(1) Background: Pneumocystis jirovecii pneumonia (PCP) has a substantial impact on the morbidity and mortality of patients, especially those with autoimmune disorders, thus requiring optimal dosing strategies of Trimethoprim–Sulfamethoxazole (TMP-SMX). Therefore, to ensure the safety of TMP-SMX, there is a high demand to review current evidence in PCP patients with a focus on dose optimization strategies; (2) Methods: Various databases were searched from January 2000 to December 2021 for articles in English, focusing on the dose optimization of TMP-SMX. The data were collected in a specific form with predefined inclusion and exclusion criteria. The quality of each article was evaluated using a Newcastle–Ottawa Scale (NOS) for retrospective studies, Joanna Briggs Institute (JBI) critical checklist for case reports, and Cochrane bias tool for randomized clinical trials (RCTs); (3) Results: Thirteen studies met the inclusion criteria for final analysis. Of the 13 selected studies, nine were retrospective cohort studies, two case reports, and two randomized controlled trials (RCT). Most of the studies compared the high-dose with low-dose TMP-SMX therapy for PCP. We have found that a low dose of TMP-SMX provides satisfactory outcomes while reducing the mortality rate and PCP-associated adverse events. This strategy reduces the economic burden of illness and enhances patients’ compliance to daily regimen plan; (4) Conclusion: The large-scale RCTs and cohort studies are required to improve dosing strategies to prevent initial occurrence of PCP or to prevent recurrence of PCP in immune compromised patients.

Cytomegalovirus (CMV) is a human herpes-type virus with variable clinical manifestations. Infections in immunocompetent patients are usually asymptomatic or mild, and severe infections are generally seen in immunosuppressed individuals. CMV colitis is not uncommon in patients with ulcerative colitis (UC) and is mostly associated with the use of steroids, immunomodulators like azathioprine, and biologics like infliximab, which have systemic immunosuppressive effects. Vedolizumab is an anti-integrin antibody that is gut-selective without any systemic effects. We report an unusual presentation of a female patient with UC who had concomitant CMV colitis and erythema nodosum, who was on vedolizumab, and not on any steroids or other immunosuppressants. She responded well to anti-viral treatment and steroids.

Surgical site infections (SSIs) are the most common healthcare-associated infections that occur among surgical patients. Surgical site infections result in longer hospital stays, hospital readmissions, and higher death and morbidity rates. The current study was designed to highlight the importance of such surveillance studies in a Malaysian surgical population with a motive to evaluate and revise concurrent infection control and prevention policies by exploring the burden of surgical site infection and identifying its associated risk factors for future considerations. In this prospective observational cohort study, a total of 216 patients admitted to a surgical ward were identified and studied. Of these 216 patients, 142 elective procedures and 74 emergency procedures were included in the study, of which 13 patients (9.2%) undergoing elective procedures and 15 (20.3%) patients undergoing emergency procedures were SSI positive (OR: 2.5, p = 0.02). Among surgical site infections, 21 were superficial and 7 were deep incisional SSI. No case of organ/space SSI was identified. The time taken for SSIs to develop ranged from 2–17 days with a median of 6 days. Risk factors such as presence of comorbidities (p = 0.011), major co-existing medical diagnosis ≥2 (p = 0.02), and pre-existing infection (p = 0.027) were statistically significant. SSI-positive patients experienced an increase in the post-operative length of hospital stay. In the current population, it was seen that identifying patients who were at high risk of malnutrition via MUST and the NNIS risk index will help clinicians in identifying high risk patients and in managing their patients appropriately. Identifying patients who were at high risk of malnutrition will also improve postoperative outcomes considerably.

Pancreatic tuberculosis is usually investigated as a mass or inflammation due to the lack of unique clinical or radiological characteristics; as a result, this rare extrapulmonary tuberculosis is usually diagnosed as pancreatic carcinoma.We present a 39-year-old female with pancreatic TB presenting as pancreatic carcinoma. The patient presented with abdominal pain in epigastric and right upper quadrant area for seven days with a previous contact of tuberculosis patient. She was jaundiced and tenderness on abdomen. Abdominal ultrasound revealed dilated common bile duct and computed tomography, and magnetic resonance cholangiopancreatography showed ill-defined mass at the medial aspect of the common bile duct involving pancreatic head.Endoscopic retrograde cholangiopancreatography also showed ill-defined lobulated lesion on pancreatic head. Biopsies revealed granulomatous inflammation and foci caseous necrosis confirming pancreatic tuberculosis.Patient was initiated on anti-TB treatment. Reporting rare cases help improve physician's abilities in identifying such specific illness which share common presentation clinically and radiographically.

Mucormycosis (zygomycosis) is a rare, rapidly progressive fungal infection that is opportunistic and usually affects immunocompromised individuals, most commonly patients with diabetes mellitus. It is a fatal infection that requires high clinical suspicion and early disease identification. The global burden of mucormycosis is unknown as it is a rare disease. However, the burden of mucormycosis is increasing worldwide, with the emergence of new risk factors and causative agents. In the Saudi population, the discovered cases and the overall prevalence were low. Herein, we present a case of mucormycosis infection aiming to illustrate the clinical characteristics and the management strategy, besides adding another case to the literature.