BackgroundWith the increased number of influenza cases observed during the 2017 – 2018 season, patients may be at a greater risk of cardiac related complications as a sequela of viral illness. We described the frequency of troponin elevations in patients with influenza infection during the 2017 – 2018 influenza season.MethodsThis was a retrospective, single-center observational study. All patients aged 18 years or older and had laboratory confirmed influenza viral infection were included in the study. Troponins were considered elevated if greater than 0.3 ng/mL. Electronic health records were reviewed for demographics, laboratory values, coronary artery disease history, electrocardiography, echocardiography results, and incidence of inpatient mortality.ResultsA total of 1,131 patients had lab confirmed influenza infection. Majority of the influenza strains were influenza A, 76.2% (n = 863), and the rest of the influenza strains comprised of influenza B, 23.8% (n = 270). Thirty three (2.9%) patients had elevation of troponin levels greater than 0.3 ng/mL. Most of the patients with elevated troponin levels had influenza A infection (90.9%, n = 30), of which H3 subtype was the most common (48.5%, n = 16). Fifteen patients (45.5%) had a myocardial infarction, 20 (60.6%) had left ventricular abnormalities visualized on echocardiogram, and four (12.1%) died while inpatient.ConclusionsOur results describe the frequency of troponin elevations in patients with influenza infection at our institution during the 2017 – 2018 influenza season.

Non-ID physicians are less likely to monitor OPAT according to the IDSA guidelines than ID physicians; however, pharmacist oversight improves adherence to recommendations. Further studies of monitoring of OPAT by pharmacists should investigate the impact of pharmacist involvement on prevention of adverse events and hospital readmissions.

Although randomized, controlled trials supporting the use of IVIG for STSS and CDI are lacking, IVIG may be considered a last-line adjunct therapy in those patients for whom the clinical benefit outweighs the potential adverse effects of therapy.

Leishmaniasis is a protozoan infection native to various countries, including those in South America and Southeast Asia. Although the incidence of leishmaniasis is low in the United States, it is an important cause of infection in individuals traveling to endemic areas. Various treatment modalities are available, depending on their availability in the geographic region. In the United States, the treatment of choice is considered to be liposomal amphotericin, although other therapies have been explored. In 2014, miltefosine became the first orally available medication approved for the treatment of leishmaniasis in the United States. Based on available data, miltefosine is a first-line option for the treatment of leishmaniasis. Miltefosine is equally efficacious to and may be as tolerable as liposomal amphotericin B. The most common adverse effects of miltefosine are vomiting, diarrhea, and transient liver enzyme level elevation. Miltefosine has not been readily available in the United States due to marketing delays and is expected to become available later this year. In the meantime, the drug may be obtained through the Centers for Disease Control and Prevention expanded-access investigational new drug protocol.