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Introduction: Non-Tuberculous Mycobacteria (NTM) are opportunistic environmental pathogens that can produce a wide range of diseases, including infection of the skin and soft tissues. Mycobacterium fortuitum is a predominant causative agent of postsurgical wound infection, especially in breast surgery. Peri-prosthetic infection due to Mycobacterium fortuitum are uncommon, but increasingly reported. This report summarizes the case of a young healthy female who underwent bilateral breast mastopexy with insertion of silicone implants. Shortly after the procedure she presented with clinical signs of wound infection that failed to heal completely in spite of repeated drainage and empiric antibiotic therapy. Additional microbiological investigation allowed for a diagnosis of Mycobacterium fortuitum. A prolonged course of anti-mycobacterial therapy, combined with removal of the implants initiated eradication of the infection and enabled re-implantation of the prosthesis. This case report underscores the importance of awareness to this type of pathogen especially in cases of exudative infection with sterile cultures. Timely identification can lead to prompt therapy of patients preventing further complications, costs and remaining aesthetic damage.

Introduction: Q fever is an acute zoonotic infection, which in some cases is complicated by a chronic disease. Diagnosis is based on serology, and in patients with a chronic disease, the source of infection must be investigated., Aims: To describe patients with chronic Q fever, who were treated at the Hillel Yaffe Medical Center: risk factors, course of the disease, and serological findings., Methods: This was an observational study; patients with chronic Q fever who were treated in the Infectious Diseases Clinic during the period 5/2015 - 1/2018 were included. The diagnosis was based on clinical findings and results of phase 1 IgG ≥ 800. Clinical, laboratory and imaging data from diagnosis to the end of treatment were collected., Results: Sixteen patients were included in the study; all these patients were treated with antibiotics, and three also underwent operations. Risk factors for a chronic infection were a significant valvular disease in 11 patients (69%) and vascular diseases in five (31%). Trans-esophageal echocardiogram (TEE) was performed in 13 patients (81%), and a 18F-FDG/PET-CT was performed in eight patients (50%). The source of infection was found in seven patients, four with endocarditis and three with vascular infection., Conclusions: Endocarditis was more common than vascular infection. In 56% of the patients, the source of the infection was not found., Discussion: We presented patients with chronic Q fever who were treated in a unique clinic in Israel. Diagnosing the source of the infection is challenging; the increasing use of 18F-FDG/PET-CT allowed accurate diagnosis in some patients in which TEE results were negative.

The life expectancy of HIV patients has increased dramatically since the introduction of combination antiretroviral therapy. This led to an increase in the incidence of non-AIDS related diseases, such as liver diseases, malignancies and metabolic disorders. Increased incidence of osteoporosis and bone fractures was found in HIV patients compared to the general population. The causes were multifactorial, combining traditional risk factors (such as age, sex, low weight, smoking, steroid treatment, vitamin D deficiency), with risk factors associated with the viral infection itself (increased bone loss and decreased bone formation), and to a lesser extent from the antiretroviral treatment itself. An association between bone density loss and antiviral drugs such as Tenofovir, and different protease inhibitors, was found in several studies, but no definite evidence of an increased risk of bone fractures was found. Current American guidelines recommend screening for low bone density only HIV patients who are over 50 years of age with a risk factor for osteoporosis. European guidelines recommend screening all HIV patients older than 50 years. HIV patients at risk for fractures should be treated according to local guidelines in the general population. Currently, no recommendations exist to change any specific antiretroviral therapy in case of osteoporosis, unless there are specific circumstances.