Candida species are usually harmless commensal organisms, frequently found in the human oral cavity. However, these polymorphic fungi can act as opportunistic pathogens in immunocompromised individuals. The resulting infections can vary in nature from mild oral candidosis to severe systemic sepsis, and management can be challenging. We present an extremely rare case of Ludwig’s angina of odontogenic origin complicated by an unusual species of Candida, which subsequently caused Lemierre’s syndrome and progressed to sepsis. We highlight the importance of early identification and targeted treatment, as well as the value of multidisciplinary input in optimising outcomes for patients with these life-threatening conditions.

Scrub typhus is a mite-borne rickettsial infection endemic in many parts of India and typically causes small-vessel vasculitis; large-vessel involvement is rare. We report a 52-year-old immunosuppressed man on long-term tofacitinib who presented with prolonged fever, weight loss, and systemic inflammation, and was found to have multiple pseudoaneurysms involving the abdominal aorta, carotid, and popliteal arteries, along with pulmonary nodules and necrotic lymphadenopathy. Extensive evaluation for tuberculosis, fungal infections, and bacterial endocarditis was negative, with no response to broad-spectrum antimicrobials or antitubercular therapy. Serology for scrub typhus was positive following identification of travel to an endemic area, and doxycycline led to rapid clinical and biochemical improvement. Selected pseudoaneurysms were managed surgically and endovascularly with good outcomes. This case highlights scrub typhus as a rare cause of large-vessel pseudoaneurysms in immunosuppressed patients in endemic regions.

Background: The immunogenicity of co-administering coronavirus disease (COVID-19) and influenza vaccines is not well-established, especially regarding cell-mediated immune response (CMIR). We aimed to evaluate both CMIR and humoral immune response (HIR) in this context. Materials and Methods: In this pilot randomized controlled trial, 36 healthy adults were randomly assigned (1:1:1) to receive the influenza vaccine, the COVID-19 vaccine, or co-administration. CMIR was assessed using the interferon-gamma enzyme-linked immunospot assay, and HIR was measured by anti-receptor-binding domain immunoglobulin G against severe acute respiratory syndrome coronavirus 2, both before and 4 weeks after vaccination. The primary outcome was the geometric mean ratio (GMR) of post-vaccination responses, with a lower bound of the 95% confidence interval (CI) >0.67 as the noninferiority margin. Results: GMRs between co-administration and COVID-19 vaccine were 1.03 (95% CI: 0.43-2.44) for CMIR and 0.82 (95% CI: 0.52-1.29) for HIR; both failed to meet the noninferiority margin. The immune response magnitude was 1.60 (95% CI: 0.64-4.00) for CMIR and 0.80 (95% CI: 0.41-1.58) for HIR. Conclusions: Post-vaccination immune responses were overall comparable, although the confidence intervals fell below the statistical noninferiority threshold. In terms of response magnitude, CMIR increased more and HIR increased less in the co-administration group. These findings may support a co-administration strategy, but larger trials are needed for confirmation.

Background: Catheter-related bloodstream infections, particularly central line-associated bloodstream infections (CLABSIs) involving central venous (CV) catheters, are major health care-associated infections, with Staphylococcus epidermidis ( S. epidermidis ) being the primary pathogen. However, the effect of catheter design, especially the section of the catheter and number of lumens, on bacterial adhesion remains unclear. The aim of the present study was to investigate S. epidermidis adhesion to various sections of double and triple-lumen CV catheters in an in vitro model. Materials and Methods: Bacterial suspensions of S. epidermidis were infused from the proximal port of double and triple-lumen CV catheters, and the number of adherent bacteria on the 6 catheter sections was quantified using a modified Brun-Buisson method. Statistical analysis was conducted to evaluate the differences in bacterial adhesion across catheter sections. Results: The highest level of bacterial adhesion was observed at the proximal port-opening section. A significantly greater number of bacteria adhered to this section than the other sections in both double and triple-lumen CV catheters, indicating that the proximal port-opening section is a critical site for potential contamination and infection risk. Conclusions: This finding highlights the importance of the proximal port region of CV catheters with regard to bacterial adhesion. Further research is warranted to explore the adhesion characteristics of other pathogens and evaluate various catheter designs to improve infection prevention strategies in clinical practices.

Introduction: Endobronchial tuberculosis (EBTB) is a microbial and histopathologically proven tuberculosis (TB) infection of the tracheobronchial tree. Because bronchoscopy is not routinely performed in all patients with TB, we aimed to investigate the incidence of EBTB in patients who underwent bronchoscopy in our clinic. Materials and Methods: We investigated the frequency of EBTB in 483 patients who underwent fiberoptic bronchoscopy (FOB) in our clinic between January 1, 2021, and July 11, 2023. Routinely, at each FOB, cytology, acid-resistant bacteria (ARB) staining, and mycobacteria culture are requested from the bronchoscopic lavage material. We analyzed the clinical, radiologic, and bronchoscopic features and treatment processes of EBTB cases. Results: The frequency of EBTB in patients who underwent FOB was 0.62%. EBTB was diagnosed by mycobacterial culture of bronchoscopic lavage material. The general characteristics of our patients were advanced age, 2/3 of them were male, they had never had TB before, and 2 of them had malignancy (1 of them had concurrent lung cancer). Conclusions: EBTB cases may present at an advanced age, in patients presenting with nonspecific symptoms; with radiology as nodules, masses, or consolidations; and with tumor lesions on FOB. Even if the bronchial lavage is ARB negative, we must follow the mycobacteria culture. Although EBTB can occur simultaneously with lung cancer, it can also be a very good cancer imitator.

Background: Chlamydia infections during pregnancy are associated with adverse outcomes such as preterm birth, low birth weight, perinatal death, and miscarriage. Many professional organizations have evidence-based guidelines recommending chlamydia screening during pregnancy, but little is known regarding the factors influencing the adoption of these guidelines into practice. This study assessed the awareness, adoption, and acceptability of prenatal chlamydia screening guidelines among physicians. Methods: Prenatal providers in the United States (MD/DO; n = 201) were recruited via an online survey platform. Items assessed provider awareness about prenatal chlamydia and STI screening guidelines, current practice behaviors, and risk factors considered when screening pregnant patients for STIs. Guideline characteristics including acceptability, feasibility, relative advantage, and evidence source were assessed. Descriptive and bivariate comparisons were analyzed using SAS v9.4. Results: Over 12% of providers were unaware of prenatal STI screening recommendations from their professional organizations, and almost 8% were unaware of chlamydia screening guidelines. Most providers reported using the prenatal chlamydia screening guideline from the American College of Obstetricians and Gynecologists (70%). Those selecting this guideline were significantly more likely to describe this guideline as clear ( P = 0.004) and report that guideline source was important ( P = 0.006) compared to other organization guidelines. Conclusions: Awareness of professional organization guidelines about prenatal chlamydia screening guidelines was high among providers. However, women are not screened adequately during their pregnancies suggesting that there are other factors contributing to the underutilization of screening. Future studies should focus on how these organizations can improve guideline dissemination to increase implementation of chlamydia screening during pregnancy.

Background Morbidity and mortality in COVID-19 patients have been associated with hypercoagulability resulting in pulmonary emboli and associated venous thromboembolism. Methods All COVID-19 patients with deep vein thromboses at a single institution were retrospectively evaluated. Typical demographic and clinicopathologic data to include outcomes were collected. Results Overall, 145 patients were assessed. Hypertension (66%), diabetes (43%), and previous thrombotic events (43%) were more prevalent in the study cohort; none were significantly associated with outcomes. Atrial fibrillation/arrhythmias (n = 22; 15%; P = 0.0110) and chronic kidney disease (n = 23; 16%; P = 0.0015) were associated with increased hospitalization and mortality in this cohort, as well as patients who had a recent hospitalization within 3 months (n = 30; P = 0.0164). Conclusions These data suggest that screening for venous thromboembolism in select COVID-19 patients should be completed to promote early diagnosis and treatment of deep vein thromboses with the goal to prevent pulmonary emboli and, overall, maximize patient outcomes.

Introduction Infectious complications after pancreatic surgery, especially in periampullary pathology, are very frequent and involve high morbidity. It is therefore essential to administer adequate prophylaxis and to establish objective criteria for postoperative antibiotic treatment. Materials and Methods This is a prospective study that included a total of 63 patients who underwent pancreatic surgery in our center. The antibiotic prophylaxis defined after the study of bacteriobilia and resistance was amoxicillin 1000 mg/clavulanic acid 200 mg and gentamicin 240 mg. In order to establish the need for antibiotic treatment in the postoperative period, it was decided to carry out intraoperative Gram stain. Results The sensitivity of the intraoperative Gram stain to determine the presence of bacteriobilia was 100%, and the specificity was 69%. The most common infectious complications described were intra-abdominal collection in 19.7% of cases and wound infection in 10.6%. Wound isolates by frequency were as follows: Enterococcus species (20.6%) and Klebsiella species (14.7%). Conclusions The changes made in antibiotic prophylaxis in relation to isolated bacteriobilia demonstrate a decrease in the number of infectious complications. Gram stain has proven to be a valid test to determine the need for postoperative treatment.