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Introduction: We describe a unique case of sclerouveitis that progressed to endogenous Fusarium endophthalmitis in a 69‐year‐old male with chronic lymphocytic leukemia (CLL). We highlight the risk of treating sclerouveitis with oral corticosteroids, which can exacerbate an infection and contribute to disease progression. Case Presentation: A 69‐year‐old male with CLL on zanubrutinib, a second‐generation Bruton's tyrosine kinase inhibitor, was admitted to the hospital for osteomyelitis of the left foot. At presentation, the patient also reported right eye pain for 1 week and vision loss over the course of 1 month. Vision in the right eye was hand motion. Slit lamp examination revealed scleral inflammation in the right eye with violaceous injection, chemosis, inflammation in the anterior chamber, and diffuse subconjunctival hemorrhage. There was significant corneal edema preventing fundus examination. B‐scan ultrasonography demonstrated a flat retina with no vitritis or scleral thickening. Forty‐eight hours after treatment with oral and topical corticosteroids, the patient's eye pain improved but his vision worsened. Repeat B‐scan showed new‐onset vitritis. Fungal culture obtained by diagnostic pars plana vitrectomy (PPV) revealed growth of Fusarium. The patient was treated with oral and intravitreal voriconazole in addition to intravenous voriconazole and amphotericin B for systemic therapy. Corticosteroids were discontinued. Despite aggressive therapy, the patient's disposition declined to the point of transitioning to comfort‐focused care, and he passed away. Conclusion: Endogenous fungal endophthalmitis is most commonly seen in immunocompromised patients, and oral corticosteroid therapy for such patients should be used with caution as it can worsen an infection. In cases of fusarial endophthalmitis, visual prognosis is poor. [ABSTRACT FROM AUTHOR]

The article discusses research conducted at Arkansas Children's Hospital, which aimed to examine the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection mitigation strategies on pediatric cases of Group A streptococcus (GAS) pharyngitis. The study found that implementing infection control measures during the pandemic resulted in a reduction in the incidence of GAS pharyngitis, particularly among younger age groups.

Background Bloodstream infections (BSIs) are a leading cause of morbidity and mortality. The Improving Outcomes and Antimicrobial Stewardship study seeks to evaluate the impact of the Accelerate PhenoTest BC Kit (AXDX) on antimicrobial use and clinical outcomes in BSIs. Methods This multicenter, quasiexperimental study compared clinical and antimicrobial stewardship metrics, prior to and after implementation of AXDX, to evaluate the impact this technology has on patients with BSIs. Laboratory and clinical data from hospitalized patients with BSIs (excluding contaminants) were compared between 2 arms, 1 that underwent testing on AXDX (post-AXDX) and 1 that underwent alternative organism identification and susceptibility testing (pre-AXDX). The primary outcomes were time to optimal therapy (TTOT) and 30-day mortality. Results A total of 854 patients with BSIs (435 pre-AXDX, 419 post-AXDX) were included. Median TTOT was 17.2 hours shorter in the post-AXDX arm (23.7 hours) compared with the pre-AXDX arm (40.9 hours; P <.0001). Compared with pre-AXDX, median time to first antimicrobial modification (24.2 vs 13.9 hours; P <.0001) and first antimicrobial deescalation (36.0 vs 27.2 hours; P =.0004) were shorter in the post-AXDX arm. Mortality (8.7% pre-AXDX vs 6.0% post-AXDX), length of stay (7.0 pre-AXDX vs 6.5 days post-AXDX), and adverse drug events were not significantly different between arms. Length of stay was shorter in the post-AXDX arm (5.4 vs 6.4 days; P =.03) among patients with gram-negative bacteremia. Conclusions For BSIs, use of AXDX was associated with significant decreases in TTOT, first antimicrobial modification, and time to antimicrobial deescalation. [ABSTRACT FROM AUTHOR]

Background: Phenylalanine-restricted diets have been the basis of therapy for phenylketonuria; however, little is known how this treatment effects homeostasis of other amino acids. This study aimed to assess blood amino acid alterations in phenylketonuric neonates before and after treatment to identify any residual amino acid alterations with phenylalanine restriction in these treated children. Methods: Concentrations of 11 amino acids were measured using liquid chromatography-tandem mass spectrometry performed on dried blood spots. Results: Elevated blood phenylalanine, arginine, citrulline, valine, methionine concentrations and decreased tyrosine, proline concentrations were observed in phenylketonuria neonates relative to controls, of which phenylalanine, arginine, methionine, tyrosine, and proline levels could be either partially or completely restored with dietary intervention, whereas citrulline and valine were not restored and remained higher. Conclusions: Blood amino acid homeostasis is disrupted in phenylketonuria. Although dietary intervention adjusts amino acid homeostasis in the direction of a healthy equilibrium, complete restoration is not achieved. [ABSTRACT FROM AUTHOR]

Background Accelerate Pheno blood culture detection system (AXDX) provides rapid identification and antimicrobial susceptibility testing results. Limited data exist regarding its clinical impact. Other rapid platforms coupled with antimicrobial stewardship program (ASP) real-time notification (RTN) have shown improved length of stay (LOS) in bacteremia. Methods A single-center, quasi-experimental study of bacteremic inpatients before and after AXDX implementation was conducted comparing clinical outcomes from 1 historical and 2 intervention cohorts (AXDX and AXDX + RTN). Results Of 830 bacteremic episodes, 188 of 245 (77%) historical and 308 (155 AXDX, 153 AXDX + RTN) of 585 (65%) intervention episodes were included. Median LOS was shorter with AXDX (6.3 days) and AXDX + RTN (6.7 days) compared to historical (8.1 days) (P =.001). In the AXDX and AXDX + RTN cohorts, achievement of optimal therapy (AOT) was more frequent (93.6% and 95.4%, respectively) and median time to optimal therapy (TTOT) was faster (1.3 days and 1.4 days, respectively) compared to historical (84.6%, P ≤.001 and 2.4 days, P ≤.001, respectively). Median antimicrobial days of therapy (DOT) was shorter in both intervention arms compared to historical (6 days each vs 7 days; P =.011). Median LOS benefit during intervention was most pronounced in coagulase-negative Staphylococcus bacteremia (P =.003). Conclusions LOS, AOT, TTOT, and total DOT significantly improved after AXDX implementation. Addition of RTN did not show further improvement over AXDX and an already active ASP. These results suggest that AXDX can be integrated into healthcare systems with an active ASP even without the resources to include RTN. [ABSTRACT FROM AUTHOR]

Background aims. The ability to predict how many CD34++ cells a donor will collect on a given day is vital for efficient leukapheresis. Methods. We validated a formula to predict daily CD34++ cell collections by leukapheresis, calculated as follows: (peripheral blood CD34++ cells/L) × (adjusted collection efficiency of 30%)/body weight (kg), multiplied by the number of liters processed. This validation was performed from 234 donors undergoing 30 L large volume leukapheresis (LVL) and 162 donors undergoing smaller collections (non-LVL). The LVL group consisted of 811 collection events (625 multiple myeloma, 186 non-myeloma). The non-LVL group consisted of 224 collection events (196 multiple myeloma, 28 non-myeloma). All predicted and observed CD34++ cell collection numbers were plotted (predicted versus observed) and assessed using linear regression analyses. Linear correlation coefficients ( r-values), slopes and intercepts of the regression lines were evaluated. Results. Predicted versus observed data points across all quantities of CD34++ cells/kg collected by both LVL and non-LVL had strong r-values of 0.947 and 0.913, respectively, demonstrating near perfect positive linear correlations. Data for LVL collections subgrouped by number of cells collected (poor, intermediate and good), mobilization regimen, collection day and diagnosis were analyzed the same way and showed consistent findings. Conclusions. We have validated a formula with a strong ability to predict collection of CD34++ cells/kg that would allow for individualization of collection for any donor once the peripheral blood CD34++ cell count and optimal goal of collection were known; to date this has not been published by other groups. [ABSTRACT FROM AUTHOR]

Aim: Lack of platelet increase after platelet transfusion is a major problem. Antibodies may develop against platelet surface proteins including HLA-Class I. Donor platelet crossmatching with patient serum is used to find compatible platelet units. The objective of this study was to determine if cPRA could predict %DP-XM. Thereby, the blood bank would be able to predict the number of platelet units to test for finding compatible units. Methods: Platelet XM were performed using the Capture-P® Immucor Gamma® and reported as percent positive of total units tested. cPRA were determined by Luminex® assay using One Lambda® single-antigen HLA-class I beads. A retrospective review of platelet XM during 2008-2012 was performed. Patients with ⩾2 platelet XM were included to compensate for donor bias due to reduced HLA diversity in the platelet donor pool. For each patient the mean %DP-XM was compared with the corresponding mean cPRA. Additionally, the cPRA of each patient was compared with the subsequent most contiguous %DP-XM. Patient cPRA vs %DP-XM were plotted and the slopes compared with the ideal line of equivalence using Microsoft® Excel®. Results: A total of 50 patients were analyzed. The mean age was 59 years (range 26-77 years). There was no correlation between positive platelet XM results and age, sex, race, or diagnosis. The mean and median %DP-XM were 61% and 60% (range 0-100%), respectively, and the mean and median cPRA levels were 66% and 68% (range 0-100%), respectively. No significant differences were seen with regression analyses comparing cPRA with its subsequent most contiguous %DP-XM value or the mean cPRA to mean %DP-XM. Conclusions: cPRA percentage correlates well with percentage of positive platelet XM. Thus, a higher cPRA is suggestive of a greater number of positive platelet XM, and thereby alerts the blood bank that additional platelets units may be required for finding XM-compatible platelet units. [ABSTRACT FROM AUTHOR]

A 65-year-old female with a history of multiple tick bites presented with fever and pancytopenia. Intracytoplasmic rickettsial morulae were detected on peripheral smear and bone marrow biopsy specimens, and PCR amplified Ehrlichia ewingii DNA from both specimens. To our knowledge, this is the first report of E. ewingii infection of human bone marrow., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)