Lemierre Syndrome involving (Formerly ) due to injection drug use into the neck.

Lemierre Syndrome, septic thrombophlebitis of the internal jugular vein following oropharyngeal infection, is classically caused by and associated with septic emboli. We present a case of Lemierre Syndrome involving (formerly ) in the setting of injection drug use. A 46-year-old man presented with right neck swelling and abscess with as the primary bacterium isolated from the abscess culture, which was introduced to the site when the patient had licked his needle and injected illicit drugs into his neck.

Risk Factors Associated With Unsuccessful Linkage to Outpatient Hepatitis C Care.

Background Modern direct-acting antivirals (DAAs) can treat and cure hepatitis C virus (HCV) infection. Treatment of HCV at a population level has the potential to decrease the prevalence of chronic HCV infection and sequela. Unfortunately, many patients fall off the HCV treatment cascade and do not complete HCV treatment.

Use of a machine learning model to predict retention in care in an urban HIV clinic.

Identifying barriers to retention in care (RIC) is critical to ending the HIV epidemic in the United States. Therefore, we developed a machine learning model (MLM) to identify predictive factors for RIC in an urban HIV clinic. Our MLM yielded a positive predictive value of 84%, higher than previously reported MLMs.

Sub-optimal routine HIV testing rates in an urban HIV and infectious disease clinic.

Routine opt-out HIV testing is central to ending the HIV epidemic, as early case finding improves outcomes and reduces transmission. Despite strong evidence-based guideline recommendations, adoption of routine opt-out testing has been sub-optimal. A survey of providers and staff at an urban HIV and infectious disease clinic assessed awareness and knowledge of guidelines, screening practices, testing barriers, and possible interventions to improve testing.

Rapidly Enlarging Parotid Mass in a Person Living with HIV: A Case of Multiple Myeloma with Extramedullary Plasmacytoma.

BACKGROUND The differential diagnosis for a parotid mass is broad, including infectious, autoimmune, and neoplastic etiologies. In people with HIV, regardless of viral suppression or immune status, neoplastic causes are more common. This report describes the evaluation of a woman with a large parotid mass, with an ultimate diagnosis of multiple myeloma with extramedullary plasmacytoma.

Documentation quality of patient-directed discharge and early warning interactions in an adult inpatient service.

Documentation quality of patient-physician discussion, assessment, and intervention at the time of patient-directed discharges (elopement and 'against medical advice' discharges) is found to be poor in available studies and, importantly, may be a proxy for quality of care delivered. Less is known about the patient-physician interactions and documentation at the time a patient vocalizes the desire to leave early ('early warning interaction') prior to a patient-directed discharge. This was a cohort study comprising a retrospective chart review of patients leaving 'against medical advice' from an inpatient internal medicine-infectious disease service at a tertiary medical center from 01 July 2020 to 24 September 2021.

A Cross-sectional Analysis of Linezolid in Combination with Methadone or Buprenorphine as a Cause of Serotonin Toxicity.

Background: Serotonin toxicity (also referred to as serotonin syndrome) results from medications that affect the neurotransmitter serotonin. The antibiotic linezolid and the opioids methadone and buprenorphine are all reported to cause serotonin toxicity, but the degree of risk with use of linezolid in combination with methadone or buprenorphine is unknown.

Methods: We conducted a retrospective cross-sectional analysis of adult patients hospitalized from November 2015 to October 2019 who were administered linezolid in combination with methadone and/or buprenorphine within 24 hours and a subgroup that received the combination for ≥3 days.

cellulitis and bacteremia associated with surgical clips.

and are the most common pathogens causing skin and soft tissue infections (SSTI). Guideline-recommended empiric antibiotics targeting these organisms would also treat coagulase negative Staphylococci, which are not typically considered skin and soft tissue pathogens. Coagulase negative Staphylococci are, however, well known for their propensity to cause indolent infections in the setting of prosthetic material.

Legionnaires' disease presenting with exanthem; Case and review of previously published cases.

Infection with (legionellosis) causes two distinct clinical presentations: Legionnaires' Disease and Pontiac Fever. Legionnaire's Disease primarily involves the lungs, often with accompanying gastrointestinal symptoms, and can also affect the liver, central nervous system, and kidneys, and cause metabolic derangements. Manifestations in the integumentary system are rare; to date, there have been eleven cases reported in the literature of Legionellosis with associated rash, with varied presentation.

People aging with HIV - protecting a population vulnerable to effects of COVID-19 and its control measures.

Certain comorbidities known to increase the risk of poor outcomes in COVID-19 exist at higher rates in people with HIV; people aging with HIV (PAWH) face additional risk due to the association of advanced age with COVID-19 mortality. Cognitive and functional deficits and social barriers have been identified in cohorts of people aging with HIV. It is postulated that the COVID-19 pandemic potentially threatens PAWH disproportionately to the general population, both in mortality risk due to age and comorbidities, and in potential deleterious effects of policies that seek to drastically limit in-person interaction and access to healthcare systems.

Current Considerations for Clinical Management and Care of People with HIV: Findings from the 11th Annual International HIV and Aging Workshop.

The number of people with HIV (PWH) aged 50 years or older continues to steadily increase. The convergence of age- and HIV-related complications in these individuals presents a challenge for both patients and clinicians alike. New findings continue to emerge, as numerous researchers evaluate the combined impact of these two factors on quality of life, physiological systems, and mental health in PWH.

Acute Limb Ischemia Caused by Inadvertent Arterial Drug Self-Injection: A Case Report.

BACKGROUND A predictable consequence of long-term injection drug use is the destruction of the native venous system; as a consequence, people who inject drugs may eventually move to injection into skin and subcutaneous tissue, wounds, muscles, and arteries. These practices put people who inject drugs at risk for injection-related soft-tissue infection, vascular damage, ischemia, and compartment syndrome, all of which have overlapping presenting symptoms. CASE REPORT A 35-year-old man who injects drugs presented with foot swelling and discoloration initially concerning for necrotizing fasciitis or compartment syndrome.

Strengths and Challenges of Various Models of Geriatric Consultation for Older Adults Living With Human Immunodeficiency Virus.

As care of persons living with human immunodeficiency virus (HIV; PWH) has transitioned from management of opportunistic infections to management of conditions associated with older age, new models of geriatric consultation are needed. The authors, who represent 9 clinics across North America and the United Kingdom, provided their insights on models of geriatric consultation for older PWH. Three models of geriatric consultation are delineated: outpatient referral/consultation, combined HIV/geriatric multidisciplinary clinic, and dually trained providers within 1 clinical setting.

Infective Endocarditis-Association With Injection Drug Use: Case Series and Review of the Literature.

Background: , or Group A (GAS), is not considered a typical cause of infective endocarditis (IE), but has anecdotally been observed in unexpectedly high rates in people who inject drugs (PWID) at our institution.

Methods: All cases of possible or definite GAS IE per Modified Duke Criteria in adults at an academic hospital between 11/15/2015 and 11/15/2020 were identified. Medical records were reviewed for demographics, comorbidities, treatment, and outcomes related to GAS IE.

pneumonia: Case report and review of reported cases in non-endemic countries.

pneumonia is much less common than pneumonia in most of the world and may evade timely diagnosis in settings that rely primarily on urine antigen testing, which detects serogroup 1 only. It is, however, widely recognized in Australia and New Zealand, where it is endemic and associated with exposure to compost and potting soils, rather than contaminated water systems as seen with can cause a similar spectrum and severity of illness as Here we present a case of a 47-year-old man with necrotizing pneumonia following exposure to possibly contaminated soil from a wastewater treatment facility. Initial presentation included cough, chest pain, and dyspnea, and progressed to hypoxic respiratory failure, tension pneumothorax, and cardiac arrest.

Multicenter retrospective cohort study of the clinical significance of Staphylococcus lugdunensis isolated from a single blood culture set.

Background: Staphylococcus lugdunensis is a coagulase negative Staphylococcus species and frequent human skin commensal with the potential for aggressive infection. Guidance surrounding S. lugdunensis bacteremia (SLB) from a single set of blood cultures is lacking.

Dalbavancin in the Treatment of Bacteremia and Endocarditis in People with Barriers to Standard Care.

Introduction: Dalbavancin is an antibiotic administered by intravenous infusion weekly or bi-weekly and is currently FDA-approved only for treatment of skin and soft-tissue infections. It has shown promise, but is not considered the standard of care, for bacteremia and infective endocarditis (IE), which typically require outpatient parenteral antibiotic therapy (OPAT) for prolonged durations. People who inject drugs (PWID) with bacteremia or IE are often perceived as having barriers to OPAT and standard daily-administered antibiotics, prompting off-label use of dalbavancin in this population.

Spontaneous pelvic inflammatory disease; Case report and review of the literature.

gynecological infections generally occur in association with childbirth, intra-uterine devices, and other invasive gynecologic procedures, but rarely cause spontaneous pelvic inflammatory disease. We describe a case of a healthy young woman with spontaneous pelvic inflammatory disease, bacteremia, and shock, and summarize an additional 13 cases found in the literature. The majority were bacteremic and a significant number were also hypotensive.

A classic and fatal case of subacute bacterial endocarditis; A now potentially underappreciated disease.

Acute bacterial endocarditis is now common and easily suspected and recognized in the setting of prosthetic valves, injection drug use, or bacteremia with virulent organisms. Conversely, subacute bacterial endocarditis has drastically decreased in incidence, and recognition may be further hampered by the indolent non-specific presentation. Delayed diagnosis is common and can lead to serious complications and fatalities.

Establishing an Anal Cancer Screening Program in an Outpatient HIV Clinic: Referral Patterns and Patient Perceptions Survey.

People living with HIV are at high risk for anal cancer (AC); however, the impact of screening for and treatment of precancerous anal lesions on AC incidence remains uncertain. In 2013, we conducted a survey of HIV providers evaluating the perceived need for an institutional AC screening program. Based on an overwhelmingly positive response, we established a dedicated AC screening clinic (including provision of high-resolution anoscopies) embedded within the institutional HIV clinic.