Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with higher transmission potential have been emerging globally, including SARS-CoV-2 variants from the United Kingdom and South Africa. We report 4 travelers from Brazil to Japan in January 2021 infected with a novel SARS-CoV-2 variant with an additional set of mutations.

An aneurysm of the sinus of Valsalva is clinically rare, and its operative indications and procedures are controversial. We herein report the rare case of a 68-year-old woman with severe right ventricular outflow tract obstruction caused by an aneurysm of the right sinus of Valsalva. We performed partial aortic root reconstruction using a bovine pericardial patch, and aortic valve replacement. Although this case provides evidence that these are suitable surgical techniques for treatment of aneurysm of the sinus of Valsalva, total aortic root replacement should have been chosen based on the pathological finding of aortic medial and valve degeneration.

Background Entamoeba histolytica (E. histolytica) is rarely identified as a cause of amebic pericarditis. We report a case of amebic pericarditis complicated by cardiac tamponade, in which the diagnosis was missed initially and was made retrospectively by polymerase chain reaction (PCR) testing of a stored sample of pericardial fluid. Furthermore, we performed a systematic review of the literature on amebic pericarditis. Case presentation A 71-year-old Japanese man who had a history of sexual intercourse with several commercial sex workers 4 months previously, presented to our hospital with left chest pain and cough. He was admitted on suspicion of pericarditis. On hospital day 7, he developed cardiac tamponade requiring urgent pericardiocentesis. The patient’s symptoms temporarily improved, but 1 month later, he returned with fever and abdominal pain, and multiple liver lesions were found in the right lobe. Polymerase chain reaction of the aspiration fluid of the liver lesion and pericardial and pleural fluid stored from the previous hospitalization were all positive for E. histolytica. Together with the positive serum antibody for E. histolytica, a diagnosis of amebic pericarditis was made. Notably, the diagnosis was missed initially and was made retrospectively by performing PCR testing. The patient improved with metronidazole 750 mg thrice daily for 14 days, followed by paromomycin 500 mg thrice daily for 10 days. Conclusions This case suggests that, although only 122 cases of amebic pericarditis have been reported, clinicians should be aware of E. histolytica as a potential causative pathogen. The polymerase chain reaction method was used to detect E. histolytica in the pericardial effusion and was found to be useful for the diagnosis of amebic pericarditis in addition to the positive results for the serum antibody testing for E. histolytica. Because of the high mortality associated with delayed treatment, prompt diagnosis should be made.

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BackgroundCoagulase-negative staphylococci (CoNS) are one of the most common contaminant microorganisms isolated from blood cultures (BCs). MethodsWe conducted a retrospective cohort study at St Luke’s International Hospital from 2004 to 2017. We collected a total of 1,192 BCs due to CoNS. Of 1,192 BCs, 143 patients with polymicrobial infection and 112 patients who were <18 years old were excluded. We defined the true infection (TI) on the following criteria; (1) patients with persistent bacteremia due to CoNS, (2) BCs that were positive more than two sets, (3) patients with foreign body implanted 28 days before taking BCs. Chi-square test, Fisher’s exact test and Student’s t-test were used in univariate analysis and logistic regression analysis was used in multivariable analysis. ResultsOf 927 patients’ BCs data, 201 patients were defined as TI, and 726 patients were defined as contamination. BCs collection location (general ward), inpatient, malignant tumor, steroids or chemotherapy use 90 days before collection, presence of central venous catheter (CVC), mortality in 90 days after collection, time to positivity (TTP: 24–48 hours, and <24 hours) differed significantly between these two groups. Based on multivariable analysis, TTP: 24–48 hours (adjusted odds ratio [OR] 1.93, P = 0.019, 95% confidential interval [CI] 1.11–3.36), and <24 hours: (OR 4.83, P < 0.001, 95% CI 2.68–8.68), BCs collection location: general ward (OR 2.21, P < 0.001, 95% CI 1.58–3.10), and presence of CVC (OR 1.91, P < 0.001, 95% CI 1.37–2.66) were identified as independent risk factors of TI. Based on the estimates of OR, we assigned a score to each factors (Table 1). Area under the curve was 0.702 (95% CI 0.662–0.741) (Figure 1). ROC analysis showed that, if a patient’s score is 0 point, TI can be excluded with sensitivity: 98%. On the other hands, if a patient’s score is 7 points or more, TI can be diagnosed with specificity: 87%. ConclusionTime to positivity, location of blood collection, and the presence of CVC were associated with TI. The prediction rule developed in this study can be useful for clinicians for making decision whether to use antibiotics or not.Table 1.Prediction Rule of CNS True Infection.Figure 1.ROC Analysis of Prediction Rule.Disclosures All authors: No reported disclosures.

An 80-year-old man with a 3-month history of emergency percutaneous stent implantation (bare metal stent, 3.5 Â 22 mm) in the left main trunk (LMT) for ST-elevation myocardial infarction (99% stenosis of LMT) with cardiogenic shock, was referred to our institution for surgical intervention. He had a recent history of worsening chest pain. Coronary angiography showed 90% intrastent stenosis (Figure 1). He underwent coronary artery bypass grafting (left internal thoracic artery to left anterior descending artery #8, aortocoronary bypass to left circumflex artery #14 with a saphenous vein graft) under cardiopulmonary bypass. Intraoperative transesophageal echocardiography showed an approximately 6-mm protrusion of the stent into the aortic root (Figure 2). On visual inspection, the protruded stent was fractured and the LMT orifice was severely narrowed. The stent was removed. The patient eventually recovered fully, without the need for further intervention. When protrusion occurs, catheter-related procedures or blood flow in the aortic root can induce stent fracture and deformation, leading to rapid progressive intrastent stenosis. Physicians and surgeons should be aware that percutaneous coronary intervention for LMT lesions has a potential risk of such complications.