Co-infection with Neisseria mucosa in a patient with tuberculous otitis media

Tuberculous otitis media(TOM) is a rare manifestation caused by Mycobacterium tuberculosis with low incidence rates among extrapulmonary tuberculosis cases. Diagnosis is often delayed because of the presence of several clinical manifestations and the high prevalence of secondary bacterial infections. Few reports have attributed secondary bacterial infections in patients with TOM to commensal Neisseria. Thus, understanding the pathogenic mechanisms and clinical features of commensal Neisseria is important, considering its recent presentation as an infection-causing pathogen. Neisseria mucosa is a commensal inhabitant in humans and is generally considered non-pathogenic but can cause infection in rare cases. Here, we report an atypical secondary infection caused by Neisseria mucosa in an 81-year-old woman with TOM being treated for pulmonary tuberculosis. Direct purulent otorrhea smear microscopy revealed no acid-fast bacilli using Ziehl-Neelsen staining, whereas the phagocytosis of gram-negative cocci by white blood cells was confirmed using Gram staining. Otorrhea culture revealed the growth of N. mucosa. Subsequently, M. tuberculosis infection in the otorrhea was identified using a culture-based method. Vigilance is critical for the early detection of TOM to prevent further complications. This report raises awareness regarding TOM and provides insight into the pathogenicity of N. mucosa in otitis media.

Identifying a competency improvement strategy for infection prevention and control professionals:A rapid systematic review and cluster analysis

Remarkable progress has been made in infection prevention and control(IPC)in many countries,but some gaps emerged in the context of the coronavirus disease 2019(COVID-19)pandemic.Core capabilities such as standard clinical precautions and tracing the source of infection were the focus of IPC in medical institutions during the pandemic.Therefore,the core competences of IPC professionals during the pandemic,and how these contributed to successful prevention and control of the epidemic,should be studied.To investigate,using a systematic review and cluster analysis,fundamental improvements in the competences of infection control and prevention professionals that may be emphasized in light of the COVID-19 pandemic.We searched the PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,and CBM databases for original articles exploring core competencies of IPC professionals during the COVID-19 pandemic(from January 1,2020 to February 7,2023).Weiciyun software was used for data extraction and the Donohue formula was followed to distinguish high-frequency technical terms.Cluster analysis was performed using the within-group linkage method and squared Euclidean distance as the metric to determine the priority competencies for development.We identified 46 studies with 29 high-frequency technical terms.The most common term was“infection prevention and control training”(184 times,17.3%),followed by“hand hygiene”(172 times,16.2%).“Infection prevention and control in clinical practice”was the most-reported core competency(367 times,34.5%),followed by“microbiology and surveillance”(292 times,27.5%).Cluster analysis showed two key areas of competence:Category 1(program management and leadership,patient safety and occupational health,education and microbiology and surveillance)and Category 2(IPC in clinical practice).During the COVID-19 pandemic,IPC program management and leadership,microbiology and surveillance,education,patient safety,and occupational health were the most important focus of development and should be given due consideration by IPC professionals.

Sclerosing angiomatoid nodular transformation of the spleen, a rare cause for splenectomy: Two case reports

BACKGROUND Sclerosing angiomatoid nodular transformation(SANT)is a rare benign disease of the spleen with unknown origin.Clinical symptoms are inhomogeneous,and suspicious splenic lesion often found incidentally,leading to splenectomy,as malignancy cannot securely be ruled out.Diagnosis is made histologically after resection.CASE SUMMARY Two cases of German,white,non-smoking,and non-drinking patients of normal weight are presented.The first one is a 26-year-old man without medical history who was exhibiting an undesired weight loss of 10 kg and recurring vomiting for about 18 mo.The second one is a 65-year-old woman with hypertension who had previously undergone gynecological surgery,suffering from a lasting feeling of abdominal fullness.Both showed radiologically an inhomogeneous splenic lesion leading to splenectomy approximately 6 and 9 wk after surgical presentation.Both diagnoses of SANT were made histologically.Follow-up went well,and both were treated according to the recommendation for asplenic patients.CONCLUSION SANT is a rare cause of splenectomy and an incidental histological finding.Further research should focus on clinical and radiological diagnosis of SANT as well as on treatment of patients with asymptomatic and small findings.

Eczema herpeticum vs dermatitis herpetiformis as a clue of dedicator of cytokinesis 8 deficiency diagnosis:A case report

BACKGROUND Dedicator of cytokinesis 8(DOCK 8) deficiency,also known as autosomal recessive hyper immunoglobulin E(IgE) syndrome,is a combined immunodeficiency disease that was first recognized in 2009.It is caused by genetic alterations(mutations or deletions) in the DOCK 8 gene and is characterized by multiple allergies,elevated IgE levels,and susceptibility to viral and bacterial infections.Early diagnosis is critical to optimize the success of stem cell transplantation.CASE SUMMARY This study reports the case of a pediatric patient with DOCK 8 deficiency who had negative genetic testing using multiplex primary immunodeficiency(PID) panel and whole-exome sequencing(WES) with a next-generation sequencing method.He presented with chronic diarrhea and was managed as celiac disease based on previous negative workup for immunodeficiency and duodenal biopsy.He developed a generalized vesicular rash which was thought to be dermatitis herpetiformis associated with celiac disease.However,it turned out to be Eczema herpeticum based on positive herpes simplex virus from blood and lesions.The diagnosis was re-evaluated after the child was found to have multiple viral,bacterial,and parasitic co-infections(herpes simplex virus,cytomegalovirus,Epstein-Barr virus,Salmonella,and cryptosporidiosis).Re-evaluation with target gene testing with copy number variation(CNV) analysis and Multiplex Ligation Probe Amplification(MLPA) showed a large homozygous deletion in the DOCK 8 gene,confirming the diagnosis of DOCK 8 deficiency.CONCLUSION Targeted gene testing with CNV analysis might detect deletions that can be missed by WES for diagnosing patients with PID.

Evaluation of adenosine triphosphate bioluminescence-based system in rooms occupied by patients with methicillin resistant Staphylococcus

Background:Adenosine triphosphate(ATP)-based monitoring systems can detect the amount of organic matter that remains on hospital surfaces after cleaning.We evaluated an ATP-based monitoring system in assessing con-tamination of high touched objects in rooms occupied by patients on methicillin resistant S.aureus precautions.Methods:We compared the ATP to standard aerobic cultures as well as to gloved hand culture to predict risk of healthcare-worker hand contamination.Results:More than a third of high touch object surfaces were measured unclean with ATP yet only reflects about 5%chance of contaminating healthcare-workers’hands.Conclusions:Our study emphasizes the shortcomings of using the ATP system even in pathogen specific environ-ment such as surfaces in methicillin resistant S.aureus rooms.