Medical Specialties Commons^™

Efficacy And Safety Of Olezarsen In Dyslipidemia: A Systematic Review And Dose-Response Meta-Analysis Of Randomized Controlled Trials, Christopher D. Tristan, Risalina Myrtha, Matthew A. Wijayanto, Erlangga M. Kynaya, Muhammad F. Hamka, Nathania E. Sudiono, Muhammad A. Rusyidi, Muhana F. Ilyas

Journal of the Saudi Heart Association

Olezarsen emerged as a novel promising Apo-C3 inhibitor for dyslipidemia. However, its dose-response relationship remains uncertain. This review aims to evaluate the lipid-lowering effect of olezarsen, safety measures, and dose-response effects to determine the optimal dose. A systematic search was conducted across Scopus, PubMed, ScienceDirect, and CENTRAL on January 2, 2025. Randomized controlled trial (RCT) comparing olezarsen with placebo in dyslipidemia was included. The Rob 2.0 tool was implemented to assess quality. R-studio and STATA were used to conduct statistical analysis. From a total of 194 documents at initial search, four RCTs involving 361 patients were included in the present …

Nosocomial Sepsis Triggered By Pluralibacter Gergoviae In A Pediatric Intensive Care Unit: A Case Report And Literature Review, Abdulrahman Özel, Nurettin Onur Kutlu, Servet Yüce, Cenk Özdalgiçoğlu, Meltem Erol

Journal of Pediatric Infectious Diseases

Pluralibacter gergoviae is a rare opportunistic gram-negative bacillus in humans and exhibits resistance to preservatives in cosmetic products. In this case report, we present nosocomial P. gergoviae sepsis that developed through contamination from a cleaning product in a previously healthy child without known chronic diseases, pediatric intensive care unit care. Contamination with the same microorganism was detected even in unused samples of the cleaning product, leading to a recall of these items. This report highlights the case of hospital-acquired P. gergoviae sepsis to emphasize the importance of adherence to antiseptic protocols by health care work as well as the necessity …

New Insights On The Clinical Significance Of Mycoplasma Pneumoniae-Dna Load In Mycoplasma Pneumoniae Pneumonia, Chen Yu, Lin Chenxi, Huang Rui, Chen Qi, Zhang Min, Chen Ling, Lai Xingqian

Journal of Pediatric Infectious Diseases

Objective: This study aimed to assess the consistency of MP-DNA load in the respiratory tracts, its correlation with Mycoplasma pneumoniae pneumonia (MPP) manifestations, and its predictive value for refractory M. pneumoniae pneumonia (RMPP).

Methods: A retrospective study was performed on a cohort of MPP cases, including 215 patients with positive nasopharyngeal aspirate (NPA) MP-DNA and 59 with positive bronchoalveolar lavage fluid (BALF) MP-DNA. Patients were categorized into two groups based on MP-DNA load: low-load (≤106/mL) and high-load (>106/mL). The consistency of MP-DNA load in NPA and BALF was determined by Spearman’s correlation coefficient. Clinical, laboratory, and radiological data were …

Comparison Of Delta Neutrophil Index And Inflammatory Markers In The Diagnosis Of Late-Onset Neonatal Sepsis In Preterm Infants, Aybuke Yazici, Hayriye Gozde Kanmaz Kutman, Gulsum Kadioglu Simsek, Betul Siyah Bilgin, Fuat Emre Canpolat, Bedia Dinc, Serife Suna Oguz

Journal of Pediatric Infectious Diseases

Objective: To assess the performance of the relatively new hematological marker delta neutrophil index (DNI) and other inflammatory markers in proven sepsis of the very preterm infant.

Methods: Infants with a gestational age of <32 weeks and examined for suspected late-onset sepsis (LOS) were evaluated retrospectively. Demographic characteristics, laboratory findings, and neonatal morbidity and mortality were compared between infants with blood culture-confirmed sepsis and clinical sepsis.

Results: The study included 358 infants, 90 with proven sepsis and 268 with clinical sepsis. The mean gestational ages in these groups were 28.2±2 and 28.2±2.1 weeks, and the mean birth weight was 1139±372 and 1148±370 g, respectively (p>0.05). The proven sepsis group had higher DNI (median 7.1% [range, 0.1-74] vs. 0.6% [range, 0.1-24.7%], p<0.01], CRP (median 5 [range, 1-38] mg/L vs. 1 [range, 1-15] mg/L, p<0.001), interleukin 6 (median 620 [range, 6.9-5500] pg/mL vs. 42.2 [range, 2.2-5500] pg/mL, p<0.01), and procalcitonin (median 6.2 [range, 0.26-86] μg/L vs. 0.6 [range, 0.06-25.7] μg/L, p=0.002). According to ROC analysis, interleukin 6 had the highest area under the curve (AUC) at 0.74 (95% CI 0.60-0.88, p<0.01). The AUC values were 0.73 (95% CI 0.59-0.88, p=0.01) for procalcitonin, 0.62 (95% CI 0.44-0.80, p=0.18) for DNI, and 0.66 (95% CI 0.50-0.82, p=0.05) for CRP.

Conclusion: The delta neutrophil index showed a statistically significant elevation …

Diagnostic Value Of Lncrna Fgd5-As1 Sponge Mir-223-3p In Infantile Pneumonia And Its Prognostic Effect On Rehabilitation, Hong-Ping Ren, Hong-Lin Wen, Ya-Nan Liu, Lin Cai

Journal of Pediatric Infectious Diseases

Objective: This study aimed to uncover the value of long non-coding RNA FGD5-AS1 (lncRNA FGD5-AS1) in the diagnosis of infantile pneumonia and explore its pathological mechanism in lung fibroblasts. This research may provide a potential biomarker for diagnosing patients and predicting their rehabilitation outcomes.

Methods: This study included 92 children with infantile pneumonia as the research object, and an equal number of healthy children were introduced as controls. The FGD5-AS1 content was detected using real-time quantitative polymerase chain reaction (RT-qPCR) assay. The diagnostic value of FGD5-AS1 was evaluated by receiver operating characteristic (ROC) and logistic analysis. The molecular mechanism of …

Hematological Parameters And Systemic Inflammatory Markers In Children With Viral Acute Lower Respiratory Tract Infections, Sadiye Sert, Fatma Sargin, Şerife Karaçal Say, Berna Erayman, Ebru Buldu

Journal of Pediatric Infectious Diseases

Objective: Viral acute lower respiratory tract infections (ALRTIs) are a leading cause of morbidity and mortality in children, particularly those under 5 years. Accurate diagnosis and timely management are crucial to improve outcomes. This study aimed to address the lack of comparative analysis between hematological and systemic inflammatory markers concerning established disease severity scores in children with viral ALRTIs. We sought to evaluate the correlations between these markers and severity scores to identify which parameters provide the most reliable predictive value for assessing the severity of ALRTI diagnoses in this population.

Methods: This retrospective cross-sectional study included 191 children hospitalized …

Evaluation Of Gastrointestinal Pathogens In Children With Inflammatory Bowel Disease Using Multiplex Polymerase Chain Reaction, Yeliz Çağan Appak, Özgür Appak, Betül Aksoy, Büşra Emi̇r, Ayça Arzu Sayiner, Maşallah Baran

Journal of Pediatric Infectious Diseases

Objective: Impaired gastrointestinal mucosa and immunosuppressant therapies increase the risk of secondary infection in patients with inflammatory bowel disease (IBD). This study evaluated the detection of pathogens in children with IBD using a gastrointestinal panel (GP). This is the first study to compare this method with clinical data from pediatric IBD patients.

Methods: Children with newly diagnosed IBD or experiencing disease flares were included. Demographic data, clinical and laboratory findings, treatments, treatment durations, and disease activity were analyzed. Stool samples were assessed using multiplex real-time polymerase chain reaction with QIAstat-Dx GP®. Results were compared between groups.

Results: Thirty-five patients with …

Abdominal Tuberculosis In Children, Melike Emiroglu, Gulsum Alkan, Meltem Kiymaz, Sadiye Kubra Tuter Oz, Hatice Turk Dagi, Mehmet Öztürk, Zeliha Esin Çelik

Journal of Pediatric Infectious Diseases

Objective: To provide an insight into the presentation, diagnosis and management of gastrointestinal tuberculosis in children.

Methods: We reviewed the medical records of children who were diagnosed with gastrointestinal tuberculosis, between October 2013 and October 2023. The analysis was performed using descriptive statistics.

Results: During the study period, 11 of 76 tuberculosis pediatric patients (14.5%) were diagnosed with gastrointestinal tuberculosis. Six of 11 patients (54.5%) were female. The median age of the patients was 60 months (51-205 months). Eight of 11 patients had intra-abdominal lymph node involvement, 3 of 11 patients had intestinal tuberculosis and 2 of 11 patients had …

Urgent Implementation Of Point-Of-Care Testing For Group A Streptococcal Infection In A Uk Children’S Emergency Department, Ruth Shorrocks, Philip J. Turner, Thomas Fanshawe, Umasha Ukwatte, Jim Gray, James Taylor, Liliana Graveto, Gail Hayward, Chris Bird

Journal of Pediatric Infectious Diseases

Objective: In late 2022, Western Europe and the United States experienced increased incidences of scarlet fever and life-threatening invasive group A strepto- coccal (iGAS) infections, especially among children. The outbreak was widely reported in the media in the United Kingdom, leading to increased emergency department (ED) attendances and threatened supplies of antibiotics. Our ED rapidly introduced point-of-care testing for GAS pharyngitis with the aim of rationalizing antibiotic prescribing.

Methods: We rapidly implemented the use of a molecular-based (polymerase chain reaction) point-of-care test for all children scoring 3 or higher on the McIsaac clinical prediction rule for GAS pharyngitis in children …

Epidemiology Of Acute Infectious Diarrhea-Associated Viruses In Children In Hangzhou, China, 2023, Ya-Jun Guo, Lin Li, Qin-Rui Lai, Wei Li

Journal of Pediatric Infectious Diseases

Objective: To investigate the epidemiological characteristics of children infected with diarrheal virus in Hangzhou, China, 2023.

Methods: From January 2023 to December 2023, 20,939 stool samples from children with acute infectious diarrhea were collected for detection of rotavirus A and human adenovirus, using Latex agglutination detection kits; 7584 stool samples were collected for detection of norovirus, using real‐time PCR reagent.

Results: 639 (3.0%, 639/20,939) tested positive for rotavirus A, and 1,201 (5.7%, 1,201/20,939) positive samples were detected by Colloidal gold method. The positive rates of norovirus were 42.2% (3,203/7,585). Among all age groups, the rotavirus A positive detection rate was …

Evaluation Of Pediatric Patients Diagnosed With Measles: A Retrospective Study In Istanbul, Zehra Yazi, Nahide Haykir Zehi̇r, Merve Akçay, Ufuk Yükselmiş, Ceren Çetin, Ayşe Karaaslan, Yasemin Akin

Journal of Pediatric Infectious Diseases

Objective: Measles, predominantly impacting the pediatric population, manifests symptoms encompassing fever, rash, rhinorrhea, cough, conjunctivitis, accompanied by infrequent yet plausible life-threatening complications.

Methods: This retrospective study conducted between January 2022 and July 2023 at a 1105-bed tertiary hospital in Istanbul, Türkiye, was focused on children diagnosed with measles and aged(PCR) were defined as definite measles cases.

Results: A total of 78 pediatric patients were diagnosed with measles, of whom 40 were evaluated as definite (51.3%) cases. Among the definite cases, 29 (72.5%) and 11 (27.5%) were girls and boys, respectively. Their median age was 78 (42–158) months. It was observed …

Rcpneoperu Trial: A Cluster Randomized Pilot Trial To Assess Traditional Neonatal Resuscitation Compared To Partially Virtual Training In Remote Areas., Carlos A Delgado, Enrique Gómez Pomar, Pablo Velásquez, Víctor Sánchez, Roberto Shimabuku, Luis Huicho

Pediatrics Faculty Publications

OBJECTIVE: To assess the effects of a neonatal resuscitation training program using traditional training and partial distance learning.

METHOD: Through an open cluster-randomized trial, the authors compared a traditional approach involving face-to-face theory and practice sessions using information and communication technology to offer theory and distance examination, followed by face-to-face practice. Twelve health facilities were allocated by blocked randomization. Comparisons were made adjusting for clustering in qualitative and quantitative data. The primary outcome was the percentage of infants with heart rates ≥100 per minute at the second minute after birth. The authors performed a cluster-level analysis for cluster randomized trials, …

Implementation And Effectiveness Of A Nurse-Enabled, Shared-Care Follow-Up Model For Early Breast Cancer Survivors (The Ibis-Survivorship Study): Protocol For A Stepped-Wedge Cluster Randomised Trial, Raymond J. Chan, Fiona Crawford-Williams, Bogda Koczwara, G. Bruce Mann, Elizabeth Eakin, Jane Turner, Meinir Krishnasamy, Louisa G. Collins, Helen Skerman, Karla Hemming, Nicolas H. Hart, Jon Emery, Bethany Crowe, Kerry Patford, Jane Mahony, Caroline Kristunas, Gillian Blanchard, Laura Healey, Jasotha Sanmugarajah, Rhea Liang, Paul Craft, Amy Shorthouse, Ruth Mccaffery, Mary Azer, Patsy Yates

Research outputs 2022 to 2026

Introduction Breast cancer is the most commonly diagnosed cancer among women worldwide. Survivors often experience physical and psychological effects arising from breast cancer and its treatment, which can last months and years, adversely impacting quality of life. As the number of early breast cancer survivors increases, models of specialist-led follow-up care in hospital settings are not sustainable and evidence suggests that they may not meet survivors’ needs. Nurse-enabled, shared-care, follow-up models between cancer specialist and primary care teams have potential to address this need. Methods and analysis The proposed research is a multicentre, prospective, pragmatic, stepped-wedge cluster-randomised trial designed to …

Blood-Based Proteomic Profiling Identifies Osmr As A Novel Biomarker Of Aml Outcomes, Patrick K Reville, Bofei Wang, Jennifer Marvin-Peek, Bin Yuan, Yu-An Kuo, Araceli Garza, Jessica Root, Wei Qiao, Andrea Arruda, Ivo Veletic, Yiwei Liu, Nicholas J Short, Courtney D Dinardo, Tapan M Kadia, Naval G Daver, Philip L Lorenzi, Koji Sasaki, Steven Kornblau, Mark D Minden, Farhad Ravandi, Hagop M Kantarjian, Hussein A Abbas

Faculty, Staff and Student Publications

Inflammation is increasingly recognized as a critical factor in acute myeloid leukemia (AML) pathogenesis. We performed blood-based proteomic profiling of 251 inflammatory proteins in 543 patients with newly diagnosed AML. Using a machine learning model, we derived an 8-protein prognostic score termed the leukemia inflammatory risk score (LIRS). Individual proteins were evaluated in multivariable Cox models, and model performance was assessed by cumulative concordance index. Findings were validated in internal and external cohorts across 2 institutions. Blood-based LIRS significantly outperformed the European LeukemiaNet 2022 risk model and was independently prognostic of overall survival after accounting for known clinical and molecular …

Risk Factors For Serious Bacterial Infections Among Young Infants With Hypothermia: Protocol For A Multicenter, Retrospective Case-Control Study, Sriram Ramgopal, Paul Aronson, Douglas Lorenz, Alexander Joseph Rogers, Andrea Tania Cruz

Faculty, Staff and Students Publications

Background: Hypothermia in young infants presenting to the emergency department (ED) may indicate a serious bacterial infection (SBI) such as a urinary tract infection, bacteremia, or bacterial meningitis. Improved understanding of the epidemiology of SBI in infants with hypothermia and the development of prediction models can help avoid unnecessary invasive procedures and antimicrobial exposure.

Objective: The aim of the study is to (1) describe the epidemiology of SBI and herpes simplex virus (HSV) among infants with hypothermia, (2) assess the role of biomarkers in predicting SBI, and (3) derive and internally validate a multivariable predictive model for SBI among infants …

Small Gifts, Big Questions: The Ethical Dilemma In Accepting Gifts In Medicine, Meiqi Luo, Md

The Medicine Forum

I remember discussing the topic of gift-giving by patients in a small group session in medical school. When asked whether it’s ethical for medical professionals to accept gifts from patients, I responded, “It depends on the value of the gifts.” If the gifts were of appropriate value and given purely out of appreciation, they serve to strengthen the physician-patient relationship. However, what I failed to realize was the difficulty in determining the value and intention of a gift. My personal experience of receiving gifts from a patient made me aware of such ethical ambiguities.

At the community clinic where I …

Navigating Care And Loss Through Aging, Disease, And Decision-Making In The Covid Era, Michael Predi, Do

The Medicine Forum

There is only one of the loved one you know.
Often it can be hard to let go.
Five years old the world became cold.
Lost my mother to breast cancer.
A cold wound that can’t be answered
Father raised you in a foreign land.
Drove you to school, combed your hair, gave you a life you could have never planned.
Taught me that I would catch a cold from the wind.
No arguing about modern medicine, my dad was thick skinned,
Here comes college, first generation, what an exciting time.
Get to medical school so exciting; here comes the …

Existential Pain, Kian Waddell

The Medicine Forum

A new type of pain
Never covered in a lecture
Not neuropathic, visceral, post-procedural, cancer, phantom pains,
But existential.

She didn’t want pain meds
And she had her reasons -
We didn’t push.

What she wanted was to talk
To be heard
For us to be silent and stop
Asking her every second
If she’d moved bowels, vomited, slept…

What she wanted was to talk.
What other medication is there for pain of the soul?

Eternal Light, Anurag Modak, Md

The Medicine Forum

The microscope is held aloft in a sea of darkness,
Illuminating the gyri and sulci of the exposed brain below.
Its harsh, sterile light creates a veritable barrier
So hot, so intense, it threatens to explode forth at any moment.

The screens scattered across the room provide companionship to this lonely machine
And I, residing amidst the sea of shadows,
Bear witness to its solitude
To the silence of the light.

I have seen vessels tied and aneurysms clipped,
And an eon has gone by…
There’s an air of anticipation,
An expectation of something more.

But, solace and quietude prevail …

Unmasking The Dvt Mimic: A Rare Case Of Diabetic Myonecrosis In A Young Patient, Avish Patel, Md, Paul Endres, Md, Alexander Marchese, Md, Dianna Cheney-Peters, Md

The Medicine Forum

Diabetic myonecrosis is an uncommon complication of diabetes mellitus, often falsely believed to be a deep vein thrombosis (DVT). Patients present with similar presentations of edema and focal tenderness that are most often unilateral in a proximal lower extremity.¹ When venous ultrasound is negative, magnetic resonance imaging (MRI) is the preferred diagnostic modality over muscle biopsy, given the potential complications.^2,3 Treatment includes rest, analgesia, and improved glycemic control.⁴ Given the rise of metabolic disorders and insulin resistance, it is important to be aware of this diagnosis to prevent overutilization of healthcare resources.⁵

Recurrent Post-Viral Rhabdomyolysis In A 36-Year-Old Male: A Case Report, Warda Naqvi, Md, David Walz, Md, Lucy Checchio, Md

The Medicine Forum

Rhabdomyolysis is a syndrome of skeletal muscle breakdown, releasing intracellular contents such as creatine kinase (CK) and myoglobin into the bloodstream, which can precipitate acute kidney injury (AKI).¹ While trauma, extreme exertion, and toxins are frequent culprits, infections, particularly viral illnesses, represent a less common but significant trigger.² Influenza and other respiratory viruses have been implicated in sporadic cases of rhabdomyolysis, often presenting with acute myalgias and elevated CK levels following a viral prodrome.³ In contrast, recurrent rhabdomyolysis is typically associated with inherited metabolic myopathies (e.g., McArdle disease) or autoimmune myositis, conditions often marked by distinct genetic …

Mcconnell’S Sign In The Absence Of Pulmonary Embolism, Alicia Bao, Md, Tendai Marume, Md

The Medicine Forum

McConnell’s sign is an echocardiographic finding characterized by hyperdynamic motion of the right ventricular (RV) apex with akinesis of the RV free wall. It is widely known as an indicator of RV strain in acute pulmonary embolism (PE) but has been described in other conditions such as sepsis-induced RV dysfunction, acute cor pulmonale, and right-sided heart failure. In critically ill patients, RV dysfunction is a major contributor to hemodynamic instability, respiratory failure, and poor outcomes. Given the overlapping signs of various underlying conditions, McConnell’s sign serves as a useful marker for assessing RV involvement but can be challenging to interpret …

A Case Of Streptococcus Pneumoniae Necrotizing Pneumonia With Pneumothorax And Abscess Formation, Susanna Betti, Md

The Medicine Forum

A 63-year-old female with a past medical history of left breast ductal carcinoma in situ, now post-left-sided lumpectomy and radiation in 2005, presented to an outside hospital with chest pain and a cough productive of green sputum. Computed tomography (CT) chest demonstrated patchy ground-glass opacities and dense consolidations in the right middle and lower lobe. Blood cultures and bronchoalveolar lavage culture were positive for Streptococcus pneumoniae, and she was started on antibiotics for community-acquired pneumonia. Her respiratory status rapidly worsened and she required intubation. She developed a large right-sided pneumothorax and had a chest tube placed for a …

A Complex Case Of Multifactorial Hypoxemia From Metastatic Testicular Cancer, Susanna Betti, Md

The Medicine Forum

A 27-year-old male with no known past medical history presented for evaluation of a 14.1 cm testicular mass (Figure A). He was found to have severe anemia (Hgb 2.8 g/dL), and biopsy demonstrated a non-seminomatous mixed germ cell tumor of testicular origin with imaging demonstrating widespread metastases to the brain, lungs, and liver. The patient received multiple blood transfusions and one dose of bleomycin, etoposide, and cisplatin followed by the development of acute respiratory failure. Computed tomography angiography (CTA) chest was negative for pulmonary thromboembolism but demonstrated diffuse ground-glass opacities (Figure B, arrows) and metastatic pulmonary masses containing dilated vessels …

Heart Core: A Framework For Leading With Empathy In Medical Education, Akash Patel, Do, Mark Liotta, Md

The Medicine Forum

In medical training, much of what defines leadership happens outside of clinical decision-making. It happens at 2 a.m. when a resident breaks down from burnout. It happens when a team is navigating interpersonal conflict or when a trainee is overwhelmed by grief, imposter syndrome, or failure. While these moments are deeply impactful, many of us are never taught how to lead through them.

This gap inspired us to create HEART CORE, a framework designed to help residents, faculty, and administrators approach complex, emotional, or high-stakes situations with clarity and compassion. Although it was originally built for chief residents handling difficult …

The Factor Viii Debate: An Auto-Cancelled Lab Near Miss, Avish Patel, Md, Daniel Elchediak, Md, Zachary Pang, Md, Charlotte Shields, Md, Bethanne Venkatesan, Md, Ananya Venkatesh, Md, Michael Alessandro, Bsn, Jeffrey Riggio, Md, Ms, Alexis Wickersham, Md

The Medicine Forum

Near misses, medical errors with no appreciable resultant harm, often go undetected and underreported despite great emphasis on patient safety event reporting over the past two decades.¹ Additionally, near misses are often not triggers for proactive institutional corrective action due to the widespread retroactive safety culture following more harmful or catastrophic safety events.² At Thomas Jefferson University Hospital, all internal medicine first-year residents (PGY1s) participate in an immersive safety event review curriculum of near miss or low-harm safety events, previously described in the literature.³ The following details the event review findings and implemented health-system level changes following …

Enhancing Community Health Center Safety Through Participatory Co-Design, Arman Afifi, Bs, Kelsey Smith, Bs, Megan Reed, Phd, Mph, Lara Weinstein, Md

The Medicine Forum

Health and social service programs are often designed from the top down, with people in power making decisions that affect others. Integrating all staff and clients in the co-design process ensures that interventions are culturally competent and tailored to the unique challenges faced by the community. Participants bring firsthand knowledge, allowing for a more accurate assessment of needs and preferences. Additionally, involving marginalized individuals helps build trust between service providers and the community, creating a foundation for sustained collaboration and positive outcomes. Overall, participant inclusion is not only a practical necessity but an ethical imperative in delivering effective and equitable …

From Er To Mortality In 48 Hours: A Fatal Case Of Overwhelming Post-Splenectomy Infection, Miriam Stern, Ba, Blaise O’Malley, Bs, Amry Majeed, Md, Michael Grodsky, Md

The Medicine Forum

Overwhelming post-splenectomy infection (OPSI) is a known complication of asplenia.^1,2 While the precise rates of morbidity and mortality are unknown, estimates range from 38% to as high as 70%.² Because the spleen plays an important role in protecting against infections with encapsulated microorganisms, OPSI is most commonly caused by infection with encapsulated bacteria, specifically Streptococcus pneumoniae.^1–3 While pneumococcal vaccines have been shown to improve immunogenicity in asplenic people, OPSI remains a danger to both vaccinated and unvaccinated patients.^4,5 Additional measures to protect asplenic patients from overwhelming infection have been proposed, but the evidence remains mixed. …

String Theory - A Case Of Hypermucoviscous Klebsiella Pneumoniae Causing Distant Necrotizing Infections, Natasa Kostic, Md, Marina Gonzalez, Md

The Medicine Forum

Klebsiella pneumoniae is a Gram-negative, encapsulated bacterium belonging to the Enterobacteriaceae family. It is more frequently associated with nosocomial infections and is one of several bacteria developing high rates of antibiotic resistance.¹ Since the mid-1980s, there have been reported cases of Klebsiella pneumoniae causing life-threatening, invasive infections acquired in the community by otherwise healthy individuals. The propensity to form metastatic foci of infection in immunocompetent hosts is unusual for an enteric, Gram-negative pathogen.² This hypervirulent variant of K. pneumoniae was originally noted only in Asian-Pacific countries but is now being identified globally.³ The variant has unique mucoid …

Negative Urine Nucleic Acid Amplification Testing In A Case Of Disseminated Gonococcal Infection Presenting As Migratory Arthritis, Benjamin Richter, Md

The Medicine Forum

Disseminated gonococcal infection (DGI) is a well-documented complication of Neisseria gonorrhoeae infection, most characteristically presenting as migratory arthritis, tenosynovitis, and dermatitis. Although modern nucleic acid amplification tests (NAATs) and cultures from mucosal sites have significantly improved diagnostic capabilities, discrepancies between clinical manifestations and laboratory findings still occur.¹ One such challenge arises when the urine gonorrhea test returns negative despite strong clinical evidence pointing toward gonococcal involvement.

Migratory arthritis—a transient, shifting pattern of joint inflammation—has long been recognized as a hallmark of DGI.² Typically, the pathogen is detected in blood, synovial fluid, or from mucosal specimens; however, negative urine …