ABSTRACT
We describe a case of endogenous endophthalmitis caused by sequence type 66-K2 hypervirulent Klebsiella pneumoniae in a diabetic patient with no travel history outside the United States. Genomic analysis showed the pathogen has remained highly conserved, retaining >98% genetic similarity to the original strain described in Indonesia in 1935.
Subject(s)
Endophthalmitis , Klebsiella Infections , Endophthalmitis/diagnosis , Endophthalmitis/epidemiology , Humans , Indonesia , Klebsiella Infections/diagnosis , Klebsiella pneumoniae/genetics , United States/epidemiology , Virulence FactorsABSTRACT
Catabacter hongkongensis, an increasingly recognized bacteria in clinical samples, was identified by direct metagenomic sequencing of positive blood culture fluid from a 55-year-old patient with colonic perforation. The bacteremia was cleared by both antibiotic treatment and surgical intervention. This is the first case report of C. hongkongensis infection in the US.
Subject(s)
Bacteremia/microbiology , Clostridiales/genetics , Clostridiales/isolation & purification , Anti-Bacterial Agents/therapeutic use , Bacteremia/blood , Bacteremia/drug therapy , Bacteremia/surgery , Blood Culture , Clostridiales/classification , Clostridiales/drug effects , Female , Humans , Metagenomics , Middle Aged , Phylogeny , Sequence Analysis, DNAABSTRACT
Liver transplantation for cholangiocarcinoma has been an absolute contraindication worldwide due to poor results. However, in recent years and thanks to improvements of patient management and treatments of this cancer, this indication has been revisited. This consensus paper, approved by the International Liver Transplant Society, aims to provide a collection of expert opinions, consensus, and best practices surrounding liver transplantation for cholangiocarcinoma.
Subject(s)
Bile Duct Neoplasms/therapy , Cholangiocarcinoma/therapy , Consensus , Liver Transplantation/standards , Medical Oncology/standards , Bile Duct Neoplasms/mortality , Chemoradiotherapy, Adjuvant/methods , Chemoradiotherapy, Adjuvant/standards , Cholangiocarcinoma/mortality , Humans , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/standards , Practice Guidelines as Topic , Preoperative Care/methods , Preoperative Care/standards , Survival Rate , Treatment OutcomeABSTRACT
Liver transplantation (LT) offers excellent long-term outcome for certain patients with hepatocellular carcinoma (HCC), with a push to not simply rely on tumor size and number. Selection criteria should also consider tumor biology (including alpha-fetoprotein), probability of waitlist and post-LT survival (ie, transplant benefit), organ availability, and waitlist composition. These criteria may be expanded for live donor LT (LDLT) compared to deceased donor LT though this should not adversely affect the double equipoise in LDLT, namely ensuring both acceptable recipient outcomes and donor safety. HCC patients with compensated liver disease and minimal tumor burden have low urgency for LT, especially after local-regional therapy with complete response, and do not appear to derive the same benefit from LT as other waitlist candidates. These guidelines were developed to assist in selecting appropriate HCC patients for both deceased donor LT and LDLT.
