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We describe a case of recurrent Kikuchi s disease in a South Asian-American man that was treated successfully with chloroquine and on recurrence with hydroxychloroquine. Each treatment led to a very prompt response. [ABSTRACT FROM AUTHOR]

We report the cases of six patients with AIDS in whom reactive hemophagocytic syndrome (RHPS) secondary to disseminated histoplasmosis was diagnosed. RHPS was diagnosed by established criteria, including fever (duration of ⩾7 days, with peak temperatures of >38.5; ° C), unexplained thrombocytopenia with anemia and/or neutropenia, and bone marrow biopsy findings of hemophagocytic histiocytosis. Disseminated Histoplasma capsulatum infection was diagnosed on the basis of the results of cultures of the bone marrow sample. The serum lactate dehydrogenase (LDH) levelwas elevated (>1,000lUlL) in all patients, and five of six patients had hyperferritinemia (range of ferritin level, 15,848–425,984 ng/mL). Five patients had features resembling severe sepsis with multiorgan dysfunction. Three patients recovered, and the findings of RHPS resolved following therapy with amphotericin B. In patients with AIDS, the combination of fever, cytopenia, elevated serum LDH level (> 1,000 IU/L), and/or hyperferritinemia (ferritin level of > 10,000 ng/mL) is a clue to the diagnosis of RHPS and disseminated histoplasmosis; bone marrow biopsy is valuable in establishing the diagnosis. [ABSTRACT FROM PUBLISHER]

Background Osteomyelitis is a complex infection with high morbidity and without standard treatment guidelines. Intravenous therapy is the standard of care, often requiring multiple daily antibiotic doses in an infusion center or home setting. Many of these infections are gram-positive and therefore are commonly treated with vancomycin or daptomycin. Oritavancin, a lipoglycopeptide antibiotic was FDA-approved in 2014 as a single dose regimen for treatment of ABSSSI and may be useful for the treatment of osteomyelitis where once-weekly therapy presents logistical advantages over vancomycin. Methods This was a retrospective case series of patients treated with four to six weekly doses of oritavancin at 20 infusion centers in 6 states under the care of 37 infectious diseases physicians. Patients were administered oritavancin between January 1, 2016 and December 31, 2018. Post therapy evaluation was completed by an ID PharmD utilizing a standardized set of questions. This study has been approved by an IRB. Results One-hundred 34 patients received oritavancin during the study period, all for acute osteomyelitis. All patients received baseline diagnostic imaging with MRI, along with clinical evaluation from a Metro Infectious Disease Consultants physician throughout their care. Cultures showing staph aureus, either MSSA or MRSA, were present in 120/134 (89.5%) of patients with MRSA encompassing the majority of patients 96/120 (80%). Patients were dosed with 1200 mg initially, and 800 mg weekly thereafter. At the end of therapy, clinical cure or improvement was achieved in one-hundred eighteen patients (88%). Follow-up was obtained through phone calls with all patients at 3 months and 6 months post-therapy in one-hundred thirty patients. Persistent or relapsing infection was diagnosed in patients 13/120 patients (10.8%). Nine patients were readmitted, but none for osteomyelitis or adverse drug reactions. Adverse reactions were reported in 5 patients (3.7%) including hypoglycemia (3) and tachycardia (2) in which 2 went to the emergency room, but were not admitted. Conclusion The use of oritavancin for gram-positive infections resulted in clinical cure or improvement in the majority of patients treated, offering a convenient and effective therapeutic option for the treatment of osteomyelitis. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Clostridium difficile infections (CDI) cause approximately 500,000 cases a year with an estimated cost that exceeds $4.8 billion. Despite interventions that addressed environmental disinfection, antibiotic stewardship, and infection control, many institutions continue to have a significant burden of disease. Public reporting and "pay for performance" have increased the impetus for better control of CDI. We describe the use of an unpublished scoring system to assess the risk of CDI with subsequent use of OVP to prevent exsporulation and infection in high-risk groups. Methods A large urban hospital in the Chicago area of approximately 400 beds, after following recommended guidelines for prevention of C. difficile, instituted an assessment tool to predict the risk of developing C. difficile infection.This is an observational, cohort study reviewing the pre- and post-implementation of OVP (oral Vancomycin prophylaxis) in hospitalized patients. From January 2017 to December 2017, eligible patients were assessed for risk of C. difficile. The intervention period, from January 2018 to December 2018, we prospectively gave eligible patients oral vancomycin (OVP) 125 mg twice daily if the risk score was 13 or above. No changes in environmental cleaning, antimicrobial stewardship, or restriction of testing were instituted during the periods of enrollment. The analysis was approved by the institutional review board. Results In 2017, 82 patients had a score of 13 or over. Of the 82 patients, 72 (87.8%) developed CDI. In 2018, 62 eligible patients had a score of 13 or over and were given OVP. Of the 62 patients, 5 (8%) developed CDI. The relative risk comparing C. difficile in ≥13 vs. <13 patients (RR = 19.2652; 95% CI = 7.3656, 50.3899). The tool is associated with a specificity of 88.54% and sensitivity of 94.67%, along with a negative predictive value of 95.51% and positive predictive value of 86.59%. Fisher's exact test was performed between OVP and no OVP in relation to the development of CDI in high-risk patients (P < 0.01). VRE rates reported on the antibiogram remained consistent throughout the study period. No significant differences in baseline characteristics were noted. Conclusion In institutions where appropriate infection control measures and antibiotic stewardship have been implemented, the use of a prediction tool to guide OVP is effective in preventing C. difficile. Disclosures All Authors: No reported Disclosures. [ABSTRACT FROM AUTHOR]