A Sixty-Nine-Year-Old Female With Serratia marcescens Infection

Serratia marcescens is a bacterial pathogen that tends to cause opportunistic infections, mainly in immune-compromised patients. In this case, we present a 69-year-old female who presented to the emergency department (ED) at Mount Sinai Hospital in Chicago on February 11th, 2022, after a mechanical fall. She had a medical history of metastatic lung cancer treated with chemotherapy, hypertension, pulmonary embolism, polysubstance abuse, and chronic obstructive pulmonary disease (COPD). The patient was found to be positive for systemic inflammatory response syndrome (SIRS). The patient was then started on broad-spectrum antibiotics, including vancomycin and cefepime. Blood cultures were ordered and came back positive for Serratia marcescens. This patient had multiple factors for immune suppression, including metastatic lung cancer, chemotherapy, and polysubstance abuse. The infectious disease department was consulted for the blood culture results, and ceftriaxone was recommended. Later on, levofloxacin was recommended. Blood cultures were negative two days after being positive. Afterward, the patient was kept for monitoring until discharge. Serratia marcescens is found in several reservoirs in nature. Therefore, preventing contact with this pathogen in immune-compromised patients can be difficult. It is important to have a degree of clinical suspicion for opportunistic pathogens like Serratia marcescens whenever a patient with factors for immune compromise presents for any condition.

A Pattern-Based Approach to Hepatic Infections

The evaluation of liver biopsies for infection can be a challenging and frustrating situation for diagnostic pathologists as well as clinicians. Patients often present with nonspecific symptoms, such as fever and elevated transaminases, leading to a broad differential diagnosis that typically includes malignancy and noninfectious inflammatory diseases in addition to infections. A pattern-based histologic approach can be extremely helpful in both making a diagnosis and guiding the next steps for the evaluation of the pathology specimen as well as the patient. This review discusses several of the more commonly encountered histologic patterns associated with hepatic infectious diseases, the most common pathogens with which they are associated, and helpful ancillary studies.

ATS Core Curriculum 2021. Pediatric Pulmonary Medicine: Pulmonary Infections

The following is a concise review of the Pediatric Pulmonary Medicine Core reviewing pediatric pulmonary infections, diagnostic assays, and imaging techniques presented at the 2021 American Thoracic Society Core Curriculum. Molecular methods have revolutionized microbiology. We highlight the need to collect appropriate samples for detection of specific pathogens or for panels and understand the limitations of the assays. Considerable progress has been made in imaging modalities for detecting pediatric pulmonary infections. Specifically, lung ultrasound and lung magnetic resonance imaging are promising radiation-free diagnostic tools, with results comparable with their radiation-exposing counterparts, for the evaluation and management of pulmonary infections. Clinicians caring for children with pulmonary disease should ensure that patients at risk for nontuberculous mycobacteria disease are identified and receive appropriate nontuberculous mycobacteria screening, monitoring, and treatment. Children with coronavirus disease (COVID-19) typically present with mild symptoms, but some may develop severe disease. Treatment is mainly supportive care, and most patients make a full recovery. Anticipatory guidance and appropriate counseling from pediatricians on social distancing and diagnostic testing remain vital to curbing the pandemic. The pediatric immunocompromised patient is at risk for invasive and opportunistic pulmonary infections. Prompt recognition of predisposing risk factors, combined with knowledge of clinical characteristics of microbial pathogens, can assist in the diagnosis and treatment of specific bacterial, viral, or fungal diseases.

Primary diffuse large B-cell lymphoma of the CNS: a rare case of spontaneous remission

There is no consensus on the optimal therapy for primary CNS lymphoma. Conventional treatment modalities include chemotherapy and radiation therapy, which carry significant risks of morbidity and mortality. In systemic lymphomas, there are situations where non-Hodgkin lymphomas have resolved spontaneously. We now report the case of a nonimmunocompromised patient with primary CNS lymphoma who underwent a spontaneous remission with a durable response. This case suggests that not all patients with primary CNS lymphomas require aggressive treatment with chemotherapy and radiation therapy.

Septic peritonitis in a dog caused by Anaerobiospirillum succiniproducens

This is the first reported case of septic peritonitis caused by Anaerobiospirillum succiniproducens in a dog. The infection was associated with marked exfoliation of reactive mesothelial cells into the abdominal fluid mimicking neoplasia. The source of the infection was not determined but was presumed to be of gastrointestinal origin as A succiniproducens is part of the normal gastrointestinal flora of dogs. Anaerobiospirillum spp. have been previously reported as causing diarrhea and bacteremia in people, particularly if immunocompromised; however, there were no indicators for a compromised immune system in this dog.

Histologic and systemic prognosticators for local control and survival in margin-negative transoral laser microsurgery treated oral cavity squamous cell carcinoma

BACKGROUND

Appreciable local recurrence rates observed in patients with margin-negative, transoral laser microsurgery (TLM)-treated oral cavity squamous cell carcinoma (SCC) necessitate identification of new prognosticators for local control and survival. A histopathologic index (Brandwein-Gensler score [BGS]) and intrinsic/iatrogenic/chronic conditions causing immune compromise are investigated.

METHODS

From a prospectively assembled database of TLM-treated oral cavity SCC, specimens for 60 patients with a minimum of 2-years follow-up could undergo BGS assignment. Local control, disease-specific survival (DSS), and overall survival (OS) were study endpoints.

RESULTS

"Low-BGS" was recorded in 28 patients (47%) and "high-BGS" in 32 patients (53%), whereas immune compromise was observed in 18%. In multivariate analyses, immune compromise was the only predictor for local control. T classification and immune compromise were prognostic for DSS and OS. "High-BGS" was prognostic only for OS.

CONCLUSION

"High-BGS" was associated with recurrences but immune compromise was the most significant predictor of local control and survival in margin-negative, TLM-treated oral cavity SCC. Strategies that maintain/restore tumor-specific immune responses in immune compromised oral cavity SCC hosts need to be developed.