of human mpox, which presented as widespread, atypical round verrucous lesions that went undiagnosed in the community for six months and was treated with antibacterials and antifungals given the similarity to skin manifestations associated with endemic mycoses. CONCLUSIONS: Suspicion for human mpox should be high in young MSM and PLHIV who present with rash and mpox should be ruled out earlier.

Tropical splenomegaly in a migrant-in-transit crossing the Darien gap, Panamá: A probable case of hyper-reactive malarial splenomegaly.

Hyper-reactive malarial splenomegaly (HMS), or tropical splenomegaly syndrome, is a severe complication of chronic and recurrent infections caused by Plasmodium spp. This condition typically results in splenomegaly greater than or equal to 10 cm and a constellation of laboratory findings, including the absence of identifiable parasites in peripheral blood smears. However, patients with HMS demonstrate serological or molecular evidence of infection. Despite being a familiar entity in malaria holoendemic countries in Africa, and regions of Papua New Guinea, the pathophysiology, natural history, and treatment of the syndrome remains to be fully elucidated. Herein, we describe a highly suggestive case of HMS in a Senegalese patient migrating northbound to reach the U.S.-Mexico border and for whom we provided medical care during his crossing of the Darien Gap in Panama. We also reviewed the literature on diagnosing and treating HMS in-depth.

Comparison of dosing strategies in obese patients prescribed intravenous acyclovir and evaluation of rate of acute kidney injury.

INTRODUCTION: There is limited guidance on the most appropriate dosing strategy for intravenous (IV) acyclovir in obese patients. The manufacturer's labelling suggests using ideal body weight (IBW); however, previous pharmacokinetic studies of obese patients have shown more rapid systemic clearance and lower area under the curve and peak concentrations compared with patients with a body mass index (BMI) < 30 kg/m2. Although pharmacokinetic data suggest that plasma concentrations of acyclovir are best predicted when using adjusted body weight (AdjBW) doses, there is concern about higher rates of acute kidney injury (AKI). METHODS: This was a retrospective cohort review of adult patients with a BMI ≥ 30 kg/m2 prescribed IV acyclovir ≥ 48 hours between 1 January 2014 and 31 August 2021 at a 511-bed academic medical centre. The primary objective was to compare AdjBW with IBW dosing in obese patients who had been prescribed IV acyclovir and to determine whether AdjBW dosing results in higher rates of AKI. RESULTS: Ninety-four patients were included: 61 were in the IBW cohort and 33 were in the AdjBW cohort. The median BMI [IQR] for all patients was 34.7 kg/m2 [31.8-40.6]. Patients in the AdjBW cohort received a significantly higher median acyclovir dose of 800 mg/dose [IQR 700-850] compared with 600 mg/dose [IQR 500-700] for the IBW cohort (P ≤ 0.0001). No patients dosed using AdjBW developed AKI compared with eight (13.1%) in the IBW group. CONCLUSION: In this study, 8.5% of all obese patients receiving acyclovir developed AKI. Further studies are needed to confirm dosing recommendations.

The expanding spectrum of disease caused by the Lone Star Tick, Amblyomma americanum.

Ticks are remarkable vectors of a diverse and growing list of infectious agents of importance to both medical and veterinary disciplines. The tick Amblyomma americanum is one of the most frequently identified ticks in the United States with an expanding spectrum of human disease given its vast geographic range. The recently described Bourbon and Heartland viruses are likely transmitted by the Lone Star tick and are just two of the several novel tick-borne pathogens discovered in recent decades. The review will focus on these two viruses that can cause illness with similar characteristics to other diseases transmitted by the Lone Star tick. Healthcare professionals should consider these viruses in patients presenting with an ailment suggestive of a tick-born rickettsial disease that fails to improve with treatment with doxycycline. Additionally, some individuals may develop life-threatening allergic reactions triggered by the bite of the Lone Star tick.

A case of invasive pulmonary mucormycosis resulting from short courses of corticosteroids in a well-controlled diabetic patient.

A patient with well-controlled type 2 diabetes mellitus developed a severe pulmonary infection secondary to Rhizopus spp. after receiving short courses of corticosteroids for a respiratory tract infection. He recovered after an aggressive surgical intervention and treatment with isavuconazole. Patients on chronic corticosteroid therapy have a higher risk for pulmonary mucormycosis, but there are much fewer reports of mucormycosis occurring in patients after only short courses of steroid therapy.