No abstract

Predisposing factors that lead to blastomycosis remain unknown, although like other fungal infections, blastomycosis is an opportunistic infection. Here, we report on an unusual presentation in a Hmong woman with preexisting liver disease. This case highlights genetic and medical factors that may increase susceptibility to blastomycosis.

e15520 Background: Chemotherapy dose is often reduced or delayed due to adverse effects. However, a low relative dose intensity (RDI) is associated with reduced disease control and survival. There is little data among patients receiving modern breast cancer regimens regarding the risk of low RDI, or factors associated with it. Methods: We used an institutional registry at a large multidisciplinary cancer center to identify subjects with incident invasive, non-metastatic breast cancer diagnosed between 2009-2018. We focused on a subset of high-risk patients for whom chemotherapy is clearly recommended by guidelines: triple negative (estrogen receptor, progesterone receptor and HER2 negative) or HER2-positive subtypes, and either positive lymph node metastases or tumor size > 1.0 cm. We obtained administration dates and doses for the following agents: doxorubicin, cyclophosphamide, paclitaxel, docetaxel, and carboplatin. Our primary outcome was RDI < 85% of guideline-recommended doses of at least one of these agents. Other outcomes included dose of each agent (first cycle dose < 85% or total dose < 85) and timing (delay ≥7 days or early discontinuation). Variables used for analyses included BMI ≥25, race, HER2 status, age ≥55 years, marital status, stage, and Charlson co-morbidity score. Results: More than half of our cohort of high risk breast cancer patients experienced a low RDI of at least one chemotherapy agent. Out of the 237 patients who met our inclusion criteria, 60% had a low RDI, 10% received a low first cycle dose, 38% received a low total dose, and 46% experienced either a dose delay or discontinued treatment. Using logistic regression analyses, we found that being overweight (CI: 1.01-3.54; p = 0.046) and stage 3 breast cancer (CI:1.05-5.96; p = 0.038) were associated with increased odds of having a low RDI. Low total dose was associated with being overweight (p = 0.0181), unmarried (p = 0.0278), and stage 3 (p = 0.0201). HER2-positive status was also associated with a low first cycle dose (p = 0.001) and dose delays or discontinuation (p = 0.0002). Conclusions: Having a BMI ≥25, higher-stage, or being unmarried, which may serve as a proxy for low social support, are factors that may help identify patients who will have guideline-recommended chemotherapy doses reduced.

Monkeypox is a zoonotic virus that is in the same family as smallpox. It is primarily spread through various forms of close contact with an infected individual, including direct contact with an infected person’s bodily fluids or surfaces and fabrics that have been contaminated. Its symptoms are generally characterized by rashes or lesions that are firm or supple, restricted to its area, and raised in its center. Vaccines for this disease were actually developed for smallpox. There are two main types of vaccinations: ACAM2000 and 0Jynneos. ACAM2000 uses a live vaccine virus while Jynneos uses a non-replicating virus. Due to the similarity between smallpox and monkeypox, Tpoxx is being researched as a potential treatment. FDA approved Tpoxx – or Tecovirimat – in 2018 as an effective treatment for smallpox after extensive animal trials and safety studies. Currently, the drug is not FDA-approved for monkeypox; however, under an expanded access protocol, it is clinically available. There are two cases presented in this article. The first case was a heterosexual male in his 30s who contracted monkeypox while having multiple sexual encounters with women while moving from tent to tent as an unhoused resident. He also shared pipes with others for recreational marijuana use. This case illustrates that monkeypox is a virus that isn’t restricted to sexuality, especially that of the LGBTQ+ community. To clarify, this virus is not an STI/STD, it’s spread by skin-to-skin contact, contact with an object that was in contact with an infected individual, or contact with respiratory secretions. However, there are fears of singling out the LGBTQ+ community and using the monkeypox virus to stigmatize these communities, much like the AIDS pandemic in the 1980s. In this case, a large proportion of those infected identifies as non-heterosexual, which may just be a result of the nature of a viral illness. Tightly knit groups and communities that spend a lot of time with each other create many opportunities for contact and facilitate disease spread. Second case is a homosexual male in his 60s who received childhood vaccination for smallpox, and yet contracted the monkeyvirus during his travels to Germany and Switzerland, where he had encountered multiple sex partners. This case presents how previous vaccination for smallpox may not be effective against monkeypox virus. Thus, prior smallpox vaccines in the distant past offered no protection against monkeypox and are capable of spreading to people outside of the borders of LGBTQ+ community.