Patient presents with dyspnea after recovering from COVID-19 pneumonia and is found to have pneumothorax. This represents an under-reported sequelae of COVID-19.

Introduction Fungal prosthetic joint infections comprise less than 1% of prosthetic joint infections. Thus, little is known regarding optimal management. This study aims to characterize the microbiology, surgical and medical management, and outcomes for these complex infections. The objectives of this study were to assess the impact of surgical approach, antifungal treatment, fungal species, and time to onset of infection from initial surgery on patient outcomes. Methods A retrospective record review over 12 years was performed in two health systems that included patients with a deep culture positive for a fungal isolate and the presence of a prosthetic joint. A literature review was performed using the same inclusion criteria. A total of 289 cases were identified and analyzed. Results Candida was the most common isolate, and a two-stage revision was the most commonly employed surgical modality. The type of surgical intervention had a statistically significant relationship with outcome (P = 0.022). Conclusions Two-stage revision with extended antifungal therapy is preferred in these infections due to higher rates of positive outcomes.

Introduction Infectious diseases (ID) consultations have been demonstrated to improve patient outcomes in the treatment of severe infections. However, ID consultation is often unavailable to patients that live in rural communities. Little is known regarding the treatment of infections in rural hospitals with no coverage from an ID specialist. We characterized the outcomes of patients cared for in hospitals without coverage from an ID physician. Methods Patients aged 18 years or older admitted to eight community hospitals without access to ID consultation during a 6.5-month period were assessed. All patients had received at least three days of continuous antimicrobial therapy. The primary outcome was the need for transfer to a tertiary facility for ID services. The secondary outcome was the characterization of antimicrobials received. Antimicrobial courses were evaluated independently by two board-certified ID physicians. Results 3706 encounters were evaluated. Transfers for ID consultation occurred in 0.01% of patients. The ID physician would have made modifications in 68.5% of patients. Areas for improvement included treatment of chronic obstructive pulmonary disease exacerbations, broad-spectrum treatment of skin and soft tissue infection, long courses of azithromycin, and management of Staphylococcus aureus bacteremia, including choice and length of therapy, as well as obtaining echocardiography. Patients evaluated received 22,807 days of antimicrobial therapy. Conclusions Patients hospitalized in community hospitals are rarely transferred for ID consultation. Our work demonstrates a need for ID consultation in community hospitals, identifying opportunities to enhance patient care by modifying antimicrobial regimens to improve antimicrobial stewardship and avoid inappropriate antimicrobials. Efforts to expand the ID workforce to include coverage at rural hospitals will likely improve antibiotic utilization.

A 57-year-old man presenting with bilateral flank pain and hematuria was found to have severe bilateral emphysematous pyelonephritis. The patient was managed with a conservative approach consisting of systemic antimicrobials and decompression via percutaneous nephrostomy tubes with piperacillin-tazobactam instillations via nephrostomy and made a full recovery.

She presented with right axillary painful lymphadenopathy. On physical examination, the patient was afebrile, appeared acutely ill and had tender adenopathy in the right axilla. The rest of the physical exam, including abdominal examination and breast exam, was unremarkable. Diabetes was well controlled with the most recent HbA1c being 6.7%. She denied any sick contacts or unusual exposures, such as contact with dead animals, fleas or rabbits. She recalled eating seafood and homecooked barbecue but denied any abnormal taste. Baseline laboratory parameters are as follows: CBC 6.4 × 10⁹ /L, haemoglobin 12.7 g/L, platelet count 139 × 10⁹ /L. Complete metabolic profile revealed mildly elevated glucose at 118 mg/dL and slightly elevated total protein at 8.2 g/dL, but was otherwise normal. C-reactive protein was 2.9 mg/dL (upper range of normal 0.744 mg/dL). CT of the chest performed in the emergency department revealed adenopathy in the right axilla with some inflammatory stranding (figure 1). Lidocaine patch was applied and empiric cefepime, vancomycin and ciprofloxacin were initiated for broad-spectrum coverage including tularaemia.