Hepatitis E virus (HEV) is a major cause of acute viral hepatitis. Since the coronavirus disease 2019 (COVID-19) pandemic, immunocompromised individuals face an increased risk of HEV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection, posing a threat of liver failure and prolonged illness. A 69-year-old male, with a history of chronic lymphocytic leukemia, was co-infected with HEV and SARS-CoV-2. Given the progressive decline in liver function post-admission, steroid therapy was initiated, which led to treatment-related complications. Additionally, the patient experienced an aggravation of COVID-19 symptoms due to persistent SARS-CoV-2 infection, effectively managed through a combination of antiviral medications and corticosteroids. This case describes the intricate clinical trajectory and therapeutic approach for managing HEV and SARS-CoV-2 co-infection, underscoring the potential efficacy of short-term corticosteroid intervention alongside comprehensive antiviral treatment.

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UNASSIGNED: It is essential to consider non-tuberculosis mycobacterium in HIV-positive patients with fever, abdominal pain, weight loss, and splenomegaly.
UNASSIGNED: Mycobacterium genavense is an opportunistic slow-growing nontuberculous mycobacterium in patients with immunocompromised backgrounds, especially HIV-positive patients. In this study, we present two cases of Mycobacterium genovese infection in HIV-positive patients with a good clinical response to accurate treatment.

Nocardia species do not replicate as rapidly as other pyogenic bacteria and nocardial infections can be highly fatal, particularly in immunocompromised patients. Here, we present the first report of fatal Nocardia kroppenstedtii bacteremic pneumonia and empyema thoracis diagnosed by next-generation sequencing (NGS) using the Oxford Nanopore Technologies\' MinION device. The bacterium was not identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Due to its low equipment cost, short turn-around-time, and portable size, the Oxford Nanopore Technologies\' MinION device is a useful platform for NGS in routine clinical microbiology laboratories.

BACKGROUND: The diagnosis of primary Aspergillus appendicitis can be missed or delayed because of its rarity. We report our experience of a case of Aspergillus appendicitis complicating chemotherapy of leukemia.
METHODS: A 48-year-old man who was diagnosed with acute myeloid leukemia developed high fever and epigastric pain two weeks after administration of his fourth consolidation chemotherapy. Right lower quadrant tenderness and rebound tenderness were noticed on physical examination, and the abdomen and pelvis computed tomography suggested acute perforated appendicitis with localized peritonitis. Emergency laparoscopy showed an inflamed appendix, which was resected. Pathology reports revealed invasive aspergillosis in the appendix. The patient recovered after high-dose antifungal therapy, although he required prolonged hospitalization.
CONCLUSIONS: Acute appendicitis is very rarely caused by fungi infection with an overall incidence of up to 1.15 %. Differential diagnosis of fungal appendicitis without pathology report is challenging due to low incidence.
CONCLUSIONS: Isolated Aspergillus appendicitis is a rare disease that can progress without appropriate antifungal therapy even after surgical resection of the appendix. Surgeons should pay attention to pathology reports after appendectomy to avoid missing unusual cases, especially in immunocompromised patients.

BACKGROUND: Malakoplakia is a very rare benign granulomatous disease, which can invade multiple organ systems, and is often related to bacterial infection and weak immunity. It is rarely occurred in the larynx, once this happens, the patient would complain of cough, hoarseness, dysphagia, and even dyspnea.
METHODS: We reported a case of malakoplakia of larynx. The patient complained of hoarseness and cough. Her lesion was located in the right false vocal cord. six case reports of malacoplakia in larynx were compiled from the literature and integrated with this case report.
RESULTS: After excising the tumor, the symptoms of the patient with cough, hoarseness and dysphagia were improved, and there was no recurrence during 1-year follow-up. The postoperative pathological diagnosis is malakoplakia. We found that malacoplakia is more commonly located in the supraglottic region, and we speculate that there may be a relationship between larynx-associated lymphoid tissue (LALT) and laryngeal malakoplakia. The effect of surgical treatment for laryngeal malacoplakia is satisfactory.
CONCLUSIONS: Malakoplakia of the larynx is rare. Bacterial infection, immune deficiency, and the distribution of LALT may be related to the pathogenesis and supraglottic localization of malakoplakia. The symptoms are related to the location and size of the mass and may be serious and fatal. Surgery is an important treatment for preserving laryngeal function and low recurrence rate.

UNASSIGNED: Hyperammonemic encephalopathy caused by Ureaplasma spp. and Mycoplasma hominis infection has been reported in immunocompromised patients undergoing lung transplant, but data are scarce in patients with hematological malignancies.
UNASSIGNED: We describe the cases of 3 female patients aged 11-16 years old, developing initially mild neurologic symptoms, rapidly evolving to coma and associated with very high ammonia levels, while undergoing intensive treatment for acute leukemia (chemotherapy: 2 and hematopoietic stem cell transplant: 1). Brain imaging displayed cerebral edema and/or microbleeding. Electroencephalograms showed diffuse slowing patterns. One patient had moderate renal failure. Extensive liver and metabolic functions were all normal. Ureaplasma spp. and M. hominis were detected by PCR and specific culture in two patients, resulting in prompt initiation of combined antibiotics therapy by fluoroquinolones and macrolides. For these 2 patients, the improvement of the neurological status and ammonia levels were observed within 96 h, without any long-term sequelae. M. hominis was detected post-mortem in vagina, using 16S rRNA PCR for the third patient who died of cerebral edema.
UNASSIGNED: Hyperammonemic encephalopathy linked to Ureaplasma spp. and M. hominis is a rare complication encountered in immunocompromised patients treated for acute leukemia, which can lead to death if unrecognized. Combining our experience with the few published cases (n=4), we observed a strong trend among female patients and very high levels of ammonia, consistently uncontrolled by classical measures (ammonia-scavenging agents and/or continuous kidney replacement therapy). The reversibility of the encephalopathy without sequelae is possible with prompt diagnosis and adequate combined specific antibiotherapy. Any neurological symptoms in an immunocompromised host should lead to the measurement of ammonia levels. If increased, and in the absence of an obvious cause, it should prompt to perform a search for Ureaplasma spp. and M. hominis by PCR as well as an immediate empirical initiation of combined specific antibiotherapy.

 Actinomycosis is a chronic inflammatory infectious disease that can affect various organ systems. Pulmonary actinomycosis is an exceptionally uncommon clinical occurrence that yet deserves special attention, as it closely mimics a broad spectrum of infectious and neoplastic lung pathologies. The non-specific nature of its clinical features and radiological appearances makes early diagnosis quite challenging. The authors reported a 25-year-female with poorly controlled diabetes mellitus and morbid obesity who presented with a one-week history of unilateral, right-sided, pleuritic chest pain and shortness of breath. Chest imaging revealed a suspicious right hilar soft tissue mass encasing the right upper lobe bronchus with post-obstructive atelectasis. Transbronchial biopsy revealed suppurative granulomatous inflammation, and anaerobic cultures from the bronchial tissues grew Actinomyces species that were identified using the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) technique. A long course of penicillin-based antibiotics was employed, and follow-up imaging revealed a satisfactory response to the antimicrobial therapy. This case demonstrates that microbiological examination is imperative to accurately diagnose the etiology of suspicious lung masses in young immunocompromised hosts. It also proves the diagnostic value of the MALDI-TOF technique in the early identification of Actinomyces species.

Cats and dogs make up an essential part of the household for families in the United States. Close contact with pets can carry a risk of potential infectious disease transmission. This case series outlines causes of zoonotic pneumonia associated with cats and dogs, with a particular focus on the three cases presented of respiratory infection with Bordetella (B.) bronchiseptica and Pasteurella (P.) multocida in patients with an underlying malignancy. B. bronchiseptica is a rare bacterial pathogen in humans that can cause disease in immunocompromised individuals. Interpreting the significance of B. bronchiseptica as a pathogenic agent can be challenging given that this microbe often accompanies other organisms in culture. P. multocida is another important pathogen known to cause severe respiratory infection in immunocompromised populations or those with certain underlying comorbidities. A broadened differential for other bacterial etiologies of zoonotic respiratory infection acquired from dogs or cats includes Francisella tularensis, Yersinia pestis, Coxiella burnetii, and Bartonella henselae. These pathogens should be considered in the correct clinical context. Pets also play a role as reservoirs for the transmission of resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus intermedius group (SIG), and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Immunocompromised individuals must be educated on the potential for household transmission of zoonotic disease and how to limit certain types of close contact with pets. This report also highlights the importance of flea and tick control in pets for the prevention of zoonotic disease spread.

BACKGROUND: The occurrence of granulomatous amoebic encephalitis (GAE) was investigated due to the exposure of a large number of immunocompromised patients to opportunistic Acanthamoeba infections, which in most cases are fatal.
METHODS: In this case-control study, 160 samples from the nasal mucosa of immunocompromised patients were collected between February 2019 to February 2020 in Isfahan, central Iran, using sterile cotton swabs; 150 ethnically matched controls were included. The pathogenic potential of the identified isolates was evaluated using temperature and osmotolerance assays. The identification of Acanthamoeba infection was confirmed by both morphological and phylomolecular tools.
RESULTS: Of 310 collected samples, 32 strains, including 25 (15.6%) and 7 (4.6%) isolates, were positive for the Acanthamoeba genus in the patient and control groups, respectively. The topology of the phylogenetic tree indicated that all the Acanthamoeba strains belonged to the T4 genotype. Only five of the isolates genotyped as T4 were positive for potential pathogenic assays. The heterogeneity analysis of 18S ribosomal RNA sequences of Acanthamoeba in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and hepatitis B and C patients revealed significant genetic diversity (haplotype diversity [Hd] 0.511) compared with that of healthy individuals (Hd 0.210).
CONCLUSIONS: The circulation of pathogenic isolates of Acanthamoeba, particularly in HIV/AIDS patients, along with their genetic traits, indicates that clinicians should be more aware of fatal cases of GAE, especially in suspected encephalitis, in Iran and worldwide.