BackgroundClostridium difficile infection (CDI) unresponsive to the standard treatments of metronidazole and oral vancomycin requires aggressive medical management and possible surgical intervention including colectomy. Intracolonic vancomycin therapy has been reported to be particularly promising in the setting of severe CDI in the presence of ileus. This is a descriptive case series exploring the effect of adjunctive intracolonic vancomycin therapy on the morbidity and mortality in patients with moderate to severe CDI.MethodsA retrospective chart review was conducted on 696 patients with CDI seen at a single institution. Each patient was assigned a severity score and 127 patients with moderate to severe CDI were identified. We describe the clinical presentation, risk factors and hospital course comparing those that received adjunctive intracolonic vancomycin to those that only received standard therapy.ResultsThe group that received adjunctive intracolonic vancomycin had higher rates of toxic megacolon, intensive care unit (ICU) admission, and colectomy, and yet maintained a similar mortality rate as the group that received only standard treatment.ConclusionThe intracolonic vancomycin group experienced more complications but showed a similar mortality rate to the standard therapy group, suggesting that intracolonic vancomycin may impart a protective effect. This study adds further evidence for the need of a randomized controlled study using intracolonic vancomycin as adjunctive therapy in patients presenting with severe CDI.

. Query fever (Q fever), caused by Coxiella burnetii , was first described in southern California in 1947. It was found to be endemic and enzoonotic to the region and associated with exposure to livestock. We describe a series of 20 patients diagnosed with Q fever at a Veterans Affairs hospital in southern California, with the aim of contributing toward the understanding of Q fever in this region. Demographics, laboratory data, diagnostic imaging, risk factors, and treatment regimens were collected via a retrospective chart review of patients diagnosed with Q fever at our institution between 2000 and 2016. Cases were categorized as acute or chronic and confirmed or probable. The majority presented with an acute febrile illness (90%). There was a delay in ordering diagnostic serology from the time of symptom onset (acute cases, average 31.9 days; chronic cases, average 63 days), and 15% progressed from acute to chronic infection. Of the chronic cases, 22.2% had endocarditis, 22.2% had endovascular infection, and 11.1% had both endocarditis and endovascular infection. The geographic distribution revealed that 20% resided in rural areas. Of the cases of Q fever that died, death attributed to Q fever was associated with an average diagnostic delay of 65.5 days. Acute Q fever is underreported in this region largely because of its often nonspecific clinical presentation.

The mRNA therapeutics have been studied since the 1970s and the currently available mRNA vaccines against COVID-19 are the culmination of decades of scientific research. The mRNA vaccines BNT162b2 and mRNA-1273 have played a key role in our global response to the COVID-19 pandemic as they have demonstrated significant advantages over conventional vaccines and have proven to be highly effective against COVID-19 associated hospitalization and severe illness in large clinical trials and studies using real-world data.

Gardnerella vaginalis colonization and invasive disease of the genitourinary tract in women has been well described. In men, this organism uncommonly causes infection, and bacteremia is rare. We describe two cases of G. vaginalis bacteremia in men and present a review of the literature. Our two patients each had underlying comorbid conditions that predispose to serious bacterial infection. One presented with symptoms of urinary tract infection, the other with sepsis. Urine, cultured under usual aerobic conditions, was negative in both cases, but blood cultures after prolonged incubation yielded G. vaginalis. Treatment with antibiotics was successful in both cases. Our review of the medical literature revealed 12 previously reported cases of G. vaginalis bacteremia in men. Nearly all infections in men have originated in the genitourinary tract. Three patients had no reported history of or evidence for disease of the urinary tract, one each with endocarditis, empyema and odontogenic abscess. Isolation and identification of G. vaginalis is often delayed. Selection and duration of treatment have ranged widely in previously reported cases, likely due to the absence of reports on antibiotic susceptibility of G. vaginalis and a lack of guidance regarding effective treatment.

A 70-year-old Caucasian male with a past medical history of hypertension and alcohol abuse presented to a local community hospital emergency department (ED) after a syncopal episode earlier that evening. He admitted to heavy drinking daily for several months. Imaging of the head and cervical spine were negative for any trauma. In the ED he became unresponsive and the electrocardiogram showed polymorphic ventricular tachycardia (PMVT). He was defibrillated with return of normal sinus rhythm but had recurrent episodes of ventricular fibrillation (VF) and received 10 consecutive external defibrillations. He was transferred to our hospital and on arrival his temperature was 101.0°F and the remainder of his vital signs were within normal limits. Physical examination was unremarkable except for a right wrist splint and edema of the left ankle. Chest X-ray demonstrated left lower lobar atelectasis. He was hypokalemic (potassium of 2.2 mMol/L) and his cardiac enzymes were mildly elevated, Troponin T was 0.05 ng/mL, CK 210 U/L and CKMB 2.4 ng/mL. His lactate was elevated at 3.0 mMol/L and he had a markedly elevated procalcitonin at 45.98 ug/L. His blood ethanol level was < 0.010 g/dL. Blood and urine cultures demon- Markedly Elevated Procalcitonin after AbstractBackground: Procalcitonin (PCT) is an amino acid prohormone of calcitonin that is released by various tissues in response to infection, systemic inflammation or sepsis [1] . High levels of PCT have been described in circumstances other than sepsis or infection, including major surgery, trauma, acute coronary syndromes, cardiogenic shock and cardiac arrest [2,3] .