A multidisciplinary approach was used to identify cases in an outbreak of M. marinum infections. The use of histopathology, culture, and IHC plus PCR from full thickness skin biopsy can lead to improved diagnosis of M. marinum SSTIs compared to relying solely on mycobacterial culture, the current gold standard.

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Introduction Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI)-related hospitalizations in older adults. Without RSV-specific treatment for adults, testing is uncommon, leading to potential underestimation of RSV incidence in real-world data studies. This study aimed to quantify the frequency of RSV testing during LRTI-related hospitalizations of older adults to inform interpretation of incidence estimates. Methods Administrative and billing data for hospitalizations of adults aged ≥ 65 years with a primary or secondary diagnosis of LRTI during the 2016–2019 RSV seasons (October–April) were extracted from the US all-payer Premier Healthcare Database (PHD). Billing codes identified RSV tests administered during eligible hospitalizations. The proportion of LRTI-related hospitalizations with a billed RSV test was calculated for each hospital in PHD, and summarized descriptively by hospital bed size, teaching status, and population served. Results Most of the 937 study hospitals performed RSV testing infrequently during LRTI hospitalization; median percentage of LRTI hospitalizations with RSV testing was 4.3%, and 78.4% of hospitals performed RSV testing in less than 25% of LRTI-related hospitalizations. RSV testing varied extensively by hospital type. Median percentage tested was significantly higher for hospitals with ≥ 200 beds (9.1%) versus < 200 beds (1.6%), for teaching (11.0%) versus non-teaching (2.5%) hospitals, and in urban (7.4%) versus rural (0.7%) settings. The median percentage of RSV testing increased over time, from 0.8% to 6.3% between the 2016/17 and 2018/19 seasons. Conclusion A small proportion of older adults hospitalized with LRTI are tested for RSV in US hospitals. Large variability occurs across hospital types. Consequently, retrospective database analyses likely result in a substantial underestimation of the true RSV-related hospitalization incidence. RSV incidence studies using real-world data need to assess for RSV testing frequency and adjust their results for under ascertainment associated with limited testing. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00758-5.

Mycobacterium marinum, a bacterium found in freshwater and saltwater, can infect persons with direct exposure to fish or aquariums. During December 2013, the New York City Department of Health and Mental Hygiene learned of four suspected or confirmed M. marinum skin or soft tissue infections (SSTIs) among persons who purchased whole fish from Chinese markets. Ninety-eight case-patients with non-tuberculous mycobacteria (NTM) SSTIs were identified with onset June 2013-March 2014. Of these, 77 (79%) were female. The median age was 62 years (range 30-91). Whole genome sequencing of clinical isolates revealed two main clusters and marked genetic diversity. Environmental samples from distributors yielded NTM though not M. marinum. We compared 56 case-patients with 185 control subjects who shopped in Chinese markets, frequency-matched by age group and sex. Risk factors for infection included skin injury to the finger or hand (odds ratio [OR]: 15·5; 95% confidence interval [CI]: 6·9-37·3), hand injury while preparing fish or seafood (OR 8·3; 95% CI 3·8-19·1), and purchasing tilapia (OR 3·6; 95% CI 1·1-13·9) or whiting (OR 2·7; 95% CI 1·1-6·6). A definitive environmental outbreak source was not identified.

There are conflicting data regarding the influence of hepatitis C virus (HCV) infection on the immune restoration experienced by HIV-infected patients who receive highly active antiretroviral therapy (HAART). In this multicenter, retrospective, longitudinal study, CD4 restoration was assessed according to HCV status in treatment-naive HIV-infected patients within 3 years of HAART. Only patients with persistent HIV suppression were included. Factors predicting CD4 gains were analyzed with multivariate linear regression. Out of 322 patients included 139 had positive HCV-RNA and 183 were only HIV infected. HCV-HIV-coinfected patients were older, more often ex-intravenous drug users (IVDU), and had less advanced HIV infection. Baseline CD4 count [OR -0.21 [95% CI (-0.34)-(-0.04)]; p = 0.01] and male sex [OR -0.19 [95% CI (-191.12)-(-10.87)]; p = 0.03] predicted smaller increments in absolute CD4 counts, and higher baseline CD4% [OR -0.38 [95% CI (-0.39)-(-0.21)]; p < 0.0001] and older age [OR -0.12 [95% CI (-0.23)-(-0.01)]; p = 0.03] predicted smaller gains in CD4% after 3 years of HAART. A history of IVDU was associated with smaller absolute CD4 count increases at 1 year of therapy [OR -0.20 [95% CI (-128.32)-(-16.24)]; p = 0.01]. Use of nucleoside reverse transcriptase inhibitor (NRTI)-only regimens and of zidovudine as part of the NRTI backbone was associated with smaller and greater gains in CD4%, respectively. HCV replication per se does not impair the CD4 restoration in HIV-infected patients successfully treated with antiretroviral therapy. Lower baseline CD4 counts are the strongest predictors of greater CD4 gains over a 3-year period, while a history of IVDU negatively affects CD4 restoration only early after the initiation of HAART.