Fatal Case of Burkholderia gladioli Pneumonia in a Patient With COVID-19.

Background: Burkholderia gladioli (B gladioli) is a rare, gram-negative rod that was initially regarded as a plant pathogen. However, B gladioli has been reported as the primary pathogen causing pneumonia in organ transplant recipients and in patients with cystic fibrosis. We report a case of bacterial pneumonia caused by B gladioli in a patient hospitalized for coronavirus disease 2019 (COVID-19). Case Report: A 68-year-old male was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. He was treated with dexamethasone and convalescent plasma, resulting in improvement in the hypoxemia. However, during the latter part of his inpatient stay, the patient developed pneumonia caused by B gladioli. The isolate of B gladioli was sensitive to meropenem, levofloxacin, and trimethoprim/sulfamethoxazole and intermediate to ceftazidime. He was treated with meropenem and levofloxacin. Despite treatment, the patient developed acute respiratory distress syndrome with multiorgan failure, suffered cardiac arrest, and died. Conclusion: To the best of our knowledge, this case is the first report of B gladioli coinfection in a patient hospitalized for COVID-19 and provides insight into the possible detrimental outcome of B gladioli and COVID-19 coinfection.

Introducing routine HIV screening for patients on an internal medicine residency inpatient service: a quality improvement project.

The US Centers for Disease Control and Prevention (CDC) recommend human immunodeficiency virus (HIV) screening for all persons aged 13 to 64 years who present to a health care provider. We sought to improve adherence to the CDC guidelines on the Internal Medicine Resident Hospital Service. We surveyed residents about the CDC guidelines, sent email reminders, provided education, and engaged them in friendly competition. Credit for guideline adherence was awarded if an offer of HIV screening was documented at admission, if a screening test was performed, or if a notation in the resident sign out sheet indicated why screening was not performed. We examined HIV screening of a postintervention group of patients admitted between August 8, 2012, and June 30, 2013, and compared them to a preintervention group admitted between August 1, 2011, and June 30, 2012. Postintervention offers of HIV screening increased significantly (7.9% [44/559] vs 55.5% [300/541]; P<.001), as did documentation of residents' contemplation of screening (8.9% [50/559] vs 67.5% [365/541]; P<.001). A significantly higher proportion of HIV screening tests was ordered postintervention (7.7% [43/559] vs 44.4% [240/541]; P<.001). Monthly HIV screening documentation ranged from 0% (0/53) to 17% (9/53) preintervention, whereas it ranged from 30.6% (11/36) to 100% (62/62) postintervention. HIV screening adherence can be improved through resident education, friendly competition, and system reminders. Barriers to achieving sustained adherence to the CDC guidelines include a heterogeneous patient population and provider discomfort with the subject.

Tuberculosis extrapulmonar en pediatría: un reto Diagnóstico / Extrapulmonary tuberculosis in pediatrics: a major diagnostic challenge

Introduccion: las bases diagnósticas y terapéuticas sobre tuberculosis extrapulmonar en pediatría son poco tenidas en cuenta, al igualque dicha entidad como diagnóstico diferencial a diversas entidades. Objetivo: búsqueda, revisión y síntesis de información acerca de lasprincipales formas extrapulmonares de tuberculosis en el ámbito pediátrico, principalmente sobre su diagnóstico y manejo. Metodología:búsqueda de información en bases de datos reconocidas y confiables (Medline, Cochrane, Scielo, Pubmed y Sivigila, y el sitio web oficialdel Ministerio de Protección Social de Colombia) con los términos tuberculosis, extrapulmonar y pediatría. Resultados y conclusiones: lainformación recopilada y tenida en cuenta para abarcar el tema, resulto ser escasa, antigua y de difícil localización. Aunque algunas resultanser de baja incidencia, las formas extrapulmonares de tuberculosis no son incluidas como diagnósticos diferenciales a diversas entidades,y menos en la población pediátrica, la cual puede llegar a desarrollar formas más graves de la enfermedad si ésta se deja avanzar o nollega a diagnosticarse, debido a que su sistema inmune no se encuentra lo suficientemente maduro para combatir la infección, además supresentación en esta edad, es un indicador de transmisión permanente de tb en la comunidad y un reservorio para futuras reactivacionesen la edad adulta. Por tal razón y sumado a diversos factores de riesgo presentes en un porcentaje considerable de nuestros pueblos, sehace necesario conocer la presentación clínica, las pautas de diagnóstico oportuno y de tratamiento adecuado de la enfermedad...

Introduction: the diagnostic and therapeutic basis of extrapulmonary tuberculosis in pediatrics are rarely taken into account, as this entityas a differential diagnosis to various entities. Objective: search, review and synthesis of information on the main forms of extrapulmonarytuberculosis in the pediatric population, especially its diagnosis and handling. Methodology: searching for information in databases andmost trusted (medline, cochrane, scielo, pubmed and sivigila, and the official website of the ministry of social protection of colombia)to the terms tuberculosis, extrapulmonary and pediatrics. Results and conclusions: the information collected and taken into account tocover the subject, turned out to be poor, old and hard to find. Although some happen to be of low incidence, extrapulmonary forms oftuberculosis are not included in the differential diagnosis of various entities, and least in the pediatric population, which may developmore severe forms of the disease if it is allowed to proceed or fails to diagnose, because their immune system is not mature enough tocombat the infection, and presentation at this age, is an indicator of ongoing transmission of tb in the community and a reservoir forfuture reactivation in adulthood. For this reason, together with various risk factors present in a significant percentage of our people ingeneral, it is necessary to know the clinical presentation, patterns of early diagnosis and proper treatment of the disease...

Clinical specificity of the enzyme immunoassay test for coccidioidomycosis varies according to the reason for its performance.

The diagnosis of coccidioidomycosis relies heavily on serologic test results in addition to clinical history, physical examination, and radiographic findings. Use of the enzyme immunoassay (EIA) has increased because it is rapidly performed and does not require referral to a reference laboratory, as do complement fixation and immunodiffusion tests. However, interpretation of immunoglobulin M (IgM) reactivity by EIA in the absence of immunoglobulin G (IgG) reactivity has been problematic. We conducted a retrospective medical record review of all patients with such IgM reactivity at our institution to identify situations where the finding was more likely to be clinically specific for coccidioidal infection. From 1 January 2004 through 31 December 2008, a total of 1,117 patients had positive EIA coccidioidal serology or EIA IgM-only reactivity; of these, 102 patients (9%) had EIA IgM-only reactivity. Among the 102 patients with EIA IgM-only reactivity, 60 were tested to evaluate symptomatic illness, 13 for follow-up of previously abnormal serology, and 29 for screening purposes. Of the 102 patients, 80 (78%) had positive serologic findings by other methods or had positive culture or histology. Fifty-four (90%) of the 60 patients whose serology was performed to evaluate symptomatic illness had coccidioidal infection, whereas 13 (45%) of 29 patients whose serology was performed for screening purposes had coccidioidal infection. Of the 102 patients with isolated IgM reactivity by EIA, 12 later seroconverted to IgG and IgM reactivity. The use of EIA for screening in 29 asymptomatic persons was associated with unconfirmable results in 13 (45%). Although the majority of patients in our study with isolated IgM reactivity by EIA had probable or confirmed coccidioidomycosis, this result must be interpreted with caution for asymptomatic patients.