Invasive pulmonary aspergillosis (IPA) is a severe fungal infection with a high mortality rate. The incidence of IPA is on the rise due to an increase in the number of patients undergoing transplants and receiving chemotherapy and immunosuppressive therapy. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of an elderly woman presenting with acute bronchitis and asthma exacerbation, who succumbed to overwhelming IPA. It is uncommon for IPA to develop in patients on short-term steroid therapy for asthma exacerbation. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.

Background Little is known about the prevalence of secondhand smoke exposure (SHSe) among cancer survivors. We sought to determine the prevalence, trends, and correlates of SHSe among non-smoking adult cancer survivors in the United States (US). Methods Interview and serum cotinine data for non-smoking adults, aged 20 years and older, with a history of cancer (N=686) were obtained from consecutive 2-year cross-sectional cycles of the National Health and Nutrition Examination Survey from 1999–2012. SHSe was defined as serum cotinine 0.05–10ng/mL among non-smokers. We calculated and trended the prevalence of SHSe among non-smoking cancer survivors. Multivariable logistic regression was used to examine the associations of SHSe with sociodemographic, smoking, and clinical characteristics. Survey weights were applied in estimating prevalence rates, adjusted odds ratios, and confidence intervals (CI). Results The weighted aggregate SHSe and self-reported indoor SHSe prevalence rates over the study period were 28.26% (95% CI: 24.97%, 31.55%) and 4.53% (95% CI: 3.48%, 5.57%), respectively. SHS exposure declined from 39.61% (95% CI: 27.88%, 51.34%) in 1999/2000 to 15.68% (95% CI: 9.38%, 21.98%) in 2011/2012 (p<0.001 for trend). Age ≥60 years was protective against SHSe while being black, having less than high school education, poverty, and a smoking-related cancer history were associated with higher odds of SHSe. Conclusion Fortunately, SHSe among non-smoking cancer survivors in the US is on the decline, although certain sub-groups remain disproportionately burdened. Impact These findings highlight clinical and public health imperatives to target socioeconomically disadvantaged non-smoking cancer survivors to reduce their SHSe.

Introduction Several comorbid conditions have been identified as risk factors in patients with coronavirus disease 2019 (COVID-19). However, there is a dearth of data describing the impact of COVID-19 infection in patients with end-stage renal disease on hemodialysis (ESRD-HD). Methods This retrospective case series analyzed 362 adult patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020, and May 13, 2020, at a teaching hospital in the New York City metropolitan area. The primary outcome was severe pneumonia as defined by the World Health Organization. Secondary outcomes were the (1) the Combined Outcome of Acute respiratory distress syndrome or in-hospital Death (COAD), and (2) need for high levels of oxygen supplementation (HiO 2). Results Patients with ESRD-HD had lower odds for poor outcomes including severe pneumonia [odds ratio (OR) 0.4, confidence interval (CI) 0.2-0.9, p=.04], HiO 2 [OR 0.3, CI (0.1-0.8), p=.02] and COAD [OR 0.4, CI (0.2-1.05), p=.06], when compared to patients without ESRD. In contrast, higher odds for severe pneumonia, COAD and HiO 2 were seen with advancing age. African Americans were over-represented in the hospitalized patient cohort, when compared to their representation in the community (35% vs 18%). Hispanics had higher odds for severe illness and HiO 2 when compared to Caucasians. Conclusions Patients with ESRD-HD had a milder course of illness with a lower likelihood of severe pneumonia and a lesser need for aggressive oxygen supplementation when compared to patients not on chronic dialysis. The lower odds of severe illness in ESRD-HD patients might have a pathophysiologic basis and need to be further explored.

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