The first case of the novel Coronavirus Diseases (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was detected in Wuhan, China in December 2019. On January 30, 2020, the World Health Organization declared a global health emergency. Countries around the world advised social distancing, businesses and schools closed, while health care workers faced a viral war. With the declaration of a global emergency, a test to rapidly detect the SARS-CoV-2 was developed to ensure swift isolation of infected persons to prevent spread of disease. Currently, the gold standard for test is Reverse Transcriptase Polymerase Chain Reaction (RT-PCR); however, patients with a high clinical suspicion for COVID-19 can sometimes have multiple negative tests. We discuss a patient under investigation (PUI) who had classic findings of COVID-19 but repeatedly tested negative from nasopharyngeal swabs until a fifth sample obtained from a deep suctioning was tested.

Current guidelines suggest that HIV-infected patients should receive chemoprophylaxis against Pneumocystis jirovecii pneumonia (PJP) if they have a cluster determinant 4 (CD4) count <200 cells/mm or oropharyngeal candidiasis. Persons with CD4 percentage (CD4%) below 14% should also be considered for prophylaxis. Discordance between CD4 count and CD4% occurs in 16% to 25% of HIV-infected patients. Provider compliance with current PJP prophylaxis guidelines when such discordance is present was assessed. Electronic medical records of 429 HIV-infected individuals who had CD4 count and CD4% measured at our clinic were reviewed. CD4 count and percentage discordance was seen in 57 (13%) of 429. Patients with CD4 count >200 but CD4% <14 were significantly less likely to be prescribed PJP prophylaxis compared with those who had CD4 count <200 and CD4% >14 (29% versus 86%; odds ratio = 0.064, 95% confidence interval: 0.0168-0.2436; P < .0001). We emphasize monitoring both the absolute CD4 count and percentage to appropriately guide PJP primary and secondary prophylaxis.

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Background: In common with other coryneform species, Corynebacterium striatum colonizes the skin and mucous membranes of normal hosts, and is one of the more frequent corynebacteria isolated in the clinical laboratory. However, its clinical significance is often unclear as it can be difficult to distinguish between colonization and infection. Most reported cases of C. striatum infection are of endocarditis, pulmonary infection or are associated with prosthetic devices. We observed a number of cases of diabetic foot osteomyelitis in our hospital from which a heavy, pure growth of C. striatum was isolated from tissue or fluid samples.Methods: A review of the medical literature was carried out and did not suggest C. striatum was a recognised cause of diabetic foot infection. We identified all pure cultures of C. striatum grown in our laboratory from tissue and fluid samples. We carried out a review of the patients' medical notes recording details of past medical history, antimicrobial history including changes made upon isolation of C. striatum and the clinical outcomes following appropriate therapy.Results: Three tissue cultures and one fluid culture of C. striatum were identified. The three tissue cultures were from patients with diabetic foot osteomyelitis. The fluid sample came from a deep washout of a diabetic foot ulcer with underlying osteomyelitis, and the growth was both heavy and pure. The four patients were male, and had a mean age of 76 years, and all had a diagnosis of insulin dependent diabetes. They were all were treated successfully with targeted antimicrobial chemotherapy, and followed up for at least eight months posttreatment, with no evidence of disease recurrence.Conclusion: We report 4 cases of C. striatum osteomyelitis of the foot in patients with diabetes mellitus. We suggest that where C. striatum is isolated in pure culture from tissue samples from diabetic feet, it should not be discounted as contaminating flora but considered as a genuine cause of infection.