Toxoplasma gondii is a known cause of encephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. Toxoplasma pneumonitis is a manifestation of extracerebral toxoplasmosis and can be clinically indistinguishable from other opportunistic infections including Pneumocystis jirovecii pneumonia (PJP) and miliary tuberculosis. In this case report, Toxoplasma pneumonitis and disseminated toxoplasmosis was diagnosed using next-generation sequencing (NGS) and polymerase chain reaction (PCR) assessment. NGS can detect microbial cell-free DNA (cfDNA) circulating in the plasma of over 1,000 pathogens. This case is a rare presentation of Toxoplasma pneumonitis in the absence of neurological symptoms and we discuss the use of NGS of microbial cfDNA and PCR tests that may be utilized for the timely diagnosis of such challenging cases.

24Nasopharygneal swabs (NPS) are the collection modality recommended by the Centers for 25 Disease Control and Prevention (CDC) for reverse-transcription polymerase chain reaction (RT-PCR) 26 testing for SARS-CoV2. NPS gather both extracellular material and human respiratory epithelial cells and, 27 when used with RT-PCR, have reliable sensitivity for detection of viral infection. However, at our 28 institution, we identified a 1.7% re-order rate within 7-days for NPS for respiratory pathogen 29 which we hypothesize may be due to low confidence in adequate sample collection. We sought to 30 identify an inexpensive and accessible strategy for benchside quality assurance of NPS adequacy by 31 observing microscopic content of viral transport media. For 801 NPS samples collected in November 32 2019, we air-dried and safranin-stained aliquots of viral transport media on glass slides. We then 33 counted morphologically distinct ciliated columnar epithelial cells (CCEs). 19% of samples negative by 34 RT-PCR for respiratory pathogens had no CCEs, while just 6% of positive samples exhibited the same. 35

Mycobacterium fortuitum is a non-tuberculous rapidly growing mycobacteria (RGM). We present a case of a 30 year old female who developed a right breast subareolar abscess due to M. fortuitum four months after a nipple piercing. She failed to respond to an initial three-week course of monotherapy with trimethoprim-sulfamethoxazole despite aspiration of abscess and removal of offending nipple piercing. Our patient was successfully treated with dual antimicrobial therapy. This report also includes a brief literature review of prior reported cases caused by this organism. It is important to keep M. fortuitum and other RGM species on the differential if there is failure of resolution of abscess and infection with routine antimicrobial therapy.

No abstract

Nocardia includes over 90 species of filamentous gram-positive bacilli that may cause disease in immunocompromised or immunocompetent hosts. Presentations may include pulmonary, 4, cutaneous, or disseminated infections. Tissue diagnosis may be required as it may mimic alternative etiologies. There is a paucity of data regarding rarer species of Nocardia. Intraspecies variability in antimicrobial susceptibility limits many treatment regimens to in-vitro activity data and treatment regimens often must be tailored to individual patients based on microbiologic cultures. We describe the case of a 63-year-old female who presented with disseminated Nocardia niwae, a species that was previously first identified in Florida for which little clinical data is known, along with concurrent lung adenocarcinoma with pulmonary and central nervous system lesions. Typical susceptibility patterns are discussed along with potential side effects of antimicrobial therapy.