BACKGROUND

Otomycosis, or fungal infection of the ear, is most commonly caused by Aspergillus, particularly of the Aspergillus niger species. On the other hand, pulmonary aspergilloma is a late manifestation of chronic cavitary pulmonary aspergillosis. Development of invasive aspergillosis is a possibility in immunocompromised patient but very rarely seen in immunocompetent persons. There have been no published reports in patients who initially presented as otomycosis and later development of pulmonary aspergilloma.

This case report presents 53-year-old Filipino immunocompetent female who was initially presented with ear discharges with diagnosed with otomycosis. She underwent modified radical mastoidectomy of the right ear with tympanoplasty type II. The patient then developed right facial nerve palsy due to erosion of the facial nerve canal. She was discharged with a final diagnosis of chronic suppurative otitis media with cholesteatoma; however, patient was not started on any anti-fungal medications. After fourteen months, the patient presented with episodes of hemoptysis and dyspnea and eventually re-admitted. Diagnostic work up was done with chest CT scan and serum galactomannan antigen test. She was diagnosed to have pulmonary aspergilloma. Patient was then started on long term anti-fungal therapy, instead of invasive surgical procedure. Repeat chest CT scan after six months showed a decrease in the size of the fungal ball.

This study illustrates the lung aspergilloma may happen with preceding history of invasive otic fungal infection even if there is no immunocompromised condition. It also emphasizes the importance of proper identification of infection etiology to ensure adequate control and prevent further opportunistic infection.

Persistent infection with high-risk human papillomavirus(HR-HPV) is the primary etiological factor in cervical lesions and cervical cancer. Toll-like receptors(TLRs), as important pattern recognition receptors of the innate immune system, play a key role in the persistence of cervical HR-HPV infection. The "latent pathogen theory" in traditional Chinese medicine(TCM) holds that latent pathogens have both "latent" and "triggered" characteristics, which closely resemble the persistent infection and latent pathogenic potential of cervical HR-HPV. Guided by the "latent pathogen theory" and using contemporary immunological techniques, this paper explores the bidirectional immunomodulatory effects of TLRs in the persistence of cervical HR-HPV infection and their relationship with latent pathogens. The results indicate that TLRs play a crucial role in immune recognition and modulation. Dysregulation and overactivation of TLRs can induce chronic inflammation, allowing cervical HR-HPV to persist and evade immune detection. TLR dysfunction, coupled with a deficiency in healthy Qi that prevents the expulsion of pathogens, is a critical factor in the pathogenicity of latent pathogens. Restoring healthy Qi to modulate the immune functions of TLRs emerges as an important strategy for clearing cervical HR-HPV infection. By harmonizing the spleen and kidney and regulating immune balance, it is possible to reverse cervical HR-HPV infection, providing a scientific basis for clinical research.
Humans ; Toll-Like Receptors/genetics* ; Female ; Papillomavirus Infections/genetics* ; Papillomaviridae/immunology* ; Persistent Infection/genetics* ; Uterine Cervical Neoplasms/immunology* ; Animals ; Medicine, Chinese Traditional ; Cervix Uteri/immunology* ; Human Papillomavirus Viruses

RATIONALE/OBJECTIVE

This study aimed to determine the knowledge, attitudes and practices of surgeons and surgical trainees regarding published SSI prevention guidelines. Specifically, the study described knowledge and attitudes towards SSI prevention guidelines among members of surgical training programs, described preoperative, intraoperative, and postoperative practices in SSI prevention and identified the presence of surgical site infection surveillance programs among various institutions.

This was a retrospective cross-sectional study that evaluated the knowledge, attitudes, and practices of surgeons and surgical trainees to published SSI prevention guidelines in the Philippines. It utilized existing data from an October 2022 online survey done by the Philippine College of Surgeons distributed to various surgical training institutions in the country.

There were a total of 213 respondents. The different attitudes and knowledge gaps towards present SSI prevention guidelines are described.

Despite the existence of local and international guidelines there still appears to be a significant lack of awareness and variability in practice among the different institutions as well as with surgeons of different levels of expertise or training. Varying preoperative, intraoperative and postoperative practices have also been described, including evident deviations from SSI guidelines. Lastly, there is a lack of standardized SSI surveillance programs among institutions and these are not aligned towards improved patient safety and quality improvement.

We present a case of Nannizziopsis spp infection in an immunocompromised patient, describe clinical findings, investigation results and treatment. This rare fungal infection is reported in reptiles and humans, but not other mammals. There are only twenty case reports in medical literature to date, most in immunocompromised patients.

A 64-year-old kidney transplant recipient from urban Nigeria presented with a verrucous plaque on his dorsal left hand which has grown rapidly over the two months. He was concerned that it might represent cancer. On further examination he also had a subcutaneous fluctuant masses on his left flank and left upper arm, a fleshy mucosal plaque and a large tender fluctuant swelling over his right tibia. He was clinically well, but in the preceding months he reported haemoptysis and 7 kilograms weight loss.

Skin biopsies from multiple sites showed identical features: suppurative granulomatous inflammation and elongated elements consistent with fungal hyphae. Grocott special staining showed scattered fungal hyphae. Beta-D-glucan was raised at 441.4 pg/mL [3-6 pg/mL]. Subsequent molecular identification confirmed Nanniziopsis spp, likely to be N. guarroi. He was treated with intravenous amphotericin-B for 7 weeks and was then switched to oral posaconazole for one month with complete resolution.

Nannizziopsis is an emerging human pathogenic fungus that predominantly causes disease in immunocompromised individuals. This case highlights the importance of suspecting atypical fungal infection in immunocompromised individuals presenting with polymorphic skin lesions and the critical diagnostic role of skin biopsy and culture.

Humans ; Herpesvirus 3, Human ; Myelitis, Transverse/complications* ; Guillain-Barre Syndrome/complications* ; Herpes Zoster/complications* ; Varicella Zoster Virus Infection/complications*

Child ; Chronic Disease ; Epstein-Barr Virus Infections/complications* ; Familial Primary Pulmonary Hypertension/complications* ; Herpesvirus 4, Human ; Humans ; Persistent Infection ; Pulmonary Arterial Hypertension

BACKGROUND: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have found that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients. METHODS: A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN. RESULTS: Final best visual acuity (BCVA) improved significantly from 1.36 ± 0.95 (median 20/400) to 0.95 ± 0.82 (median 20/100) (t = 2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2 ± 5.2 years) and 12 of the 13 samples in the senior group (53.6 ± 4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1. CONCLUSIONS This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before determining the causative virus, especially in younger patients.
Adult ; Age Factors ; Female ; Herpesvirus 3, Human ; pathogenicity ; Humans ; Male ; Middle Aged ; Retinal Necrosis Syndrome, Acute ; etiology ; physiopathology ; virology ; Retrospective Studies ; Varicella Zoster Virus Infection ; complications ; Visual Acuity ; physiology

OBJECTIVE: Human bocavirus (HBoV) is a newly identified pathogen that can cause upper and lower respiratory infections usually in children; however, its clinical characteristics and significance in respiratory infections in adults have not been well known. Our objective was to evaluate the clinical features of respiratory HBoV infection and to describe the CT findings of HBoV pneumonia in adults. MATERIALS AND METHODS: A total of 185 adult patients diagnosed with HBoV infection at a tertiary referral center between January 2010 and December 2017 were retrospectively evaluated with respect to the clinical characteristics of HBoV infection and its risk factors for pneumonia. Chest CT findings for 34 patients with HBoV pneumonia without co-infection were analyzed and compared between immunocompetent (n = 18) and immunocompromised (n = 16) patients. RESULTS: HBoV infections were predominantly noted between February and June. Among the 185 patients with HBoV infection, 119 (64.3%) had community-acquired infections and 110 (59.5%) had pneumonia. In multivariable analysis, older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.04; p = 0.045) and nosocomial infection (OR, 2.07; 95% CI, 1.05–4.10; p = 0.037) were associated with HBoV pneumonia. The main CT findings were bilateral consolidation (70.6%) and/or ground-glass opacities (64.7%); centrilobular nodules (14.7%) were found less frequently. The pattern of CT findings were not significantly different between immunocompetent and immunocompromised patients (all, p > 0.05). CONCLUSION: HBoV infection can be a potential respiratory tract infection in adults. The most frequent CT findings of HBoV pneumonia were bilateral consolidation and/or ground-glass opacities.
Adult ; Child ; Coinfection ; Community-Acquired Infections ; Cross Infection ; Human bocavirus ; Humans ; Immunocompromised Host ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Tomography, X-Ray Computed

Background: One of the most common complications of episiotomy is infection. Most infections will resolve with local perineal care. Hence, episiotomy wound care is important. In preventing wound infection cleansing the vulva and external genital area with an antiseptic solution prior to, and several days after the procedure until the wound is healed is potentially beneficial. Objective: To compare the efficacy and patients? satisfaction of commercially prepared guava extract with povidone iodine as external genital antiseptic wash in women who underwent vaginal delivery and had episiorraphy in a Tertiary Hospital. Results: There were 248 women who underwent episiotomy and randomized to the guava leaf extract (n=122) and povidone-iodine (n=126) feminine wash groups. Episiotomy wound infection rate between guava (0.81%) and povidone iodine (2.38%) feminine wash, was not significantly different (p=0.33). Occurrence of adverse event was lower in the guava leaf extract (1, 0.81%) as compared to povidone iodine (4, 3.17%) feminine wash group, but is not statistically significant (p=0.19). The mean patient satisfaction score for the guava feminine wash is 4.4 which was significantly higher than the mean score of those in the povidone iodine feminine wash which is 3.6 (p< 0.001). Conclusion The efficacy in preventing episiotomy wound infection and rate of adverse reaction with the use of commercially prepared guava leaf extract is comparable with povidone iodine as an external genital antiseptic. With regards to patients? satisfaction and cost this was found to favor the use of commercially prepared guava leaf extract external genital wash
Human ; Female ; Episiotomy ; Wound Infection ; Guava Leaf Extract ; Povidone Iodine Feminine Wash ; Antiseptic External Genital Wash

Varicella-zoster virus (VZV) causes a highly contagious and generally benign, self-limited disease. However, in high-risk populations including immunocompromised patients, pregnant women, and neonates, VZV infection can be associated with significant morbidity and mortality. Healthcare-associated transmission of VZV occurs among healthcare workers (HCWs) and patients by airborne transmission or by direct contact with the index case. To minimize the risk of transmission in healthcare settings, all VZV-susceptible HCWs should be encouraged strongly to be immunized with the varicella vaccine. For post-exposure management, active immunization (varicella vaccine), passive immunization (varicella-zoster immune globulin) and/or antiviral agents, and isolation could be used in specific situations. To prevent the transmission of VZV infection in the hospital settings, the development and implementation of hospital policies for appropriate infection control is also warranted. This article reviews the general information and healthcare-associated transmission of VZV and summarizes the recommendations for the pre- and post-exposure management of HCWs and patients, in hospital settings.
Antiviral Agents ; Chickenpox Vaccine ; Delivery of Health Care* ; Female ; Herpesvirus 3, Human* ; Hospitals, Isolation ; Humans ; Immunization, Passive ; Immunocompromised Host ; Infant, Newborn ; Infection Control ; Mortality ; Occupational Exposure ; Pregnant Women ; Vaccination