Burn injuries are a major cause of morbidity and mortality, largely due to complications such as infection. Impairment of the immune system following burns increases susceptibility to both internal and external infections, underscoring the need for effective infection control strategies in burn care. In addition, burn patients frequently exhibit profound alterations in drug pharmacokinetics and pharmacodynamics (PK/PD), particularly during the resuscitation and hypermetabolic phases. In the resuscitation phase, increased capillary permeability and reduced cardiac output can prolong drug distribution, delay therapeutic response, lower peak plasma concentrations, and slow elimination. In contrast, the hypermetabolic phase is characterized by elevated catecholamine levels and enhanced tissue perfusion, which accelerate drug distribution and clearance. These physiological changes often necessitate antimicrobial dose adjustments to maintain therapeutic efficacy. This review emphasizes the critical importance of infection prevention and management in burn patients, with a focus on optimizing antimicrobial dosing and therapeutic monitoring in the context of PK/PD alterations.

A paradoxical reaction (PR) during the treatment of tuberculosis was defined as the worsening of preexisting disease either clinically or radiologically or the appearance of a new tuberculous lesion. These reactions are frequently observed in patients coinfected with human immunodeficiency virus (HIV) upon the initiation of antiretroviral therapy (ART). Herein, we present a unique case of a paradoxical reaction in a previously healthy 19-year-old female who started anti-tuberculosis treatment for disseminated tuberculosis. Four weeks after treatment initiation, she developed two new swollen masses in her left dorsum of the hand, accompanied by fever and new right submandibular painful lymphadenopathy, with worsening of the preexisting left lower neck lymph node. The patient underwent needle aspiration from her new skin abscess on the dorsum of her left hand, which revealed positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Anti-tuberculosis treatment was continued, and the patient fully recovered. We described an unusual presentation of paradoxical reaction manifested by a skin abscess at a site distant from her primary disease in an immunocompetent TB patient, which demonstrated the importance of considering paradoxical reactions in HIV-negative patients who present with worsening signs and symptoms after initial improvement following treatment initiation.

Despite advances in medical mycology, invasive Trichosporon spp. infections continue to be associated with high mortality rates. Limited data exist on the risk factors and outcomes of Trichosporon fungemia, particularly in our region. Therefore, this study aims to describe the risk factors, patient characteristics, antifungal susceptibility, and outcome of Trichosporon bloodstream infections at a tertiary care hospital in Saudi Arabia. This was a single-center retrospective chart review that included adult patients ≥ 16 years with positive blood cultures for Trichosporon spp. from January 2016 to December 2022. Descriptive statistics are presented using the mean for continuous variables and the number (percentage) for categorical variables. Ten patients with Trichosporon spp. isolated from blood cultures were eligible for inclusion in this study. The mean age was 58.1 years (range 17–83), with 70% male patients. Additionally, 40% had diabetes mellitus, and 40% had underlying malignancy. Trichosporon asahii was the predominant species in 90% of isolates. All patients had recent broad-spectrum antibiotic use, 80% were exposed to corticosteroids, and all had central venous catheters. One kidney transplant had an early recurrence of Trichosporon spp. fungemia. Four patients were cured of the infection, two were treated with voriconazole monotherapy, and two were treated with a combination of liposomal amphotericin B plus Voriconazole. Thirty-day all-cause mortality was 60%, with three deaths occurring before identification of the isolates. In conclusion, our study reported a predominance of Trichosporon asahii and a mortality rate of 60% in patients with Trichosporon fungemia. Challenges include delayed diagnosis, high mortality, and antifungal resistance, underscoring the need for further research to enhance treatment strategies and patient outcomes.

The Hajj is an annual mass gathering of people in Makkah, Saudi Arabia. Respiratory infections are common due to their potential for rapid spread in crowded settings. There is a lack of data regarding the effectiveness of face masks in preventing respiratory tract infections (RTIs), specifically during Hajj. We systematically searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials until July 3, 2023 for studies comparing the incidence or prevalence of RTIs in those who used any face mask during Hajj compared with no mask. Risk ratio (RRs) and 95% CIs were calculated using either a fixed or random-effect model, depending on the heterogeneity. A comprehensive analysis encompassed 10 studies involving 5007 participants. The overall RR favored wearing masks over not wearing masks regarding the incidence of RTIs; however, the difference was not statistically significant (RR = 0.78; 95% CI = 0.55–1.10; P = 0.16). A significantly lower incidence of RTIs was found in those wearing masks most of the time versus intermittently (RR = 0.59; 95% CI = [0.38–0.94; P = 0.02). In subgroup analyses, there was no difference between wearing masks and not wearing masks across different study designs (cohort/case-control), different groups (pilgrims/healthcare workers), and different years of Hajj, except from 2000 to 2008, when there was a significant difference favoring wearing face masks. This meta-analysis found wearing masks most of the time was associated with significantly lower risk of RTIs than wearing it intermittently.

Patients with hematological malignancies are at increased risk of persistent coronavirus disease 2019 (COVID-19) infection, a unique clinical condition, for which the optimal treatment is unknown. Here we report a case of persistent COVID-19 in acute lymphoblastic leukemia (ALL) patient who successfully responded to extended course nirmatrelvir/ritonavir.