COVID-19 Vaccination Rates and Predictors of Vaccine Uptake Among Adults With Chronic Obstructive Pulmonary Disease: Insights From the 2022 National Health Interview Survey.

Background and objective The coronavirus disease 2019 (COVID-19) vaccination rates and predictors of vaccine uptake among patients with chronic obstructive pulmonary disease (COPD) in the United States are unknown. In light of this, we assessed COVID-19 vaccination rates in this population and evaluated predictors of vaccine uptake. Methods Using 2022 survey data from the National Health Interview Survey (NHIS), 1486 adults with COPD who responded with "yes/no" to whether they had received the COVID-19 vaccine were identified, including those who had received booster doses. A chi-square test was used to ascertain differences between those who had received the vaccine and those who had not, as well as between those who had received booster doses and those who had not. A logistic regression was used to evaluate predictors of COVID-19 vaccination uptake. Results A total of 1195 individuals among 1486 respondents with chronic pulmonary disease (78.4%) had been vaccinated against COVID-19, and 789/1195 (62.5%) had received booster shots. The majority of individuals were aged 65 years and above, exceeded the 1+ threshold for the ratio of family income to poverty (RFIP), and were covered by insurance. Positive predictors of COVID-19 vaccination were as follows: age 40 - 64 years (OR: 2.34, 95% CI: 1.31 - 4.19; p=0.004) and 65 years and above (OR: 1.93, 95% CI: 1.36 - 2.72; p<0.001), RFIP threshold of ≥1 (OR: 2.02, 95% CI: 1.42 - 2.88; p<0.001), having a college degree (OR: 1.92, 95% CI: 1.92 - 3.26, p=0.016), and being insured (OR: 3.12, 95% CI: 1.46 - 6.66, p=0.003). The current smoking habit negatively predicted the uptake (OR: 0.54, 95% CI: 0.33 - 0.87, p=0.012). The positive predictors of COVID-19 vaccination boosters were as follows: age 40 - 64 years (OR: 2.72, 95% CI: 1.39 - 5.30, p=0.003) and 65 years and above (OR: 4.85, 95% CI: 2.45 - 9.58, p<0.001). Being from the non-Hispanic (NH) black ethnicity negatively predicted receiving the COVID-19 booster (OR: 0.55, 95% CI: 0.36 - 0.85, p=0.007). Conclusions While COVID-19 vaccination rates are fairly satisfactory in COPD patients, the uptake of booster vaccines is relatively lower in this population. Socioeconomic and behavioral factors are associated with poor vaccine uptake, and targeted interventions should be implemented to address these factors.

Once-Weekly Liposomal Amphotericin B Use for Maintenance and Consolidation Phase Treatment of Cryptococcal Meningitis in Patients With AIDS.

Cryptococcal meningitis should be considered in individuals diagnosed with human immunodeficiency virus (HIV) infection and presenting with a cluster of differentiation 4 (CD4)-helper T cell count below 100 cells/ml. The 2022 guidelines from the World Health Organization (WHO) advocate for initiating treatment with a high dose (10 mg/kg) of liposomal amphotericin B, followed by flucytosine and fluconazole for a two-week duration. Additionally, alternative treatment options involving a combination of flucytosine and fluconazole are recommended. Consolidation therapy, as per the WHO guidelines, involves an eight-week course of fluconazole (800 mg), initiated after the induction phase. The dosage is then reduced to 200 mg/day, maintaining this level until the CD4 count exceeds 200 cells/mm3. Notably, the 2022 WHO guidelines prioritize a single dose of liposomal amphotericin B (LampB) over amphotericin B deoxycholate (AmpB-D) at 1 mg/kg due to its association with fewer side effects, including decreased mortality, kidney damage, and anemia. These recommendations are founded on the outcomes of the Ambisome Therapy Induction Optimization (AMBITION-CM), a multicenter, open-label, randomized controlled trial. This case report details the outpatient management of cryptococcal meningitis in a 47-year-old male with acquired immunodeficiency syndrome (AIDS) who exhibited intolerance to fluconazole. In this scenario, the decision to employ liposomal amphotericin B (LampB) as the sole agent for treatment during the outpatient phase was driven by challenges in tolerating fluconazole. Despite the absence of specific research on LampB's standalone use during the maintenance and consolidation phases, concerns regarding the patient's adverse reaction to fluconazole influenced the choice. Notably, LampB's once-weekly infusion schedule, although more expensive than AmpB-D, contributes to enhanced patient compliance. Exploring alternatives to traditional medications, such as interferon-gamma (INF-γ), Mycograb, 18B7, APX001, and T2307, holds promise in targeting novel antigens or complementing existing treatment regimens. Post-discharge, the patient received weekly LampB infusions alongside antiretroviral therapy (ART), resulting in an undetectable viral load and an increased CD4 count. A subsequent cerebrospinal fluid analysis post-discharge revealed a positive India ink stain but negative cultures for Cryptococcus, underscoring the necessity for a comprehensive and adaptable approach in managing cryptococcal meningitis.

A Rare Case of Acute Myeloid Leukemia Initially Presenting With Fever of Unknown Origin and Rapidly Progressing Pericardial Effusion.

This case report highlights a patient who had persistent fevers for weeks and rapidly progressing pericardial effusion following a positive test for coronavirus disease 2019 (COVID-19) two weeks before presentation to the hospital. The initial thought was that her fever was of infectious etiology, but relevant investigations led to the diagnosis of acute myeloid leukemia (AML). AML, which is characterized by clonal expansion of immature "blast cells" in the peripheral blood and bone marrow resulting in ineffective erythropoiesis and bone marrow failure, is the most prevalent form of leukemia. It is the most aggressive form of leukemia, which has varying prognoses determined by the subtypes. This report explores the association between AML, fever of unknown origin, and pericardial effusion, shedding light on a notable clinical aspect. Fever in AML may be attributed to underlying inflammatory processes, cytokine dysregulation, or bone marrow failure. Recognition of fever as a potential indicator of AML contributes to enhanced clinical vigilance. Pericardial effusions and cardiac tamponade, although rare, can be a presenting feature of AML, and can present side by side with fever of unknown origin as seen in this case report.

Salmonella Group B Ileitis Mimicking Crohn's Disease: A Case Report.

Salmonellae, considered among the enteric-fever-causing pathogens, is associated with a range of human infections, including gastroenteritis, bacteremia, and osteomyelitis. Salmonella-induced mesenteric adenitis and terminal ileitis resembling acute appendicitis have been reported in the literature. Here, we present a rare case of a patient presenting with severe acute active ileitis and colitis mimicking Crohn's disease with no prior history of inflammatory bowel disease and found to have Salmonella group B bacteremia.

COVID-19 Vaccination Rates and Predictors of Uptake Among Adults With Coronary Heart Disease: Insight From the 2022 National Health Interview Survey.

INTRODUCTION: COVID-19 has become a burden to all nations across the globe, and vaccination currently remains the most effective means of fighting the SARS-COV-2 pandemic. From the time of approval and subsequent distribution of the various COVID-19 vaccines, nearly 72.3% (5.5 billion) of the globe's population have been vaccinated, leaving slightly more than a quarter of the globe's population at risk. With the approval and availability of booster vaccine dosages to individuals with chronic conditions, including coronary heart disease (CHD), it is vital to comprehend the factors underlying the uptake of COVID-19 vaccination in such subgroups. Further, the American Heart Association recommends vaccination against COVID-19 in populations with coronary heart disease (CHD). This is because they are more likely to experience severe outcomes due to COVID-19 infection. This study assesses the uptake of COVID-19 vaccines as well as predictors of its uptake. METHODS: Using the 2022 survey data from the National Health Interview Survey (NHIS), 1,708 adults ≥ 40 years with CHD who responded yes/no to whether they had received the vaccine were identified. A Pearson's chi-square test was used to ascertain differences among those who had received the vaccine and those who had not. A logistic regression (multivariate regression) was used to evaluate predictors of COVID-19 vaccination. RESULTS: About 1,491/1,708 (86.8%) adults ≥ 40 years reported being vaccinated against COVID-19. Among them, 1,065/1,491 (68.4%) had received more than two vaccination doses. The predictors of COVID-19 vaccination were older age (odds ratio (OR): 2.01 (95% confidence interval (CI): 1.40-2.89), p < 0.001), ratio of family income to poverty threshold of 1 and above (OR: 2.40 (95% CI: 1.58-3.64), p < 0.001), having a college degree (OR: 3.09 (95% CI: 1.85-5.14), p < 0.001), and being insured (OR: 3.26 (95% CI: 1.03-10.26), p = 0.044). CONCLUSION: The findings of the study have indicated that 68.4% of adults 40 years and above with CHD have been vaccinated against COVID-19 and have received more than two doses of vaccines. More than half have followed recommendations and have received booster doses of the vaccine. Old age (above 40 years) and a higher socioeconomic class are associated with being more likely to follow COVID-19 vaccination guidelines. Despite the higher vaccination rate of 68.4% in the adults with heart diseases group, strategies for improving booster vaccine awareness alongside accessibility are needed to enhance additional dosage uptake, protect them against novel COVID-19 variants, and ensure the development of sustained immunity.

The Association of Mycobacterium tuberculosis with Kikuchi Syndrome: A Case Report and Literature Review.

Kikuchi-Fujimoto disease (KFD) is considered one of the rare benign conditions of unknown etiology presenting with the triad of cervical lymphadenopathy, fever, and weight loss. The inciting cause continues to be elusive. One of the leading thoughts is that it may be a post-infectious immune response of T-cells and histocytes. The most common triggers reported have been viral infections. Treatment mainly revolves around the reduction of the inflammatory response with anti-inflammatory medication and steroids when appropriate. To date, there are very limited reports of Mycobacterium tuberculosis as an inciting agent documented. Here, we present a rare case of Kikuchi-Fujimoto disease following Mycobacterium tuberculosis infection, more than four years after the completion of therapy.

A Rare Case of Polymerase Chain Reaction-Negative Severe Clostridioides difficile Infection.

Accurately diagnosing Clostridioides difficile infection (CDI) is crucial for effective patient management. A misdiagnosis poses risks to patients, leads to treatment delays, and contributes to infection transmission in healthcare settings. While using polymerase chain reaction (PCR) to amplify the toxin B gene is a sensitive method for detecting toxigenic C. difficile, there is still a risk of false-negative results. These inaccuracies could have significant consequences for diagnosing and treating CDI, emphasizing the need for careful consideration and other diagnostic approaches. This case report highlights a patient with severe CDI who had negative PCR and toxin and a biopsy showing pseudomembranous colitis on further testing due to persistence and worsening of symptoms. In the diagnosis of C. difficile infection, healthcare providers should consider clinical symptoms, although diarrhea, which is a major sign of CDI, can be due to other causes. Even in the presence of negative PCR results, if a patient displays symptoms consistent with C. difficile-associated disease, healthcare providers may still contemplate treatment.