Are reporting guidelines used in infectious diseases publications? An analysis of more than 1,000 articles.

Objective: To assess whether 16 reporting guidelines of Enhancing the QUAlity and Transparency Of Health Research (EQUATOR) were used in infectious diseases research publications. Design: This cross-sectional, audit-type study assessed articles published in five infectious diseases journals in 2019. Methods: All articles were manually reviewed to assess if a reporting guideline was advisable and searched for the names and acronyms of 16 reporting guidelines. An "advisable use rate" was calculated. Results: We reviewed 1,251 manuscripts across five infectious diseases journals. Guideline use was advisable for 973 (75%) articles. Reporting guidelines were used in 85 articles, 6.1% of total articles, and 8% (95% CI 6%-9%) of articles for which guidelines were advised. The advisable use rate ranged from 0.06 to 0.17 for any guideline, 0-0.08 for CONSORT, 0.53-1 for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and 0-0.66 for Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) : The TRIPOD statement. No trends were observed across the five journals. Conclusions: The use of EQUATOR-related reporting guidelines is infrequent, despite journals and publishers promoting their usage. Whether this finding is attributable to knowledge, acceptance, or perceived usefulness of the guidelines still needs to be clarified.

Gender balance in infectious diseases and hospital epidemiology journals.

Objective: Diversity is recognized as a driver of excellence and innovation. Women represent a significant part of the infectious diseases (ID) and hospital epidemiology (HE) workforce. We aimed to assess gender representation among editors of top ID and HE journals and explore potential correlations with the gender of first and last authors in published articles. Methods: Using Scimago Journal & Country Rank, we identified 40 ID and 4 HE high-ranking journals. Editorial members were categorized by decision-making influence (levels I-III). We retrieved names of first and corresponding authors from 12 ID-focused journals' 2019 research articles. Gender assignment for editors, first authors, and last authors utilized digital galleries and manual searches. Results: Among 2,797 editors from 44 journals, 33% were women. Female representation varied across editorial levels: 26% at level I, 36% at level II, and 31% at level III. Gender balance disparities existed among journals. Female first authors accounted for 50%, and female last authors accounted for 36% of the 2,725 published articles. We found weak but significant correlations between the editors' gender and the gender of the first and last authors. Conclusion: Gender representation among ID and HE journal editors displayed unevenness, but no overt vertical segregation was observed. A generational transition among authors may be underway. Our findings suggest that a generational transition may be occurring among authors.

Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients.

During the SARS-CoV-2 pandemic, few cases of Nocar-dia spp. co-infection have been reported during or after a COVID-19 infection. Nocardia spp. are gram-positive aerobic actinomycetes that stain partially acid-fast, can infect immunocompromised patients, and may cause dis-seminated disease. We report the case of a 52-year-old immunocompromised man who had Nocardia pseudobrasiliensis pneumonia develop after a SARS-CoV-2 in-fection. We also summarize the literature for no-cardiosis and SARS-CoV-2 co-infections. Nocardia spp. infection should remain a part of the differential diagnosis for pneumonia in immunocompromised hosts, regardless of other co-infections. Sulfonamide/carbapenem combina-tions are used as empiric therapy for nocardiosis; species identification and susceptibility testing are required to se-lect the optimal treatment for each patient.

Resolution of possible acquired protein S deficiency after viral suppression in HIV infection.

Current literature suggests an increased risk of venous thromboembolism (VTE) in people living with HIV (PLWH) with poorly controlled viraemia and immunodeficiency. VTE treatment guidelines do not specifically address anticoagulation management in PLWH. We report a case of a 33-year-old woman diagnosed with an unprovoked pulmonary embolism (PE) and deemed protein S deficient. Three years later, she was diagnosed with AIDS. Antiretroviral therapy (ART) was promptly initiated with viral suppression and immune reconstitution within 12 months. Eight years after her initial PE, the patient self-discontinued warfarin. Multiple repeat protein S values were normal. ART without anticoagulation has continued for 3 years with no thrombotic events. This case describes a patient with VTE presumably secondary to undiagnosed HIV with possible consequent acquired protein S deficiency. Additional research is needed to understand the characteristics of PLWH with VTE who may warrant long-term anticoagulation as opposed to shorter courses.

Pericarditis and Sacroiliitis in a World Traveler.

A 65-year-old immunocompromised woman presented with progressive dyspnea and sacroiliac joint pain. Cardiac magnetic resonance showed abnormal right ventricular filling with septal bounce and abnormal pericardial enhancement, suggestive of constrictive pericarditis. Cultures from pericardium following pericardiectomy grew Coccidioides immitis. She was diagnosed with coccidioidomycosis and responded to pericardiectomy and amphotericin. (Level of Difficulty: Intermediate.).

Bordetella hinzii Meningitis in Patient with History of Kidney Transplant, Virginia, USA.

A patient in Virginia, USA, who had previously undergone multiple kidney transplantations showed signs of Bordetella hinzii bacteremia and meningitis. This emerging pathogen has been increasingly identified as a clinically significant pathogen in immunosuppressed and, less frequently, immunocompetent patients. This patient was treated and recovered without further issue.

Attributable mortality from extensively drug-resistant gram-negative infections using propensity-matched tracer antibiotic algorithms.

BACKGROUND: Tracer antibiotic algorithms using administrative data were investigated to estimate mortality attributable to extensively drug-resistant gram-negative infections (GNIs). METHODS: Among adult inpatients coded for GNIs, colistin cases and 2 comparator cohorts (non-carbapenem ß-lactams or carbapenems) treated for ≥4 consecutive days, or died while receiving the antibiotic, were separately propensity score-matched (1:2). Attributable mortality was the in-hospital mortality difference among propensity-matched groups. Infection characteristics and sepsis severity influences on attributable mortality were examined. Algorithm accuracy was assessed by chart review. RESULTS: Of 232,834 GNIs between 2010 and 2013 at 79 hospitals, 1,023 per 3,350 (30.5%) colistin and 9,188 per 105,641 (8.7%) ß-lactam (non-carbapenem) comparator cases died. Propensity-matched colistin and ß-lactam case mortality was 29.2% and 16.6%, respectively, for an attributable mortality of 12.6% (95% confidence interval 10.8-14.4%). Attributable mortality varied from 11.0% (7.5%-14.7%) for urinary to 15.5% (12.6%-18.4%) for respiratory (P < .0001), and 4.6% (2.1%-7.4%) for early (≤4 days) to 16.6% (14.3%-18.9%) for late-onset infections (P < .0001). Attributable mortality decreased to 7.5% (5.6%-9.4%) using a carbapenem comparator cohort but increased 9-fold in patients coded for severe sepsis or septic shock (P < .0001). Our colistin algorithm had a positive predictive value of 60.4% and sensitivity of 65.3%. CONCLUSIONS: Mortality attributable to treatment-limiting resistance during GNIs varied considerably by site, onset, and severity of infection.

Case Report: Paederus Dermatitis in the Returning Traveler.

Rash in the returned traveler can provide a diagnostic dilemma for clinicians, but a detailed history including epidemiologic exposures can allow prompt diagnosis of etiologies uncommon in the United States. One such disease is Paederus dermatitis, an irritant contact dermatitis related to exposure to the rove beetle characterized by bullous lesions with surrounding erythema. Although cases and outbreaks have commonly been reported throughout the world, they are rarely reported in travelers returning to the United States. Here, we describe a patient who presented to an academic medical center in Virginia after travel to Sierra Leone with clinical presentation including exposure history and histopathology consistent with Paederus dermatitis. Our patient's clinic course is described in detail including treatment. Usual treatment includes antihistamines, topical steroids, and oral antibiotics, particularly with antimicrobials with activity against Pseudomonas sp. In addition, this case suggests a potential role for oral steroids in the treatment of this condition but further investigation is required. This case demonstrates the importance of considering a patient's travel and exposure history, as well as having familiarity with disease processes common in other parts of the world that are rarely seen in the United States.

Respiratory viruses in transplant recipients: more than just a cold. Clinical syndromes and infection prevention principles.

OBJECTIVES: The aim of this review is to provide updated information on the clinical spectrum, treatment options, and infection prevention strategies for respiratory viral infections (RVIs) in both solid organ (SOT) and hematopoietic stem cell transplant (HSCT) patients. METHODS: The MEDLINE and PubMed databases were searched for literature regarding the aforementioned aspects of RVIs, with focus on respiratory syncytial virus, adenovirus, influenza virus, parainfluenza virus, human metapneumovirus, and rhinovirus. RESULTS: Compared to immunocompetent hosts, SOT and HSCT patients are much more likely to experience a prolonged duration of illness, prolonged shedding, and progression of upper respiratory tract disease to pneumonia when infected with respiratory viruses. Adenovirus and respiratory syncytial virus tend to have the highest mortality and risk for disseminated disease, but all the RVIs are associated with higher morbidity and mortality in these patients than in the general population. These viruses are spread via direct contact and aerosolized droplets, and nosocomial spread has been reported. CONCLUSIONS: RVIs are associated with high morbidity and mortality among SOT and HSCT recipients. Management options are currently limited or lack strong clinical evidence. As community and nosocomial spread has been reported for all reviewed RVIs, strict adherence to infection control measures is key to preventing outbreaks.

Bartonella Endocarditis and Pauci-Immune Glomerulonephritis: A Case Report and Review of the Literature.

Among culture-negative endocarditis in the United States, Bartonella species are the most common cause, with Bartonella henselae and Bartonella quintana comprising the majority of cases. Kidney manifestations, particularly glomerulonephritis, are common sequelae of infectious endocarditis, with nearly half of all Bartonella patients demonstrating renal involvement. Although a pauci-immune pattern is a frequent finding in infectious endocarditis-associated glomerulonephritis, it is rarely reported in Bartonella endocarditis. Anti-neutrophil cytoplasmic antibody (ANCA) positivity can be seen with many pathogens causing endocarditis and has been previously reported with Bartonella species. In addition, ANCA-associated vasculitis can also present with renal and cardiac involvement, including noninfectious valvular vegetations and pauci-immune glomerulonephritis. Given the overlap in their clinical presentation, it is difficult to differentiate between Bartonella endocarditis and ANCA-associated vasculitis but imperative to do so to guide management decisions. We present a case of ANCA-positive Bartonella endocarditis with associated pauci-immune glomerulonephritis that was successfully treated with medical management alone.

EEG screening for temporal lobe epilepsy in patients with acute psychosis.

Seizures may present with ictal or interictal psychosis mimicking primary psychiatric disorders. The authors reviewed EEG, brain-imaging, and clinical data of 240 patients presenting with acute psychotic episode to assess the diagnostic value of EEG in differentiating ictal psychosis from primary psychosis. Seven patients had interictal spikes, but there were no patients with ictal discharges. There were no significant associations between the tested variables except that taking neuroleptics/antidepressants was associated with abnormal EEG, and older age and taking anti-epileptic drugs were associated with abnormal CT scans. These findings do not support routine use of EEG in patients presenting with acute psychosis.