Solid organ transplant (SOT) recipients are at high risk for severe disease with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Emerging variants of concern have disproportionately affected this population. Data on severity and outcomes with the Omicron variant in SOT recipients are limited. Thus we conducted this single‐center, retrospective cohort study of SOT recipients diagnosed with SARS‐CoV‐2 infection from December 18, 2021 to January 18, 2022, when prevalence of the Omicron variant was more than 80%‐95% in the community. Univariate and multivariate logistic regression analysis was performed to identify risk factors for hospital admission. We identified 166 SOT patients: 112 (67.5%) kidney, 22 (13.3%) liver, 10 (6.0%) lung, seven (4.2%) heart, and 15 (9.0%) combined transplants. SARS‐CoV‐2 vaccine series was completed in 59 (35.5%) recipients. Ninety‐nine (59.6%) and 13 (7.8%) recipients received casirivimab/imdevimab and sotrovimab, respectively. Fifty‐three (32%) recipients required hospital admission, of which 19 (35.8%) required intensive care unit level of care. Median follow‐up was 50 (interquartile range, 25‐59) days, with mortality reported in six (3.6%) patients. Risk factors identified for hospital admission were African American race (p < .001, odds ratio [OR] 4.00, 95% confidence interval [CI] 1.84‐8.70), history of coronary artery disease (p = .031, OR 3.50, 95% CI 1.12‐10.87), and maintenance immunosuppression with corticosteroids (p = .048, OR 2.00, 95% CI 1.01‐4.00). In conclusion, contrary to that in the general population, we found a higher hospital admission rate in SOT recipients with omicron variant infection. Further studies to investigate the efficacy of newer treatments are necessary, even as outcomes continue to improve. image

Leptospirosis has been rarely reported in the United States and has been historically related to occupational exposure to infected animals, and contaminated environments. Over the past decade, there are indications that at-risk populations may be changing in the United States, to also include participants in freshwater sports and occasionally individuals living in economically disadvantaged urban inner- city environments. We present a case of Weil`s disease in a 39-year-old homeless man who had been released from prison two weeks prior and denied direct contact with infected animals or contaminated fresh water. Prison inmates and homeless patients are potentially at high risk of rat exposure and infection with Leptospira. A high index of suspicion is needed for diagnosis of leptospirosis in the absence of traditional risk factors. To our knowledge, this is the first case of leptospirosis associated with homelessness and incarceration in the United States. A literature review on leptospirosis cases in Florida over the past 60 years was performed.

Solid organ transplant recipients (SOTRs) are at an increased risk of nocardiosis, a rare but life-threatening opportunistic infection. Universal PCP prophylaxis with trimethoprim–sulfamethoxazole (TMP-SMX) is used at our center, which is active in vitro against most species of the Nocardia genus and may have a role in preventing early infections. This is a single-center retrospective cohort study of nocardiosis in adult SOTRs at a large transplant center between January 2012 and June 2022, with comprehensive review of literature. Out of 6179 consecutive cases, 13 (0.2%) were diagnosed with nocardiosis. The patients were predominantly male (76.9%) and kidney transplant recipients (62%). Infection was diagnosed at median of 8.8 months (range, 3.7–98) after transplant. Patients were followed for a median of 457 days (range 8–3367). Overall mortality within one year after diagnosis was 46% (6/13), of which 17% (1/6) of deaths was attributable to Nocardia infection. No recurrence was reported. Nocardia infections were noted in a small proportion of our SOTRs and carried significant morbidity and mortality. TMP-SMX prophylaxis may be protective in some cases given low incidence of cases.

Background: Candida prosthetic joint infection (PJI) is a rare complication of total knee arthroplasty (TKA). The literature regarding its diagnosis and management is scarce. Case summary: We present the case of a 79-year-old woman with history of TKA and femoral intramedullary nailing, who developed PJI caused by Candida lusitaniae. A two-stage exchange arthroplasty was performed. She underwent implant removal, debridement and placement of temporary antibiotic impregnated spacer. Postoperatively, the patient received treatment with micafungin for 24 weeks. Eleven months after the first stage, the spacer was removed and a new knee prosthesis was placed. Complete eradication of infection was demonstrated by negative culture of cement spacer, synovial fluid and periprosthetic tissue. Histology of surgical samples was unremarkable. Empiric treatment with micafungin was given for 6 weeks after placement of the new prosthesis. At 6-month follow-up, there was no evidence of recurrent infection. Conclusion: To our knowledge, this is the first reported case of Candida lusitaniae PJI.

Primary intramedullary spinal cord lymphoma (PISCL) is rare and constitutes only 1% of central nervous system lymphomas. We report a case of PISCL in a 37-year-old man with advanced AIDS. To our knowledge, only 4 cases of PISCL in the setting of HIV/AIDS have been reported in the literature. Despite treatment, prognosis remains dismal.

Mycobacterium abscessus complex (MABC), a rapidly growing Mycobacterium, is one of the most common causes of non-tuberculous mycobacteria (NTM) infections in the United States of America, and it has been associated with a wide spectrum of infections in immunocompetent and immunosuppressed individuals. Eradicating MABC is very challenging, even with prolonged combination therapies. The management of MABC infections in solid organ transplant (SOT) patients is usually complex given their net state of immunosuppression, associated comorbidities, and potential drug–drug interactions, among other things. In this manuscript, we discussed the antimicrobial management of pulmonary and extrapulmonary MABC infections. In addition, we reviewed promising novel therapies such as clofazimine, omadacycline, bedaquiline, and inhaled tigecycline that could join the existing antimicrobial armamentarium to fight this infection associated with significant morbidity and mortality. However, further studies are needed, especially among the immunocompromised host.