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Abstract A 26-year-old man with Ehlers-Danlos syndrome, recurrent otitis externa, and chronic otitis media sustained a left lower extremity amputation and open femur fracture with internal hardware fixation after a motor vehicle collision in Arizona. He presented to the emergency department at our institution with severe left leg pain and purulent discharge despite receiving two unidentified antibiotics upon discharge. Evaluations revealed an abscess and malunion of the femur. Initial cultures yielded scant Priestia endophytica, leading to daptomycin treatment. His condition worsened until Gram-positive bacilli identified as Mycobacterium goodii, a rare nosocomial mycobacterial species, were found. Significant improvement occurred with appropriate antibiotics. This case highlights the challenges in diagnosing and managing M. goodii infections in immunocompromised patients with orthopedic complications and notes P. endophytica as a previously unreported, possibly opportunistic human pathogen.

Purpose: This report describes a case of Cryptococcus neoformans found in an unlikely location, the orbit, in an apparently immunocompetent host. Observations: A coordinated, multi-disciplinary approach between the ophthalmology, neurosurgery, pathology, and infectious disease departments was integral to saving both vision and life. Conclusions and Importance: This is the first case of primary orbital cryptococcosis described in the medical literature, to the authors’ knowledge. The case draws attention to the possibility that Cryptococcus neoformans can indeed invade the orbit and should be considered part of the differential diagnosis for patients presenting with orbital masses of uncertain etiology.

In developing countries, typhoid fever is a common cause of febrile illness accompanied by abdominal pain and weakness. It is caused by Salmonella enterica serovar Typhi. Humans are the only known reservoir of infection, and typhoid fever is common in regions where access to clean water and sanitation is limited. The antimicrobials of choice for a case of typhoid fever acquired outside Pakistan are third generation cephalosporins. Lately, cases of extensively drug-resistant (XDR) Salmonella Typhi have been reported in people with a travel history to Pakistan. We present a case of XDR typhoid fever which relapsed after treatment with meropenem.

Background: Methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) may fail to improve with standard monotherapy, particularly in patients with multifocal infection, incomplete source control, or persistent bacteremia. Synergy observed in vitro between ceftaroline (CPT) and daptomycin (DAP) or vancomycin (VAN) may translate into clinical benefit. Here, we describe our experience with DAP/CPT and VAN/CPT for complicated MRSA-B after monotherapy failure. Methods: Single-center, retrospective review of consecutive patients treated with DAP/CPT or VAN/CPT for MRSA-B after monotherapy failure from 1 January 2016 to 30 November 2018. Results: We identified 11 instances of combination therapy in 10 patients (DAP/CPT = 6, VAN/CPT = 5) with 1 patient receiving VAN/CPT followed by DAP/CPT. Rates of multifocal infection, incomplete source control, persistent bacteremia, and infective endocarditis were high (100%, 80%, 60%, and 60%, respectively). Combination therapy was initiated most commonly for persistent bacteremia (60%). When patients were persistently bacteremic, median preceding duration was 13 days and median time to clearance was 3 days. Total microbiologic cure rate was 100%. There were zero instances of bacteremia relapse at 30 days (30D) or 60 days (60D). All-cause 30D and 60D mortality rates were 11.1% and 33.3%, respectively. Conclusions: Combination therapy demonstrated success in diverse cases of refractory MRSA-B, including instances of persistent bacteremia paired with incomplete source control. Optimal timing and therapeutic cadence for combination therapy remain unclear. Our findings suggest that DAP/CPT and VAN/CPT can be considered for complicated MRSA bacteremia when other treatment options fail or are unavailable. We propose persistent bacteremia with incomplete source control to be a clinical niche particularly worthy of further investigation.

People with HIV are at for metabolic syndrome (MetS) and fatty liver disease, but the role of Antiretroviral therapy (ART) is poorly understood. MetS and fatty liver disease been associated with changes in adiponectin, soluble ST2 (sST2), chitinase 3-like 1 (Chi3L1), hyaluronic acid (HA), tissue inhibitor of metalloproteinase-1 (TIMP-1), lysyl oxidase-like-2 (LOXL2) and transforming growth factor β (TGF-β) concentrations in HIV-uninfected populations. Protease (PI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) may contribute to these comorbidities, but the effects of switching from PI- or NNRTI to raltegravir (RAL) on these biomarkers is unknown.Cryopreserved plasma was obtained from a completed, prospective trial of HIV-infected women with central adiposity on NNRTI- or PI-based ART during which they were randomized to remain on their current ART or switch to a RAL based regimen. Biomarker concentrations were quantified using ELISA and Multiplex assays at baseline and 24 weeks after randomization. Wilcoxon-signed rank test evaluated within-group changes, Spearman and linear regression models evaluated correlations between biomarkers and clinical covariates.Participants had a median age of 43 years, CD4+ T lymphocyte count 558 cells/mm3 and BMI 32 kg/m2; 35% met criteria for MetS. At baseline, higher adiponectin levels correlated with higher Chi3L1 levels (r = 0.42, p = 0.02), as did declines after 24 weeks (r = 0.40, p = 0.03). Changes in sST2 correlated with changes in Chi3L1 (r = 0.43, p = 0.02) and adiponectin (r = 0.40, p = 0.03). Adiponectin and Chi3L1 levels decreased significantly in women switched to RAL vs continue PI/NNRTI.In women with HIV and central obesity, the hepatic steatosis/fibrosis marker Chi3L1 and adiponectin decrease in conjunction with sST2 decreases following switch to RAL. Whether switching from NNRTI/PI-based regimens to RAL can improve hepatic steatosis and dysmetabolism requires further study.Clinicaltrials.gov NCT00656175.

Sand flies deliver Leishmania parasites to a host alongside salivary molecules that affect infection outcomes. Though some proteins are immunogenic and have potential as markers of vector exposure, their identity and vector specificity remain elusive.We screened human, dog, and fox sera from endemic areas of visceral leishmaniasis to identify potential markers of specific exposure to saliva of Lutzomyia longipalpis. Human and dog sera were further tested against additional sand fly species. Recombinant proteins of nine transcripts encoding secreted salivary molecules of Lu. longipalpis were produced, purified, and tested for antigenicity and specificity. Use of recombinant proteins corresponding to immunogenic molecules in Lu. longipalpis saliva identified LJM17 and LJM11 as potential markers of exposure. LJM17 was recognized by human, dog, and fox sera; LJM11 by humans and dogs. Notably, LJM17 and LJM11 were specifically recognized by humans exposed to Lu. longipalpis but not by individuals exposed to Lu. intermedia.Salivary recombinant proteins are of value as markers of vector exposure. In humans, LJM17 and LJM11 emerged as potential markers of specific exposure to Lu. longipalpis, the vector of Leishmania infantum chagasi in Latin America. In dogs, LJM17, LJM11, LJL13, LJL23, and LJL143 emerged as potential markers of sand fly exposure. Testing these recombinant proteins in large scale studies will validate their usefulness as specific markers of Lu. longipalpis exposure in humans and of sand fly exposure in dogs.

Recent unprecedented events worldwide, such as floods in Dubai, recurring heavy rainfall in Santo Domingo, and abrupt temperature changes in the United Kingdom (UK), underscore the tangible impacts of climate change. In response to escalating threats from natural disasters, global communities prioritise resilience and effective disaster management systems. This paper addresses best practices for managing abnormal floods, laying the foundation for the next generation of preparedness and mitigation plans. Focusing on flood risk in Santo Domingo, the study employs the Community Disaster Resilience Framework, conducting a workshop with over 100 stakeholders from government, private, and academic sectors. The assessment spans physical, economic, environmental, and social aspects, revealing common challenges in infrastructure upkeep, public awareness, urban planning, drainage, and economic disparities. The paper proposes technological solutions like predictive maintenance and smart drainage systems, emphasising the potential for implementation. Recognising the importance of community involvement and preparedness, insights from the United Kingdom guide initial steps in strategy development. The conclusions advocate for collaborative efforts among government, academia, and society to navigate the complexities of disaster management and community resilience, ultimately proposing a framework to address these challenges. Further research is suggested in expanding online platforms for disaster risk reduction education in the Caribbean region.

Modelar el nicho ecológico óptimo para determinar la distribución potencial de las especies es una opción viable en la ubicación de las mejores áreas para establecer Unidades Productoras de Germoplasma Forestal (UPGF). El objetivo del presente estudio fue modelar la distribución potencial de Pinus pseudostrobus y P. oocarpa en Chiapas, México, mediante el procesamiento cartográfico de variables topográficas, climáticas, edáficas, ecológicas y modelos de nicho ecológico (MaxEnt). Se utilizaron 220 datos de presencia de P. oocarpa y 52 para P. pseudostrobus obtenidos de la Red Mundial de Información sobre Biodiversidad, Global Biodiversity Information Facility, del Missouri Botanical Garden y del Herbario Nacional de México (MEXU). La distribución potencial de la especie fue modelada con 500 y 1 000 iteraciones a través de las regresiones de tipo Logistic, Cumulative y Cloglog. La validación estadística se realizó con 28 % de los datos para cada taxón con las técnicas Crossvalidate y Bootstrap. El modelo que mejor se ajustó fue el logístico con método de remuestreo crossvalidate. Los valores del Área Bajo la Curva (AUC) para los datos estimados y validados fueron de 0.882 para P. oocarpa y 0.947 en P. pseudostrobus. La variable que más influyó en la presencia o ausencia de las especies fue la altitud con 84.5 y 97.3 % para P. oocarpa y P. pseudostrobus, respectivamente. Los resultados del modelo permitieron ubicar áreas óptimas para el establecimiento de UPGF.