Herpes zoster ophthalmicus presenting with orbital myositis prior to the appearance of vesicular lesions: A case report and mini‑review of the literature

All orbital tissues, including extra-ocular muscles, can be affected by the varicella-zoster virus (VZV). However, only a minority of all individuals with herpes zoster infections present with herpes zoster ophthalmicus. The present study reports the case of a middle-aged male patient presenting with an acute intractable right-sided headache. His neurological examination yielded normal results. The analysis of cerebrospinal fluid by biochemistry and cultural analysis yielded normal results; however, the analysis of this fluid using polymerase chain reaction yielded a positive result for VZV. Thus, treatment with acyclovir was commenced. Brain magnetic resonance imaging revealed a bilateral intraorbital intraconal enhancement consistent with myositis. His symptoms evolved into a shock-like pain over the scalp associated with painful ocular movements. On the 2nd day of admission, he developed new vesicular lesions found on the right-side cranial nerve V1 dermatome. By the 6th day of admission, he was asymptomatic, and his physical examination revealed the resolution of the dermatologic manifestations of the VZV. The patient was stable for outpatient follow-up with ophthalmology and was discharged on an oral valacyclovir course for 7 days. To the authors' knowledge, there are four cases reported in the literature of herpes zoster ophthalmicus with orbital myositis prior to the appearance of vesicular lesions. Thus, it is suggested that VZV serology be investigated before a final diagnosis of idiopathic orbital myositis is made.

Unusual orbital mucormycosis due to pecking injury: clinical characteristics and outcomes of four immunocompetent pediatric patients

Mucormycosis is a serious fungal infection caused by fungi in the order of Mucorales. Orbital mucormycosis occurs more frequently in rhino-orbital, sino-orbital, and rhino-orbito-cerebral forms of the disease, while isolated orbital mucormycosis is much less common. Herein, we present four cases of immunocompetent children who developed primary cutaneous mucormycosis, which subsequently invaded and progressed to orbital mucormycosis following direct traumatic injury caused by pecking from Acridotheres tristis (Common Myna). Given the low prevalence of orbital mucormycosis in healthy children, an unknown source of infection and delayed diagnosis followed by late therapeutic interventions could result in life-threatening conditions and serious sequelae.

Diagnostic Dilemmas: A Review of Reported Cases of Human Herpesvirus 6 Encephalitis in Immunocompetent Adults

Human herpesvirus 6 (HHV-6) is associated with its presentation in the pediatric population as roseola infantum. Rarely, it is the causative agent of encephalitis, with most cases reported among the immunocompromised population due to reactivation. This review article analyzes the published records of cases labeled HHV-6 encephalitis in immunocompetent adults, aiming to understand the diagnostic methods behind each case and explore the complexities of such a diagnosis. We note significant variability in the methods used to come to a diagnosis of HHV-6 encephalitis, as well as inconsistent approaches to treatment of this condition. Given the rarity of HHV-6 encephalitis in immunocompetent adults, there are no clearly structured diagnostic guidelines for this condition in this patient population. We highlight several diagnostic methods that provide more convincing evidence of true HHV-6 encephalitis and may provide a basis for further development of guidelines for the diagnosis and treatment of this condition.

Sinonasal Plasmablastic Lymphoma Arising in the Setting of Recurrent Nasal Polyposis in an Immunocompetent Individual

Plasmablastic lymphoma (PBL) is an aggressive, rare variant of B-cell lymphoma typically associated with human immunodeficiency virus and other immunocompromised populations. Most commonly found in the oral cavity, PBL can occasionally originate in the sinonasal tract. Diagnosis of PBL is difficult due to overlapping features with other malignancies; however, early detection and treatment are imperative given its aggressive clinical course. When in the sinonasal tract, the diagnostic process can be further complicated if the patient has a history of recurrent nasal polyposis. Described is the case of a 57-year-old immunocompetent male who initially presented with benign nasal polyposis, only to return a year after sinus surgery with a unilateral sinonasal mass consistent with PBL. As literature has yet to characterize this phenomenon, this article presents the first case reported of sinonasal PBL arising in the setting of recurrent nasal polyposis. This case emphasizes the importance of investigating sinonasal masses showing laterality, maintaining a high index of suspicion for malignancy, and keeping close surveillance of the patient after treatment of PBL.

An unusual case of crusted scabies in an immunocompetent adult: A case report

Key Clinical Message

Although rare, crusted scabies can affect immunocompetent individuals with no identifiable risk factors. A high index of suspicion, regardless of an individual's immunological status or absence of traditional risk factors, should be maintained by health professionals to facilitate prompt referral to a dermatologist.

Abstract

Crusted scabies is an uncommon variant of human scabies characterized by extensive crusted and scaly hyperkeratotic papules, and plaques resulting from profound proliferation of mites in the skin. It is highly contagious and typically occurs in immunocompromised individuals. Reports of cases in healthy adults are rare. It is often resistant to routine treatment. We report a case of a 30-year-old immunocompetent male who presented to us with an extensive pruritic papular rash that started in the inter-digital web spaces of his hands. Within 3 months from onset, the lesions progressed, and became hyperkeratotic, scaly, non-pruritic, spreading to involve his entire body (sparing his face only). Crusty scabies was eventually diagnosed and treated by a dermatologist after months of misdiagnosis at peripheral facilities. Although rare, crusted scabies can affect immunocompetent individuals. A high index of suspicion is required, regardless of immunological status. Among immunocompetent individuals, a thorough search for traditional risk factors is imperative.

Do Repeated Respiratory Tract Infections Predispose to Amoebic Meningoencephalitis Caused by Free-Living Amoebae?

Recent reports of fatal meningoencephalitis from Kerala, South India, are creating ripples among medical and health administrations. Free-living amoebae (FLA) have been attributed to these infections. Despite their free-living nature, these amoebae have been recognized as potential opportunistic organisms that occasionally cause infections in immunocompetent and immunocompromised individuals. The pathophysiology, epidemiology, and clinical course of diseases caused by FLA are not completely understood. Exposure to humans and animals is imminent given their presence in the air, water, and soil. Human infections, although infrequent, can lead to severe morbidity and mortality as evidenced by the recently emerging reports from Kerala, South India. Since these infections were noticed among children, it is unlikely that they were immunocompromised. Therefore, in this editorial, we speculate on the possibility of frequent upper respiratory tract viral infections as predisposing factors for infection with FLA.

Exposing the Masquerade of Nocardia otitidiscaviarum Pneumonia: A Case Report

We present a rare case of an immunocompetent 49-year-old male agriculturalist from India diagnosed with Nocardia otitidiscaviarum pneumonia. Nocardia species are ubiquitous gram-positive, partially acid-fast bacilli that predominantly infect immunocompromised individuals. Only 0.3% to 2.9% of all nocardiosis cases are attributed to N. otitidiscaviarum. The patient presented with a 25-day history of wet cough and high-grade fever, with bilateral bronchial breath sounds on chest auscultation and findings consistent with pneumonia on chest X-ray. During hospitalization, multiple treatment revisions were made. On admission, empiric antibiotic therapy against community-acquired pneumonia was initiated. Later, GeneXpert sputum testing for Mycobacterium tuberculosis complex (MTBC) was positive for MTBC DNA. Suspected tuberculosis with a secondary infection prompted a treatment switch to antitubercular therapy (ATT) along with meropenem. Despite changes to treatment, the patient continued to deteriorate with no signs of clinical improvement. ATT with meropenem was discontinued when a repeat GeneXpert for MTBC was negative, ruling out tuberculosis. Slow-growing bronchial wash culture identified the rare pathogen N. otitidiscaviarum, prompting an urgent referral to a specialized Infectious Diseases team. Treatment was then tailored according to antibiotic resistance-sensitivity testing. Targeted multidrug antibiotic therapy with trimethoprim-sulfamethoxazole and amikacin against N. otitidiscaviarum facilitated gradual clinical improvement. This case underscores the importance of considering uncommon pathogens in differential diagnosis and highlights the critical role of microbiological diagnostics in guiding effective treatment. Drug resistance and changing bacterial pathogenicity trends must not be overlooked. The round-about antibiotic treatment changes in this case point to the necessity for faster diagnostic methods in identifying Nocardia species. Further research into rapid diagnostic methods and up-to-date treatment guidelines are warranted to optimize outcomes in nocardiosis management.

Clinical and radiological features of a cluster of immunocompetent adolescents with varicella pneumonia: a descriptive study

Background

Varicella pneumonia is one of the most common and severe complications of chickenpox infection. This study aimed to describe the clinical and radiological features of varicella pneumonia in a cluster of immunocompetent adolescents.

Methods

A retrospective analysis was conducted on a cohort of adolescent patients diagnosed with varicella pneumonia at Wuhan Jinyintan Hospital between February 2023 and May 2023. The clinical and imaging data were collected and analyzed. A total of 116 patients were divided into two groups by the absence (group 1, n=57) or presence (group 2, n=59) of lower respiratory symptoms for data comparison.

Results

Among 116 patients (median age, 16 years; 60 males), rash (100%) was the most prevalent clinical symptom. The most common respiratory symptom and sign were fever (42.2%) and coarse breath sounds (41.4%). Chest computed tomography (CT) performed within five days of symptoms onset revealed multiple (89.7%), peripheral (51.7%), and ill-defined (73.3%) lung nodules in most patients, which gradually improved 6-10 days after symptom onset. Group 2 had higher levels of interleukin-6 (P<0.001), C-reactive protein (P=0.02), serum amyloid-A protein (P=0.002), longer hospital stays (P=0.04), more involved lung lobes (P=0.02), and a higher incidence of multiple nodules (P=0.043) than those of group 1.

Conclusions

In immunocompetent adolescents, clustered varicella pneumonia often presents as mild and more uniform in clinical and radiological presentations than sporadic cases. The most common CT findings were multiple pulmonary nodules. Patients with lower respiratory symptoms exhibited more severe clinical and radiological manifestations. Generally, it is not recommended that patients undergo frequent CT scans in a short period.

Clinical characteristics of pediatric patients hospitalized with community-acquired pneumonia and cytomegalovirus DNA detected in bronchoalveolar lavage fluid

Background

This study aimed to investigate the clinical characteristics of pediatric patients hospitalized with community-acquired pneumonia (CAP) and concomitant cytomegalovirus (CMV) infection.

Methods

This cross-sectional study enrolled consecutive pediatric patients admitted with CAP who tested positive for CMV DNA in bronchoalveolar lavage fluid (BALF). Flexible fiberoptic bronchoscopy was performed when routine treatment for CAP proved ineffective. The study participants were further stratified into two groups based on CMV serological test results: recent CMV infection group and CMV replication group. Clinical characteristics were compared between these two groups.

Results

Among 124 patients aged 1-11 months included in this study, 80 (64.5%) patients were categorized as having recent CMV infection, and 44 (35.5%) tested positive for CMV replication. Co-infection with other pathogens was detected more frequently in the CMV replication group (n = 29, 65.9%) than in the recent CMV infection group (n = 35, 43.7%; P = 0.018). Patients with recent CMV infection were younger and exhibited higher levels of alanine transaminase (ALT) and aspartate aminotransferase compared to those with CMV replication (all P < 0.05). Multivariable regression analysis showed age was independently associated with recent CMV infection (odds ratio [OR], 0.707; 95% confidence interval [CI], 0.586-0.853; P < 0.001). Notably, receiver operating characteristic curve analysis showed that a CMV PCR level of 3,840 copies/ml in blood samples had a sensitivity of 34.7% and specificity of 90.0% for diagnosis of recent CMV infection with an area under the curve (AUC) of 0.625 (95% CI: 0.513-0.736, P = 0.048). A CMV PCR level of 6,375 copies/ml in urine samples had a sensitivity of 77.1% and specificity of 61.5% for diagnosis of recent CMV infection with an AUC of 0.695 (95% CI: 0.531-0.858, P = 0.04). Furthermore, multivariate linear regression analysis revealed that the blood CMV DNA copy number was associated with ALT (B = 0.001; P < 0.001).

Conclusions

The CMV DNA copy numbers in blood and urine could serve as discriminatory markers between recent CMV infection and CMV replication. Measuring CMV DNA levels in blood may be an effective method for monitoring liver function impairment in pediatric patients presenting with CAP and concurrent CMV infection.

Atypical cutaneous manifestations of methicillin resistant Staphylococcus aureus infections in two immunocompetent pediatric patients: Case reports and review of the literature

Although many clinical variants of Staphylococcus aureus infection are well-recognized, atypical presentations may mimic other conditions. We describe two cases of atypical S. aureus infections in pediatric patients: a S. aureus infection presenting with a vesicopustular rash mimicking varicella zoster virus and a case of multifocal panniculitis. Both of these cases were specifically caused by methicillin-resistant S. aureus (MRSA). Additional cases of atypical S. aureus infections and presenting features from the current literature are also discussed.

Histoplasmosis in non-immunosuppressed patients from an endemic area in Northeastern Brazil

Differently from immunocompromised patients, very little information is available in the literature regarding the clinical presentation, epidemiology, and outcomes of histoplasmosis in non-immunosuppressed individuals living in endemic areas. This retrospective case series study was carried out by reviewing the medical records of non-immunocompromised patients with histoplasmosis, residents in a hyperendemic area in northeastern Brazil, between 2011 and 2022. Thirty HIV-negative patients were identified with histoplasmosis, and 19 cases met the inclusion criteria: three had acute, five subacute and one chronic pulmonary forms; two with mediastinal picture and eight had disseminated disease (two with severe symptoms). The median age of our sample was 32.7 years old [interquartile range: 24-45]. Most of the patients were male (male-to-female ratio = 15:4) and resided in the state capital (n = 9). The majority had a previous history of exposure to well-known risk factors for Histoplasma infection. Pulmonary nodules were observed in all subacute form, two patients (acute and subacute forms) were initially treated empirically for pulmonary tuberculosis; one death was registered in the subacute form. The chronic pulmonary form of histoplasmosis was diagnosed in one patient only after the symptoms persisted despite specific treatment. The primary clinical manifestations of the moderate form of DH were enlarged lymph nodes, with histopathology being the main diagnostic method. The cases were detected as isolated occurrences and not as an outbreak, suggesting that exposure to Histoplasma can be more widespread than presumed. Despite the self-limiting nature of the disease, death can occur even in previously heathy patients.

Disseminated Nocardia cyriacigeorgica Infection Disguised as a Metastatic Adrenal Gland Malignancy in a Healthy Patient

Nocardia, typically recognized as an uncommon opportunistic pathogen affecting immunocompromised individuals, has also been documented in various case reports involving infections in immunocompetent hosts. Transmission occurs through inhalation or inoculation into compromised skin. Subsequently, it can lead to disseminated infection via hematogenous spread, affecting nearly any organ with a particular affinity for the central nervous system. Dissemination to the adrenal glands is extremely rare, with only a few cases reported. In this report, we present a rare case of disseminated Nocardia cyriacigeorgica, initially resembling a metastatic adrenal gland malignancy in an otherwise healthy individual. The patient presented with non-specific symptoms, had multiple sets of negative blood cultures, clinical findings suggestive of an underlying adrenal gland malignancy, and lacked identifiable risk factors for Nocardia, creating a significant diagnostic challenge. Additionally, we review the existing literature on nocardiosis involving the adrenal glands. This case marks the third reported instance of a Nocardia cyriacigeorgica adrenal gland abscess in the literature.

Stenotrophomonas maltophilia-associated odontogenic cerebral abscess in an immunocompetent patient: A case report

Key Clinical Message

Stenotrophomonas maltophilia can cause rare odontogenic brain abscesses in immunocompetent patients, highlighting the importance of considering uncommon pathogens in central nervous system infections. With only three reported cases of cerebral abscesses and one pituitary abscess caused by this microorganism, tailored diagnostic methods and individualized treatment regimens are crucial for accurate management.

Abstract

Brain abscesses present diagnostic and therapeutic challenges, with Stenotrophomonas maltophilia infections being exceptionally rare in the central nervous system. We present a case of odontogenic brain abscesses caused by S. maltophilia in an immunocompetent patient, highlighting the rarity and complexity of such infections. A 66-year-old male presented with spatial-temporal disorientation and left-sided weakness. Radiological investigations revealed an expansive lesion in the right posterior frontal region. A craniotomy and drainage were performed, identifying S. maltophilia in the purulent material. The patient responded well to tailored antibiotic therapy. S. maltophilia-related central nervous system infections are infrequent, emphasizing the need for a heightened clinical suspicion in atypical cases. This case contributes to the literature, emphasizing the importance of a multidisciplinary approach for successful diagnosis and management.

A Case of Co-infection Due to Shigella flexneri Colitis Resulting in Bacillus Septic Shock in an Immunocompetent Patient

Shigella flexneri (S. flexneri) is a facultatively anaerobic gram-negative bacterium that is a member of Enterobacteriaceae. The bacterium has been known to cause mild symptoms, such as diarrhea, to more severe diseases such as hemorrhagic colitis. Fortunately, such instances of severe diseases are rare. Nevertheless, even though S. flexneri is a more benign bacterium of the Shigella genus when compared to Shigella dysenteriae, this doesn't mean that it should be neglected. In fact, the ability of this microorganism to cause inflammation of the colon or colitis and disrupt tissue architecture can allow other organisms that would otherwise be benign to cause severe complications, hence allowing said organisms to be opportunistic. Here, we would like to present a case of S. flexneri colitis resulting in bacillus bacteremia and eventually causing an inappropriate physiological host response leading to hypotension, systematic organ failure, etc., also known as septic shock. The pathogenesis and treatment of this patient will also be discussed.

Mucormycosis in an Immunocompetent Patient Recovering From Dengue Fever

Mucormycosis is a rare yet aggressive fungal infection. Despite its rarity, India has experienced a surge in cases during the post-COVID-19 era. The high mortality rate associated with this infection necessitates early diagnosis, intervention, and aggressive treatment. Typically, it is observed in immunocompromised patients, where the disease progresses rapidly and leads to unfavorable outcomes. However, occurrences in previously healthy individuals are not uncommon. Dengue has been occasionally associated with mucormycosis in the post-recovery phase. This case report highlights the importance of heightened clinical suspicion and early intervention in patients with recent dengue infections and chronic sinus conditions. It explores potential risk factors, such as dengue-related immune alterations, environmental exposures, and anatomical alterations that may contribute to the development of mucormycosis in otherwise healthy individuals.

Unveiling the Enigma: John Cunningham Virus-Associated Progressive Multifocal Leukoencephalopathy in an Immunocompetent Individual

Progressive multifocal leukoencephalopathy (PML) is considered an often fatal, demon-leading disease primarily associated with immunosuppression. Immunocompromised individuals predominantly exhibit this manifestation, while immunocompatible patients rarely encounter it. We present a unique case of PML in an immunocompetent individual who initially presented with stroke-like symptoms, received management, and was subsequently discharged. He returned to our hospital a few days later with similar complaints, prompting further investigations that revealed PML, a condition often overlooked, especially in individuals with an intact immune system. Although he received successful treatment with mefloquine and other anti-malarial medications and followed up on an outpatient basis, his subsequent outcome was unfavourable. As a result, this case emphasises the importance of having PML as a significant differential and therapeutic option.

Modeling human gastric cancers in immunocompetent mice

Gastric cancer (GC) is a major cause of cancer-related mortality worldwide. GC is determined by multiple (epi)genetic and environmental factors; can occur at distinct anatomic positions of the stomach; and displays high heterogeneity, with different cellular origins and diverse histological and molecular features. This heterogeneity has hindered efforts to fully understand the pathology of GC and develop efficient therapeutics. In the past decade, great progress has been made in the study of GC, particularly in molecular subtyping, investigation of the immune microenvironment, and defining the evolutionary path and dynamics. Preclinical mouse models, particularly immunocompetent models that mimic the cellular and molecular features of human GC, in combination with organoid culture and clinical studies, have provided powerful tools for elucidating the molecular and cellular mechanisms underlying GC pathology and immune evasion, and the development of novel therapeutic strategies. Herein, we first briefly introduce current progress and challenges in GC study and subsequently summarize immunocompetent GC mouse models, emphasizing the potential application of genetically engineered mouse models in antitumor immunity and immunotherapy studies.

First report of Nocardia wallacei infection in an immunocompetent patient in Zhejiang province

Nocardiosis is an infectious disease caused by Nocardia spp., mainly affecting immunocompromised hosts. Nocardia infection is not common; especially Nocardia wallacei infection is even rarer. The patient, female, 61 years old, farmer, has been working in the field for a long time and has normal immune function. Her main clinical manifestation was persistent back pain. Chest-enhanced computed tomography showed pulmonary inflammation. Rare pathogen Nocardia wallacei was detected in alveolar lavage fluid using matrix-assisted laser destructive ionization time-of-flight mass spectrometry. She received treatment with linezolid and was discharged after her condition improved.

Unravelling lung adenocarcinoma in an immunocompetent patient with endobronchial aspergilloma: A case report

Inhalation of Aspergillus spp. can cause a wide spectrum of lung diseases. Endobronchial aspergilloma is an uncommon clinical entity that occurs because of Aspergillus spp. overgrowth in the airway lumen. We present a 73-year-old gentleman with a rare dual pathology of endobronchial aspergilloma and endobronchial adenocarcinoma. He initially presented with prolonged cough, dyspnoea, and haemoptysis. Bronchoscopy revealed an obstructed right main bronchus by a necrotic mass whereby histological examination showed evidence of Aspergillus spp. infection. The lesion however persisted despite treatment with anti-fungal agents. Repeated bronchoscopy and biopsy eventually unravelled an underlying endobronchial adenocarcinoma. He received chemotherapy but ultimately passed away 3 months later.

Epstein Barr Virus-Related Acute Liver Failure and Hemophagocytosis in an Immunocompetent Individual: An Autopsy Report

Epstein-Barr virus (EBV) is a nonhepatotropic virus. It causes mild self-limiting illness characterized by fever, oral ulcer, diarrhea, lymphadenopathy, and hepatosplenomegaly. Rarely it causes acute liver failure (ALF). EBV-related ALF (EBV-ALF) accounts for 0.2% of all ALF cases. The prognosis of EBV-ALF is dismal, and it can affect both immunocompromised and immunocompetent individuals. We performed a partial autopsy on a 30-year-old immunocompetent individual with infectious mononucleosis and ALF. The autopsy showed characteristic histomorphology of EBV-ALF in the form of centrizonal confluent hepatocytic necrosis, portal mixed inflammatory infiltrate, sinusoidal lymphocytosis, numerous hemophagocytic figures, and tissue Epstein-Barr encoded RNA-in situ hybridization (EBER-ISH) positivity. Extensive hemophagocytosis was noted in the liver, spleen, lymph node, and bone marrow. Other features include T-zone expansion of lymph nodes and spleen, interstitial pneumonia pattern in the lungs, and exanthematous skin changes. EBV-DNA polymerase chain reaction from the postmortem blood sample yielded 70,200 copies/µL. The index case highlights the uncommon occurrence of EBV-ALF, its histomorphological features, and its putative pathogenesis.

Disseminated Histoplasmosis Causing Temporally and Spatially Discrete Gastrointestinal Perforations in an HIV-Negative Patient

Histoplasma capsulatum is a dimorphic fungi endemic to the Ohio and Mississippi River valleys. Immunocompetent persons who become infected are generally asymptomatic or present with mild symptoms. Symptomatic disease is seen primarily in immunocompromised patients with pulmonary manifestations being the most common presentation. We present a case of a young HIV-negative male who required 4 exploratory laparotomies over the course of 4 months during 2 hospitalizations due to discrete perforations of the ileum and jejunum caused by biopsy-proven gastrointestinal histoplasmosis despite maximal medical therapy as well as a gastric perforation.

[Primary hepatic tuberculosis in an immunocompetent patient: a case report]

Tuberculosis (TB) is a common infectious disease that most often affects the lungs, but it can also affect any other organ with a wide range of clinical manifestations. There are three forms of hepatic involvement: diffuse hepatic tuberculosis combined with pulmonary tuberculosis; diffuse hepatic tuberculosis without pulmonary involvement; and nodular or focal/local hepatic tuberculosis, which is a very rare form and presents a diagnostic challenge. We here report the case of a young Moroccan man presenting with biliary colic that had been evolving for a month, associated with a forme fruste of tuberculous impregnation. CT scan and magnetic resonance imaging (MRI) of the liver showed nodular hepatic lesions. The diagnosis of focal hepatic tuberculosis was confirmed based on anatomopathological examination of biopsies obtained during laparoscopy. The patient received antitubercular treatment with good clinical-biological outcome.

Host immunity involvement in the outcome of phage therapy against hypervirulent Klebsiella pneumoniae infections

Highly encapsulated hypervirulent Klebsiella pneumoniae (hvKp) causes severe infections. Bacteriophage therapy, an antibiotic alternative, effectively treats bacterial infections. Phage φFK1979 encoding polysaccharide depolymerases can target and disarm the capsule of hvKp FK1979, showing promise against FK1979 infection. Resistant strains induced by φFK1979 are possibly eliminated by host immunity and new phage phiR3 targeting them. We constructed varied immunocompromised FK1979 infection mouse models to assess the therapy efficacy of φFK1979 alone or in combination with phiR3. Survival rates, bacterial loads, histopathology, inflammation, and immune cell distribution of mice were studied. Prompt and adequate administration of φFK1979, rather than phiR3, significantly improved survival rates in mice with different immune statuses. However, immunocompromised mice showed lower efficacy due to reduced tolerance to low-virulence φFK1979-resistant bacteria compared to immunocompetent mice. Adding phiR3 sequentially greatly enhanced therapy efficacy for them, leading to increased survival rates and notable improvements in pathology and inflammation. Immunocompetent mice exhibited the most favorable response to φFK1979 monotherapy, as their immune system cleared φFK1979-resistant bacteria while avoiding a robust response to phiR3 combating φFK1979-resistant bacteria. This study revealed host immunity involvement in the outcome of phage therapy against infections and introduced, for the first time, personalized phage therapy strategies for hvKp-infected mice with varying immune statuses.IMPORTANCEHypervirulent Klebsiella pneumoniae (hvKp), with high capsular polysaccharide production, can cause severe invasive infections. Capsule-targeting phage poses the potential to fight against hvKp. We previously elucidated that the capsule-targeting phage induces resistance in hvKp, while phage-resistant strains exhibit sensitivity to host innate immunity and new phages targeting them. This indicated that phage-resistant strains can be eliminated by the immune system in immunocompetent patients, whereas they may require treatment with phages targeting resistant bacteria in immunocompromised patients. HvKp can infect individuals with varying immune statuses, including both immunocompetent and immunocompromised/deficient patients. This study, for the first time, developed personalized phage therapy strategies for hvKp-infected mice with different immune statuses, optimizing phage therapy against hvKp infections. This research is expected to provide a theoretical foundation and novel insights for clinical phage therapy against hvKp infections, offering significant societal benefits and clinical value.

A Case of Vaping-Associated Candida and Herpes Simplex Virus (HSV) Co-infection Causing Esophagitis in an Immunocompetent Patient

Electronic cigarettes (e-cigarettes) and vaping have gained popularity in the last two to five years as an alternative way of consuming nicotine, as well as tetrahydrocannabinol (THC), particularly in the younger population. Vaping/e-cigarettes heat nicotine/THC and other chemical components to create the vapor to be inhaled, which increases the risk of mucosal infection and esophagitis. Although tobacco smoking has been extensively studied and known to affect the oral cavity and esophagus, the effect of vaping is yet to be well-studied. We report a case of odynophagia secondary to esophageal candidiasis, herpes simplex virus (HSV) esophagitis, and reflux esophagitis associated with vaping.

Disseminated Cutaneous Histoplasmosis and Its Recurrence in an Apparently Immunocompetent Patient

Histoplasmosis is a fungal infection caused by the fungus Histoplasma capsulatum. It can manifest in various ways, ranging from pulmonary to disseminated presentations. Most of the disseminated cases are seen in immunocompromised patients; here, we present an unusual case of an 81-year-old Mexican male with a history of cave exposure in his childhood, with 75 years of incubation period of the disease, who developed disseminated cutaneous histoplasmosis with no evident immunocompromising conditions. We considered the hypotheses of transient immunosuppression, CD4+ T lymphocytopenia, and immune senescence as the cause of this manifestation. The present case is also notable for its recurrence following therapy. This report underscores the challenges in diagnosing histoplasmosis in immunocompetent individuals and highlights the importance of long-term treatment and follow-up.