IntroductionFolliculitis is inflammation of hair follicles, most commonly due to infection. Ingrown hairs and trauma from shaving or waxing promote follicular occlusion and irritation and increase risk of folliculitis.Folliculitis is classified by depth of infection. Superficial folliculitis involves the superficial part of the hair follicle (infundibulum) while deep folliculitis involves the entire hair follicle. On examination, inflammation of superficial folliculitis is restricted to the epidermis. Deep folliculitis is distinguished by widespread erythema, edema, and tenderness involving the dermis.

Introduction Zanubrutinib is a second generation Bruton’s tyrosine kinase inhibitor (BTKi) often used to treat B cell malignancies such as marginal zone lymphoma. BTKis belong to a protein tyrosine kinase family that plays an essential role in the proliferation, differentiation, and survival of B cells. The side effects of BTKis include infection, diarrhea, skin rash, and atrial fibrillation. Invasive fungal infections have been previously described with Ibrutinib (a first generation BTKi) but seldom with second generation BTKis such as zanubrutinib.

Tongue Necrosis as a Manifestation of Immune Dysfunction: A Complex Case of Lupus, Histoplasmosis, and Macrophage Activation SyndromeMadalyn Walsh, MD1, Alick Feng, MD2, Petar Lenart, MD PhD2, Bharat Kumar, MD MME21Department of Internal Medicine, University of Iowa Hospitals & Clinics2Division of Immunology, University of Iowa Hospitals & Clinics

INTRODUCTION:Human beings are often infected with species of filariasis which are naturally found in animals. Among these the commonly reported is due to dirofilaria species - D repens and D imitis. It is transmitted by mosquito bite. The review of literature revealed around 800 cases reported worldwide. Most of the pediatric cases reported in India are ocular dirofilariasis. Subcutaneous dirofilariasis cases are mostly reported in adult population. Here we present a series of four cases of subcutaneous dirofilariasis in children presenting as subcutaneous nodules.

Background Use of continuous renal replacement therapy (CRRT) in children receiving anti-infective drugs may lead to inappropriate concentrations with risks of treatment failure, toxicity and emergence of multidrug-resistant bacteria. We aimed to describe anti-infective prescribing practices in critically ill children undergoing CRRT. Methods An online survey to assess CRRT, anti-infective prescribing and therapeutic drug monitoring (TDM) practices was sent by e-mail to physicians working in pediatric intensive care units (PICUs) through the French-speaking Group of Pediatric Intensive Care and Emergency medicine (GFRUP). Results From April 1st 2021 to May 1st 2021, 26/40 different PICUs participated in the survey, corresponding to a response rate of 65%. Twenty-one were located in France and five abroad. All PICU practiced CRRT mainly with Prismaflex™ System. Anti-infective prescriptions were adjusted to the presence of CRRT in 23 (88%) PICUs mainly according to the molecular weight in 6 (23%), the molecule protein binding in 6 (23%) and the elimination routes in 15 (58%) including the residual diuresis in 9 (35%), to the CRRT flow in 6 (23%) and to the modality of CRRT used in 15 (58%), PICUs. There was a wide variability noticed between PICUs and between physicians in the same unit. Barriers to TDM were mainly an excessive delay in obtaining results in 11 (42%) and the lack of an on-site laboratory in 8 (31%) PICUs. Conclusions Our survey reported wide variability in anti-infective prescribing practices in children undergoing CRRT highlighting the gap in the knowledge and the need for education and recommendations

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening skin reactions, often triggered by medications such as antiepileptic drugs, nonsteroidal anti-inflammatory drugs, and certain antibiotics. Carbamazepine is one of the most common antiepileptic medicine that causes SJS. A 13-year-old male with a history of 2 years of epilepsy presented with a painful rash and extensive blistering with mucous membrane involvement, along with fever and Nilkolsky sign. Based on clinical presentation and previous medication history, the patient was diagnosed with Stevens-Johnson syndrome, and carbamazepine was identified as the cause. Carbamazepine was discontinued, and the patient was given nutritional support, wound care, and intravenous fluids, along with steroid and antihistamine treatment. The patient’s symptoms improved, and he was discharged after 13 days. Physicians must be aware of the potential for life-threatening drug hypersensitivity reactions in patients taking certain medications, particularly antiepileptic drugs. A thorough history and careful monitoring are essential for the early recognition and treatment of SJS and TEN. We want to advise all physicians that for patients with a previous drug reaction to this class of medication, carbamazepine prescribing should be avoided. KEYWORDS: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), carbamazepine (CBZ), phenytoin (PHT), ADR.

Objective: To investigate the ENT department’s (OPD, IPD) antibiotic prescribing practices at a tertiary care hospital in Lucknow, India. Material and Methods A prospective, cross-sectional, non-experimental (observational) study was performed in (OPD, IPD) department of Ear, Nose and Throat (ENT) over a period of 6 months. Result In this study, 100 ENT patients (51 male, 49 female) were selected based on inclusion and exclusion criteria. Ear infections were the most common reason for visits (86 patients), followed by nose (7 patients) and throat infections (5 patients). The most commonly prescribed antibiotics were β-lactam antibiotics, with penicillin’s (amoxicillin with clavulanic acid) and cephalosporin’s (cefixime) being the most commonly used. Combination therapy was used in 117 patients, with an average of 1.9 antibiotics per patient per course. A total of 40 antibiotics were prescribed, with oral being the most common route of administration. Only one adverse drug reaction was reported, with a suspected link to cefixime causing an increase in rashes in one patient. The study population had comorbid conditions of anxiety, epilepsy, and anaemia. Conclusions To conclude, our study in the university teaching hospital (IIMSR) highlighted lesser utilization of antibiotics in ENT infections, as some of the ENT infections are not due to bacteria. The majority of ENT patients admitted to the hospital appear to have bacterial infections, and most of them reacted favourably to antibiotic treatment. Majority of the patients used the regimen in accordance with the current guidelines. Keywords: Antibiotic agents, drug utilization, adverse drug reaction, ENT infection.

Clostridium sordellii: A cause of toxic shock syndrome after a breach in the GI tractSydney Pence,1 Rajshri Joshi,2Kasturi Shrestha31. Ohio University Heritage College of Osteopathic Medicine, 4180 Warrensville Center Rd, Warrensville Heights, OH 44122. Email: sp883713@ohio.edu2. Internal Medicine, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307. Email: JOSHIR4@ccf.org3. Infectious Disease, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307. Email: SHRESTK2@ccf.org

Rhinoscleroma is a granulomatous infectious disease that typically affects the nasopharynx and upper respiratory tract. Non-endemic (e.g., North American) and laryngeal cases are rare. This case highlights the importance of pathognomonic Mikulicz cells for diagnosis.

Abstract Background This study aimed to establish a method to determine tigecycline (TGC) in cerebrospinal fluid (CSF) and serum of 12 patients with Multidrug-resistant acinetobacter baumannii (MDRAB) central nervous system infection (CNSI) and evaluate the correlation of TGC in CSF and serum samples. Methods TGC in CSF and serum was extracted by acetonitrile and detected by HPLC-MS/MS. The separation was performed on the Waters XBridge® BEH Shield RP18 column. This method could achieve the quantification accurately in a very short time. Results For these 12 patients, the trough concentration ranges of TGC in CSF and serum at steady-state were 16.35-53.56 ng/mL and 67.76-211.9 ng/mL. The CSF-to-serum ratio of TGC at steady-state trough concentration was ranged from 21.46% to 44.46%, and the mean value was 31.61 ± 8.13%. The correlation of TGC in CSF and serum was 0.5065. CNSI might have no potential to increase the penetration ability of TGC to CSF. Conclusion The method was validated to be accurate and effective. The correlation between the concentrations of TGC in CSF and serum at steady-state was demonstrated to be positive based on quantification of TGC in bio-samples from 12 MDRAB patients.

Introduction:Brucellosis is a zoonotic infectious disease with a wide range of manifestations including malaise, anorexia, fever, and profound muscular weakness, as described by Marston in 18601. It is caused by the Gram-negative coccobacillus, Brucella, and remains endemic in some developing countries, such as Iran. There are 6 types of brucella that 4 of which include Brucella melitensis, Brucella abortus, Brucella canis, and Brucella suis were recognized as pathogens involving humans. Brucella melitensis was described as the most common and virulent pathogen worldwide. The first case of ocular brucellosis in a human being was described by Lemaire in 1924 2, presented with bilateral optic neuritis and external ophthalmoplegia in a patient with brucella meningitis.Ocular manifestations of acute and chronic infection include anterior and posterior uveitis, panuveitis, keratitis, conjunctivitis, papillitis, cataract, maculopathies, glaucoma, and ocular muscle paresis. Modern treatments of ocular brucellosis, intraocular as well as systemic antibiotics, have improved the prognosis of the disease3. Herein, we present a patient with endogenous endophthalmitis caused by Brucella Melitensis (B.Melitensis), which is very rare and unusual.

Title pageTitle: Rust-colored patches of the lower extremity in a COVID-19 patientAuthrors: Jacem Rouatbi1, Mouna Korbi1*, Nouha Ben Abdeljalil2, Hichem Belhadjali1*, Jameleddine Zili1*

Numerous different complications have been reported following Covid-19 disease.Although the disease often improves after going through various clinical phases,some people have Various complications, including coagulation disorders. The patient is a 59-year-old man who developed extensive heart thrombosis following covid19 involvement a month ago and was hospitalized with extensive cardiac dysrhythmias

Skull Base Osteomyelitis with Extensive Bony Erosion Complicated by Venous Sinus Thrombosis

A case report and clinical implications of medication-related osteonecrosis of the jaw resulting in sepsis in a patient with rheumatoid arthritis

”A Case of Acute Encephalitis Syndrome and Cranial Nerve Palsy secondary to Scrub Typhus: A Rare Presentation from Western Nepal”.SK Lamichhane1, Eliz Achhami2, Satyam Mahaju3, Rabin Gautam 4, Amrit Adhikari51 Bir Hospital, Kathmandu, Nepal(email:- lamichhaneak1312@gmail.com )2 Sukraraj Tropical & Infectious Disease Hospital, Kathmandu, Nepal(email:- eliz0917@gmail.com )3 Sukraraj Tropical & Infectious Disease Hospital, Kathmandu, Nepal(email:- mahaju.satyam1@gmail.com )4 Bir Hospital, Kathmandu, Nepal(email:- rabingautam1@gmail.com )5 Bir Hospital, Kathmandu, Nepal(email:- a1amrit12@gmail.com )*Corresponding author.Eliz Achhami, MBBSSukraraj Tropical & Infectious Disease Hospital, Kathmandu, NepalMobile no. : - 977-9846710319E-mail: eliz0917@gmail.com

Although Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been controlled and prevented, mathematical modeling and analysis of transmission dynamics of COVID-19 still plays an essential role not only in the post COVID-19 era but also in the study of infectious diseases. This is an important foundation to propose effective strategies and measures for controlling diseases and projecting public health. This work is devoted to proposing and analyzing a new mathematical study for transmission dynamics of COVID-19. We first introduce a generalized SEIR epidemic model that use general nonlinear incidence rates to describe the “psychological” effect. After that, a rigorous mathematical analysis for the proposed COVID-19 model is performed. We establish the positivity and boundedness, calculate the basic reproduction number, determine possible (disease-free and endemic-disease) equilibrium points and investigate their asymptotic stability properties of the SEIR model. The obtained results improve and extend an SEIR model constructed in a recent work. For the purpose of numerical simulation, the Mickens’ methodology is applied to construct a dynamically consistent nonstandard finite difference (NSFD) model for the proposed SEIR epidemic model. The constructed NSFD scheme has the ability to provide reliable approximations that not only preserve the dynamical properties of the SEIR model for all the values of the step size but also are easy to be implemented. Finally, a set of illustrative numerical experiments is conducted to support the theoretical findings and to confirm advantages of the NSFD scheme over some well-known standard ones.

We reported the first case of Guillain-Barré syndrome that is associated with COVID-19 and malaria coinfection. The current report demonstrates diagnostic challenge to identify GBS case in a country like Sudan that is endemic with several infectious diseases associated with developing GBS.

Introduction: Abscess on the isthmus of horseshoe kidney is rare. Our goal is to report the diagnostic and therapeutic difficulty. Observation: woman 42-year-old , had history of dental caries. The clinical manifestation is atypical, marked by chronic pain in the right hypochondrium and periumbilical. The biological anomaly is an increase

Hepatitis A virus infection can cause extra-hepatic manifestations like myocarditis. An 8-year-old female with HAV infection presented with fever, abdominal pain, vomiting, and icterus. She developed viral myocarditis with complete AV dissociation on ECG and was treated with a temporary pacemaker, but her condition worsened, and she died.

Introduction: A global health issue known as antimicrobial resistance (AMR) transcends geopolitical boundaries. Surgical antibiotic prophylaxis (SAP) is the process of administering antimicrobial to treat contagions as a preventative measure, avoid them before, during, and after surgery. During surgery or after surgery there may be chances of acquiring infection. Infection at the surgical site is one such complication known as surgical site infection (SSI). It is one of the problems that reoccur the most frequently in clinical setting. Surgical site infection is described as an infection that develops with in thirty days of surgery and might be deep, affecting the organs reached during surgery, or superficial, involving only the skin. SSIs are occasionally the leading cause of death following surgical treatments. So, to reduce these types of complication we use surgical antibiotic prophylaxis. Methods: PubMed, Google Scholar, ResearchGate, and healthcare system evidence were searched from 2005 to 2022 for systemic review that was published in the English language. Result: Data were extracted for all primary outcomes, 38 reviews were included, and review quality was evaluated using AMSTAR 2. The most often reported administration of antibiotic, timing, drug class, and primary result, respectively, were preoperative antibiotic administration, first generation cephalosporin usage, and surgical site infection (SSI). Results indicate that, in comparison to a placebo or no SAP, SAP may, on average, decrease SSIs. The finding showed that postoperative SAP did not differ significantly from intraoperative SAP in reducing SSI. Keywords: Surgical Antibiotic Prophylaxis (SAP), Surgical Site Infections (SSIs), Wound Classification

We described a 17-year-old male with a large pulmonary hydatid cyst with a spontaneous rupture. He developed acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. He was treated with albendazole, broad-spectrum antibiotics, and corticosteroids. He underwent surgery after discharge. ARDS after rupture of hydatid cyst was rarely reported.

Cardiac hydatidosis is a relatively rare complication of echinococcosis, with a potentially life-threatening condition. Here, we reported a large interventricular septal hydatid cyst with bulging in the left ventricle accompanied by a huge cervical lamp with recurrent hepatic cysts that underwent cardiac surgery to excise the cyst uneventfully.

Brucellosis is a thousand-face disease and a common zoonotic infection in the endemic region. A 42-year-old female was admitted with sternoclavicular arthritis and breast abscess. After laboratory investigation and imaging, positive serological test results and positive blood culture for brucella revealed acute sternoclavicular arthritis and breast abscess due to brucellosis.