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Town or Gown? ID Needs Both

In 1978, Robert G. Petersdorf, MD, made the statement that the war against infectious diseases had been won and that additional ID specialists were no longer necessary. He went on to say that if additional specialists were trained, they would end up culturing one another. He continued that: Infectious disease is destined to function best as an academic specialty whose trainees should pursue careers primarily as investigators. The number of clinicians leaving training should be reduced and not further glut the marketplace; they should be based in academic divisions and devote their clinical time and effort to the care of complex referral and to indigent patients.

Case of Mycobacterium bovis Prosthetic Joint Infection from Intravesicular BCG

An 89-year-old man was seen for worsening left hip pain. He had a history of bladder cancer status post-transurethral resection of bladder tumor followed by intravesicular instillations of bacillus Calmette-Guérin (BCG). About one year later, he developed worsening pain in his left prosthetic hip that continued to worsen over the next three months. A computed tomography scan of the hip revealed loosening hardware and periprosthetic fluid collection. Aspiration and operative cultures revealed Mycobacterium bovis BCG. Susceptibility testing revealed resistance to pyrazinamide. The patient underwent a surgical washout with retention of hardware. Treatment with isoniazid, rifampin, ethambutol, and pyridoxine was initiated. This case highlights an extremely rare and delayed complication of intravesicular BCG leading to prosthetic joint infection.

Hyperpyrexic Toxic Shock Syndrome in Association with TSST-1 Cross-Reactive Superantigen SE-like X-Producing Staphylococcus aureus: Case Report, Toxin Analysis and a Proposed Case Definition

Herein, we report two additional cases of extreme pyrexia and rapid death due to Staphylococcus aureus infection. The organisms produced a variant superantigen, cross-reactive with toxic shock syndrome toxin-1 (TSST-1 cross-reactive superantigen SE-like X), which we purport to be the causative agent for this syndrome.

Use of Fecal Microbiota, Live-jslm (RBL) in the Routine Clinical Management of Clostridioides Difficile—First Five Cases

Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections. The current recommended treatment regimen for an initial episode of CDI is fidaxomicin (200 mg twice daily for 10 days) or vancomycin (125 mg, four times daily for 10 days) as an acceptable alternative [1]. Unfortunately, in approximately 25–35% of cases, CDI recurs within 1–2 months of the initial infection [2–5]. After a first recurrence, patients are substantially more likely to have a subsequent recurrence, with approximately 50–60% of these patients experiencing multiple recurrent CDI (rCDI) [2]. We report our early clinical experience in a multi-center community infectious disease private practice setting with the initial five patients who received the live biotherapeutic product, REBYOTA (RBL). Methods: Five patients who had experienced multiple recurrent episodes of C difficile infection and had failed the standard antibiotic therapy were prescribed the live biotherapeutic product REBYOTA (RBL). The product was administered as a single dose via the rectum. The patients were followed for eight weeks for clinical response and adverse events. Results: Patients included three males and two females, aged 20–86 years with recurrences ranging from 3 to 6 in the previous 18 months. Four patients received standard vancomycin, two patients had vancomycin taper, two had fidaxomicin and one had bezlotoxumab (Zinplava). RBL was administered easily and in less than 10 minutes. No new symptoms occurred within seven days. No recurrence was reported at eight weeks. No adverse events were reported, including no bacteremia or fungemia. No patient incurred expenses other than deductible costs. Conclusion: In a real-world setting, our initial five patients found that RBL was easy and convenient to administer with normalization of formed stools and an excellent overall clinical response at eight weeks. Furthermore, no adverse events were reported.

Herpes Simplex Virus Type 2 (HSV-2) Infection

A seventy-year-old African American female with a past medical history of essential hypertension, type two diabetes mellitus, gout, and osteoarthritis presented to the hospital with complaints of pruritic skin rash around the eyes, diarrhea, and weakness. The patient was started on allopurinol a few weeks prior to presentation after an acute gout flare in the right foot. Patient had an oral temperature
of 103 ˝F, a maculopapular rash of the face, eyelids, torso, and extremities, and diffuse tenderness with palpation of the abdomen.

Dare to DAIR: Is Rifampin Always Necessary?

The treatment of early post-operative staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics, and retention of the implant (DAIR) is becoming increasingly common. This approach has many advantages, primarily more rapid mobilization and return to normal activities compared to a one- or two-stage revision.