A novel coronavirus causing acute illness with severe symptoms has been isolated in Wuhan, Hubei Province, China. Since its emergence, cases have been found worldwide, reminiscent of severe acute respiratory syndrome and Middle East respiratory syndrome outbreaks over the past 2 decades. Current understanding of this epidemic remains limited due to its rapid development and available data. While occurrence outside mainland China remains low, the likelihood of increasing cases globally continues to rise. Given this potential, it is imperative that emergency clinicians understand the preliminary data behind the dynamics of this disease, recognize possible presentations of patients, and understand proposed treatment modalities.

Introduction The aim of this study was to evaluate the performance of five general severity-of-illness scores (Acute Physiology and Chronic Health Evaluation II and III-J, the Simplified Acute Physiology Score II, and the Mortality Probability Models at admission and at 24 hours of intensive care unit [ICU] stay), and to validate a specific score -the ICU Cancer Mortality Model (CMM) -in cancer patients requiring admission to the ICU. Methods A prospective observational cohort study was performed in an oncological medical/surgical ICU in a Brazilian cancer centre. Data were collected over the first 24 hours of ICU stay. Discrimination was assessed by area under the receiver operating characteristic curves and calibration was done using Hosmer-Lemeshow goodness-of-fit H-tests. Results A total of 1257 consecutive patients were included over a 39-month period, and 715 (56.9%) were scheduled surgical patients. The observed hospital mortality was 28.6%. Two performance analyses were carried out: in the first analysis all patients were studied; and in the second, scheduled surgical patients were excluded in order to better compare CMM and general prognostic scores. The results of the two analyses were similar. Discrimination was good for all of the six studied models and best for Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation III-J. However, calibration was uniformly insufficient (P < 0.001). General scores significantly underestimated mortality (in comparison with the observed mortality); this was in contrast to the CMM, which tended to overestimate mortality. Conclusion None of the model scores accurately predicted outcome in the present group of critically ill cancer patients. In addition, there was no advantage of CMM over the other general models.

Clofazimine appears safe and may be considered as a salvage therapeutic option in SOT recipients with MAC infection who are intolerant or unresponsive to standard therapy. The small sample size does not allow conclusions regarding efficacy.

dPrepatellar bursitis is typically a monomicrobial bacterial infection. A fungal cause is rarely identified. We describe a 61-year-old man who had received a renal transplant 21 months prior to presentation whose synovial fluid and surgical specimens grew Phomopsis bougainvilleicola, a pycnidial coelomycete. CASE REPORTA 61-year-old man with chronic renal disease secondary to diabetic nephropathy and hypertensive nephrosclerosis underwent deceased-donor kidney transplantation 21 months prior to presentation. His posttransplant course was uncomplicated, although he had a history of gout, hepatitis C (genotype 1a), and coronary artery disease. Although the patient received therapy for hepatitis C with ribavarin and interferon prior to transplantation, he did not have a sustained virologic response and his hepatitis C virus load was 227,754 IU/ml 2 months before transplantation. The patient developed right knee pain for 2 days and then sought care. Immunosuppressive agents included tacrolimus, mycophenolate, and prednisone, none of which had been recently changed. He was a retired carpenter and auto mechanic who was born in Puerto Rico but had been living in mainland United States since childhood.On physical examination, he was in no apparent distress and was afebrile with marked edema and erythema of the right knee. He had inability to flex his knee beyond 30 degrees due to excruciating pain. The remainder of the examination was unremarkable.Laboratory evaluation showed a complete blood count that was within normal limits (white blood cell count of 6,100/mm 3 , hemoglobin of 14.8 g/dl, hematocrit of 45.1%, and platelet count of 178,000/mm 3 ), C-reactive protein of 20.1 mg/liter, and an erythrocyte sedimentation rate of 23 mm/h. Ultrasonography showed a heterogenous collection in the prepatellar superficial subcutaneous tissue. Magnetic resonance imaging demonstrated marked thinning and surface irregularity of the patellar cartilage with full-thickness cartilage loss at the patellar apex and associated subchondral bone marrow edema and intact bones (Fig. 1), consistent with prepatellar bursitis. A chest X-ray did not show any evidence of pulmonary disease.Arthrocentesis revealed red and cloudy synovial fluid with 232,000 white blood cells, predominantly neutrophils; no crystals were seen. After arthrocentesis, empirical therapy with vancomycin and ceftriaxone was initiated to cover the most likely organisms. However, fluid reaccumulated, requiring repeated arthrocenteses followed, 5 days later, by surgical drainage in the operating room, where purulent material under pressure and inflamed synovial tissue were found.The same filamentous fungus grew in six different specimens from the percutaneous aspirates and from the operating room tissue. Culture from the initial aspirate was planted on thioglycolate broth, tryptocase soy agar (TSA) with 5% sheep blood, chocolate agar, and MacConkey agar. The routine culture was positive 4 days later and grew on TSA and chocolate agar at 35°C in 5% CO 2 . The fungal culture grew...