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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.

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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.

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Specific Antibody Deficiency

Specific antibody deficiency was previously known as selective antibody deficiency with normal immunoglobulins (SADNI). The diagnosis of SAD depends on normal immunoglobulin and IgG subclass levels, as well as a normal reaction to protein-based and conjugate vaccinations. The only immunologic deficiency in patients with SAD is an abnormal response to polysaccharide antigens, as found in the PPV23, known as the twenty-three valent pneumococcal vaccine.

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A Case of Triple-Infection with SARS-CoV-2, Chikungunya, and Dengue Fever in a Returning Traveler

A 39-year-old woman presented to the emergency department (ED) four days after returning from a 5-day-long trip to The Gambia in West Africa with complaints of fever, nausea, anorexia, and fatigue. The onset of symptoms started two days after her return to the United States.

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Reactivation Histoplasmosis Manifested by Lymphocutaneous Fistula with Cervical Drainage of Stones

A 22-year-old female from the midwestern U.S. presented for the assessment of a tender neck lesion. Eight years earlier, she underwent a biopsy of a mass in the same location; the culture grew Histoplasma capsulatum. The patients prior physicians felt that the infection was likely to be self-limiting and did not prescribe antimicrobial therapy.

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