An 8-month-old infant with cyanotic heart disease and transfusion-associated Babesia microti infection is reported here. At initial presentation, she was ill appearing, febrile and cyanotic. Laboratory tests revealed severe anemia, thrombocytopenia and an increase in hepatic enzymes. The diagnosis was made by the presence of intraerythrocytic parasites on thin blood smear and confirmed by serology and polymerase chain reaction. The infant was treated successfully with a combination of oral azithromycin and atovaquone. This combination is an alternative to clindamycin and quinine for the treatment of children with babesiosis.

Granulocyte rich buffy coats were transfused to infected neutropenic patients when leukapheresis donors were not available. Efficacy of transfusions was evaluated from data supplied by hospitals administering them. Buffy coats separated from ACD blood contained a mean of 4.9 X 10(8) granulocytes. Fifty-seven patients received a course consisting of a mean of 3.8 transfusions. Of these, 27 received a mean of 17.5 units per transfusion and had a survival rate of 44.4%, which was not significantly different from the 50.0% found in 30 who received a mean of 11.1 units per transfusion. No significant difference in survival rate was found between 31 patients with acute leukemia and 26 with other disorders or 38 patients with positive and 19 with negative cultures. Finally, no significant difference in survival rate was noted between patients who received a course of greater than or equal to four transfusions or less than or equal to three transfusions in any of the above groups. Survival rates were less than those generally reported following similar courses of leukapheresis units. Buffy coat transfusions consisting of a mean of approximately 17.5 units as produced during this study have therefore been shown to be not generally beneficial. The increased survival seen in some studies utilizing leukapheresis products may relate in part to the larger number of granulocytes they contained. Greater benefit from buffy coat transfusions might result if the number of granulocytes infused were increased. Evaluation of possible efficacy associated with transfusions of increased numbers of buffy coat units further enriched with granulocytes may be justified when leukapheresis donors are not available.

The use of cannabis for recreational as well as medicinal use is on the rise recently with more states legalizing it. We conducted a review analysis of the literature published on acute respiratory failure from vaping cannabis oil. We have also summarized the clinical details (age, length of stay, mode of ventilation, common clinical findings, and steroid use) along with common laboratory abnormalities. This article aims to educate health care providers on the clinical manifestations and management strategies for vaping-induced acute respiratory failure. We also discussed the different available formulations of cannabis oil and key ingredients responsible for the vaping-associated lung injury.

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Nocardia causes rare opportunistic infections, that can be challenging to diagnose because of atypical features on conventional microbiological identification techniques. Immunosuppressed patients are more susceptible to infections from Nocardia and are associated with multi-organ involvement. We report a case of a 63-year-old male who developed peritonitis from Nocardia farcinica that rarely causes infections in humans. The nonspecific symptoms, negative blood cultures, and slow growth can make diagnosis difficult. Despite aggressive therapy, the virulence and inherent resistance to the antibiotics can result in high mortality from Nocardia farcinica infections.