Two Cases Illustrating the Diagnostic Challenge of Pediatric Blastomycosis Presenting as Osteomyelitis
Blastomyces dermatitidis is a dimorphic fungus endemic to the United States and Canada. Although both Histoplasma and Blastomyces are found in similar geographic regions, Blastomyces is many times more likely to cause dissemination in the immunocompetent host, frequently involving the bone. However, given the indolent nature of this fungal infection and more prevalent bacterial etiologies of osteomyelitis, diagnosis and treatment are often significantly delayed. We review 2 pediatric cases that initially presented with isolated orthopedic symptoms without documented fever or pulmonary complaints, although both had signs of pulmonary infection on imaging. These cases demonstrate the importance of a high level of suspicion as well as appropriate diagnostic workup, including surgical pathology with fungal stains, when evaluating osteomyelitis in patients exposed to a Blastomyces-endemic region.
Abstract Trace metals concentrations of 25 elements were determined for 22 subcomponents of biodegradable and non-biodegradable waste samples representing the United States municipal solid waste (MSW) stream collected during three separate waste sorts. The subcomponent trace metal concentrations and estimated composition results were used to predict trace metal concentrations present in the overall MSW stream along with MSW compost and waste to energy (WTE) ash, which were compared to health-based standards (i.e., US EPA regional screening levels) and to values previously reported in the literature. These estimate...
Secretary Azar testified before Congress that “herd immunity is not the strategy of the U.S. government.” Yet, frequently the Trump Administration’s rhetoric tells a different story. The Administration’s recent actions on the ground belie its claims of not advancing a herd immunity policy.
The researchers urge Australian leaders to safeguard the nation's political system "from these very insidious and ongoing threats."
CONCLUSION: Our study showed that transaminitis on admission was associated with severe clinical outcomes such as admission to the intensive care unit, need for mechanical ventilation, and mortality. PMID: 33033568 [PubMed]