Background: Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. Results: Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84–0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72–0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. Conclusions: Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

In patients with newly diagnosed HIV, IR testing is projected to result in worse outcomes and is not cost-effective. Pretreatment assessment for INSTI resistance should not be recommended in treatment guidelines.

Background Acute myeloid leukemia (AML) is associated with a poor prognosis, particularly in elderly patients with comorbidities. Combining azacitidine (AZA) with the BCL-2 inhibitor venetoclax (VEN) demonstrated significant improvement in outcomes for newly diagnosed older AML patients compared to AZA alone. However, this regimen is myelosuppressive, and the incidence of invasive fungal infections (IFI) and impact of antifungal prophylaxis are not well defined. Methods This retrospective cohort study evaluated newly-diagnosed AML patients treated with VEN/AZA at the University of Colorado Hospital from January 2014 to August 2020. Patients with a history of prior IFI were excluded. The primary outcome was incidence of IFI during VEN/AZA therapy. Chi-square and Fisher’s exact test assessed the impact of patient demographics, AML-specific risk factors, and receipt of antifungal prophylaxis on incidence of IFI. Results One hundred forty-four VEN/AZA-treated AML patients were included in the study. Twenty-five (17%) patients developed IFI: 8% (n=2) “proven”, 24% (n=6) “probable”, and 68% (n=17) “possible” per EORTC/MSGERC criteria. There was no statistically significant association between incidence of IFI with age, sex, or European LeukemiaNet (ELN) classification. Ten patients received antifungal prophylaxis, and none developed IFI. Incidence rate of IFI per 1000 patient-days was greatest 0-9 days after starting VEN/AZA, at 8.39. Conclusions The incidence of “proven” and “probable” IFI in our AML cohort treated with VEN/AZA was 5.6%, which is in line with incidence rates reported by recent similar studies. Furthermore, incidence of IFI generally decreased as the number of days from starting VEN/AZA therapy increased.

Cryptococcus species are ubiquitous in the environment with a global distribution. Whilst causing disease predominantly in immunocompromised hosts such as those with advanced HIV, HIV-uninfected patients are increasingly recognized to be affected. The most common forms of infection are cryptococcal pneumonia and meningitis. HIV-uninfected patients and extrapulmonary infections have worse outcomes, likely due to delayed diagnosis and treatment. Cryptococcus infections involving chylothorax or chyloabdomen have rarely been reported in humans. We describe a case of fulminant disseminated cryptococcosis with fungemia, peritonitis, and empyema in a patient with chronic chylothorax treated with an indwelling pleurovenous shunt. Key autopsy findings included cryptococcal organisms identified on calcified lymphadenopathy, pleural adhesions, and pericardium. We discuss the importance of identifying patients with non-traditional risks factors for cryptococcal disease, such as lymphopenia and hypogammaglobulinemia, and the potential implications of pleurovenous catheters in Cryptococcus dissemination.

Tuberculosis is of particular concern in lung transplant recipients. We present the case of a patient who received a double lung transplant from a deceased donor from Mexico and developed disseminated tuberculosis 60 days post-transplant manifested as tenosynovitis, liver abscesses, and subcutaneous nodules with no definitive lung allograft involvement. The recipient did not have evidence of tuberculosis on explanted lungs, had a negative interferon gamma release assay pre-transplant, and did not have risk factors for this infection. Mycobacterium tuberculosis should remain in the differential diagnosis of early post-transplant infections with atypical presentations, evidence of dissemination, or lack of improvement with appropriate antimicrobial coverage, even in the absence of typical lung findings.