Background: Bartonella henselae is a species of intracellular bacteria transmitted to humans through animal bites and scratches contaminated with the feces of arthropod vectors, and are most commonly associated with cat exposure although transmission from other mammals has been reported. Bartonella henselae infection has a spectrum of clinical manifestations and has rarely been reported as cause of hemophagocytic lymphohistiocytosis (HLH) in immunocompromised hosts. Case presentation: We present a report of Bartonella henselae infection progressing to HLH in an immunocompetent patient. The patient initially presented with regional lymphadenopathy but the diagnosis was not suspected as the patient reported no exposure to cats. On further history, he did report a scratch from a dog prior to development of symptoms. The patient was treated with methylprednisolone, intravenous immunoglobulin and anakinra for the HLH and three months of Doxycycline for Bartonella infection, with complete resolution of symptoms. Conclusions: Although commonly associated with cat exposure, Bartonella henselae transmission can occur after exposure to other animals and vectors including dogs and clinicians need to maintain an index of suspicion for timely diagnosis. Bartonella henselae is associated with a spectrum of clinical manifestations which can include disseminated infection with severe complications such as hemophagocytic lymphohistiocytosis. Prompt initiation of Bartonella treatment is essential when thought to be the trigger for hemophagocytic lymphohistiocytosis although the optimal treatment regimen is unclear.

We conducted a retrospective cohort study to identify factors influencing intravenous (IV) versus oral antibiotic therapy in first-episode prosthetic joint infections. Of the 34/78 (44%) cases treated intravenously, negative cultures (26%), concomitant infections necessitating IV antibiotics (21%), and delays in susceptibility testing (15%) were the most common reasons for IV therapy.

Given the overlap of epidemiological and clinical presentations of both rickettsioses and malaria infections, diagnostic testing where malaria is confirmed or excluded, without subsequent rickettsial testing, specifically in the case of Plasmodium vivax or P. ovale infection, may mask the possibility of relapse. A lack of clinical suspicion of co-infections, absence of knowledge on the geographic distribution of diseases, and lack of availability of point-of-care diagnostic testing for other tropical diseases can often lead to missed diagnosis or misdiagnosis of common tropical infections, including rickettsioses. We herein describe a case of confirmed intercurrent rickettsial and P. vivax infection, with the former potentially triggering a relapse of the latter in a febrile traveler returning to Canada from South America, and review the literature on tropical coinfections in returning travelers.

Introduction: There have been consistent reports of tension between the dual goals of assessment of learning and assessment for learning in competency‐based medical education. This is exemplified by assessments of Entrustable Professional Activities where trainees report a focus on assessment of learning and engaging in performance‐oriented behaviours that undermine meaningful assessment. It has been proposed that fostering a growth mindset amongst trainees may encourage use of EPA assessments for learning. This study aimed to explore how trainee mindset interacts with their perception of the role of EPAs in assessment of and for learning. Methods: We conducted 19 semi‐structured interviews of residents enrolled in 12 Canadian specialty post‐graduate programmes. Interviews explored residents' experiences with EPAs and their views on how tasks are learned. Transcripts were analysed using reflexive thematic analysis to generate themes. Results: Though most participants described attitudes of a growth mindset and a desire to learn from failure, a minority described attitudes associated with a fixed mindset contributing to avoidance of unsuccessful EPA assessments, suggesting mindset may impact the use of EPA assessments for learning. However, even amongst residents expressing views consistent with a growth mindset, the lack of meaningful feedback on EPA assessments prevented them from being a tool for learning. Participants described a variety of system factors that undermined provision of meaningful feedback and a view that programmes utilised EPA assessments only as a checkbox. Discussion: Even if a growth mindset may promote assessment for learning, a system that results in poor‐quality feedback turns EPA‐based assessments into an assessment of learning. An assessment system that supports both a culture of growth mindset and high quality of feedback is needed if EPA assessments are to be utilised for assessment for learning.