Building an Infectious Disease Diversity, Equity, and Antiracism (ID2EA) Curriculum: A Single Center's Experience and Reflections.

In response to longstanding healthcare inequities unmasked by the Coronavirus Disease 2019 pandemic, the infectious diseases (ID) section at the Yale School of Medicine designed and implemented a pilot curriculum integrating Infectious Disease Diversity, Equity, and Antiracism (ID2EA) into ID educational training and measured program outcomes. We herein describe a mixed-methods assessment of section members on whether the ID2EA curriculum affected their beliefs and behaviors regarding racism and healthcare inequities. Participants rated the curriculum as useful (92% averaging across sessions) and effective in achieving stated learning objectives (89% averaging across sessions), including fostering understanding of how inequities and racism are linked to health disparities and identifying strategies to effectively deal with racism and inequities. Despite limitations in response rates and assessment of longer-term behavioral change, this work demonstrates that training in diversity, equity, and antiracism can be successfully integrated into ID physicians' educational activities and affect physicians' perspectives on these topics.

A Patient With Type 1 Diabetes and Acute Rhinosinusitis.

A 41-year-old with type 1 diabetes had generalized weakness, muffled voice, and slurred speech. Neck computed tomography showed soft-tissue gas in the nasopharynx and prevertebral fascia; examination of sinus mucosal samples identified numerous broad, nonseptate right-angled hyphae and fruiting bodies. What is the diagnosis and what would you do next?

Pseudo-Thrombotic Thrombocytopenic Purpura due to Severe Vitamin B12 Deficiency.

As a subset of microangiopathic hemolytic anemia, thrombotic thrombocytopenic purpura can present with a constellation of symptoms similar to the hemolytic anemia attributed to severe vitamin B12 deficiency. There have been few case reports in the medical literature concerning the development of a clinical syndrome consistent with microangiopathic hemolytic anemia attributable to B12 deficiency. We report a case of B12 deficiency leading to microangiopathic hemolytic anemia that was corrected solely with a ten-day course of intramuscular cobalamin replacement. Prompt diagnostic and clinical evaluation utilizing specific exclusion parameters can promote accurate and safe treatment of the clinical syndrome of microangiopathic hemolytic anemia related to B12 deficiency.

Current Concepts in the Diagnosis and Management of Pneumocystis Pneumonia in Solid Organ Transplantation.

Pneumocystis infection manifests predominantly as an interstitial pneumonia in immunocompromised patients. Diagnostic testing in the appropriate clinical context can be highly sensitive and specific and involves radiographic imaging, fungal biomarkers, nucleic acid amplification, histopathology, and lung fluid or tissue sampling. Trimethoprim-sulfamethoxazole remains the first-choice agent for treatment and prophylaxis. Investigation continues to promote a deeper understanding of the pathogen's ecology, epidemiology, host susceptibility, and optimal treatment and prevention strategies in solid organ transplant recipients.

Diagnostic Testing of COVID-19 in Solid Organ Transplantation: Current Clinical Application and Future Strategies.

PURPOSE OF REVIEW: While a great deal of literature has been published recently on the viral kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and diagnostic testing performance for coronavirus disease 2019 (COVID-19) in the general population, a relative paucity of information has come to light regarding implications of COVID-19 diagnostics for solid organ transplantation. This review examines the current state of knowledge regarding the two principal diagnostic testing strategies for SARS-CoV-2 infection, polymerase chain reaction (PCR)-based testing and serology, and discusses COVID-19 diagnostic implications for solid organ transplantation. RECENT FINDINGS: The interpretation of diagnostics for SARS-CoV-2 infection can present several challenges and raises questions regarding optimal donor and candidate screening as well as infection prevention practices in solid organ transplant recipients with SARS-CoV-2 infection. Guidance from several societies regarding donor and recipient suitability for transplantation during the COVID-19 pandemic is reviewed. Prolonged positive testing by polymerase chain reaction has been described in transplant recipients which may impact infection prevention practices. SUMMARY: The COVID-19 pandemic has put multiple aspects of solid organ transplantation at risk, with impacts on donor and recipient suitability, and mitigation of infection and transmission after transplantation. Accumulating evidence regarding diagnostic fidelity and transmissibility of SARS-CoV-2 in immunocompromised patients will continue to inform optimal practices surrounding solid organ transplantation during the COVID-19 pandemic.