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Invasive fungal disease (IFD) occurs in about 5%-20% of solid organ transplant recipients depending on the type of organ transplant and antifungal prophylaxis strategies used. 1,2 Liver transplant recipients are highly susceptible to IFD because of complex biliary-enteric anastomosis and underlying immunological defects related to liver dysfunction and immunosuppressive treatment. They are surpassed

Background and Aims: Spontaneous bacterial peritonitis (SBP) is a common and potentially fatal complication of liver cirrhosis. This study aims to analyze the prevalence of SBP among liver cirrhotic patients according to geographical location and income level, and risk factors and outcomes of SBP.Methods: A systematic search for articles describing prevalence, risk factors and outcomes of SBP was conducted. A single-arm meta-analysis was performed using generalized linear mix model (GLMM) with Clopper-Pearson intervals.Results: Ninety-Nine articles, comprising a total of 5,861,142 individuals with cirrhosis were included. Pooled prevalence of SBP was found to be 17.12% globally (CI: 13.63–21.30%), highest in Africa (68.20%; CI: 12.17–97.08%), and lowest in North America (10.81%; CI: 5.32–20.73%). Prevalence of community-acquired SBP was 6.05% (CI: 4.32–8.40%), and 11.11% (CI: 5.84–20.11%,) for healthcare-associated SBP. Antibiotic-resistant microorganisms were found in 11.77% (CI: 7.63–17.73%) of SBP patients. Of which, methicillin-resistant Staphylococcus aureus was most common (6.23%; CI: 3.83–9.97%), followed by extended-spectrum beta-lactamase producing organisms (6.19%; CI: 3.32–11.26%), and lastly vancomycin-resistant enterococci (1.91%; CI: 0.41–8.46%). Subgroup analysis comparing prevalence, antibiotic resistance, and outcomes between income groups was conducted to explore a link between socioeconomic status and SBP, which revealed decreased risk of SBP and negative outcomes in high-income countries.Conclusion: SBP remains a frequent complication of liver cirrhosis worldwide. The drawn link between income level and SBP in liver cirrhosis may enable further insight on actions necessary to tackle the disease on a global scale.

AG-AKI is common in the elderly, with a significant risk of ERD, but the cause and severity are greatly influenced by critical illness and shock, more so than AG therapy alone.

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Background On January 30, COVID-19 was declared a Public Health Emergency of International Concern—a week after Singapore’s first imported case and 5 days before local transmission. The National University Hospital (NUH) is Singapore’s third largest hospital with 1200 beds, heavy clinical workloads, and major roles in research and teaching. Main body With memories of SARS still vivid, there was an urgent requirement for the NUH Division of Infectious Diseases to adapt—undergoing major reorganization to face rapidly changing priorities while ensuring usual essential services and standards. Leveraging on individual strengths, our division mobilized to meet the demands of COVID-19 while engaging in high-level coordination, strategy, and advocacy. We present our experience of the 60 days since the nation’s first case. During this time, our hospital has managed 3030 suspect cases, including 1300 inpatients, 37 confirmed cases, and overseen 4384 samples tested for COVID-19. Conclusion Complex hospital adaptations were supported by an unprecedented number of workflows and coordination channels essential to safe and effective operations. The actions we describe, aligned with international recommendations and emerging evidence-based best practices, may serve as a framework for other divisions and institutions facing the spread of COVID-19 globally.

Cryptococcosis is a fungal infection caused by Cryptococcus neoformans and Cryptococcus gattii. Although it typically affects immunocompromised patients, it can cause disease in immunocompetent patients. The range of clinical infections includes chronic skin infections, lung infections and meningitis. Diagnostic modalities include cryptococcal antigen (CrAg) detection tests and culture from infected sites. More recently, the Biofire meningitis/encephalitis (ME) panel (bioM erieux, Marcy l'Etoile, France) was added to the range of available tests for cryptococcal meningitis. The Biofire ME panel is a user-friendly PCR panel with 14 targets for bacterial and viral causes of community-acquired meningitis/ encephalitis including C. neoformans and C. gattii (both species combined as a single target) able to return results within an hour. The fast turnaround time allows clinicians to rapidly initiate targeted therapies. However, when a new test is introduced, previously unknown issues may arise. False-negative results following erroneous automated result interpretation [1] and false-positive results for the Cryptococcus PCR on the Biofire have been reported [2]. Other cases where samples with positive results on conventional testing were negative on the Biofire ME panel have also been reported [3]. We report two cases of false-negative Cryptococcus results on the Biofire ME panel. The first patient was a 24-year-old man with a history of gonadal dysgenesis and congenital pulmonary stenosis, who presented with meningitis symptoms and fever. A lumbar puncture was performed 48 h after intravenous ceftriaxone and acyclovir therapy. The cerebrospinal fluid (CSF) biochemistry and cell counts are as follows: glucose: 1.6 mmol/L, protein: 1.34 g/L, white blood cells: 287 cells/mL (6.0% neutrophils, 74.0% lymphocytes, 16.0% monocytes, 4.0% eosinophils), red blood cells: 18 cells/mL. Bacterial cultures, India ink smear and the Biofire ME panels were negative. Antimicrobials were ceased following clinical improvement and the patient was observed for an additional 48 h and subsequently discharged well. At day 5, fungal cultures grew C. neoformans. The patient was recalled and a lumbar puncture was repeated as he remained asymptomatic. CrAg lateral flow assay (LFA) (IMMY, Norman, OK, USA) was performed and was positive. Culture again grew C. neoformans. The second patient was a 65-year-old man with a history of Hashimoto's thyroiditis, rheumatoid arthritis (on methotrexate) and hypertension, who presented with an altered mental state. MRI revealed a diffuse leptomeningeal enhancement of bilateral