PubMed was searched from 1935 to December 2017 with a variety of search phrases among article titles. The references of the identified manuscripts were then manually searched. The inclusion criteria were as follows: (1) the paper presented data on measured normal body temperature of healthy human subjects ages 18 and older, (2) a prospective design was used, and (3) the paper was written in or translated into the English language. Thirty-six articles met the inclusion criteria. This comprised 9227 measurement sites from 7636 subjects. The calculated ranges (mean ± 2 standard deviations) were 36.32–37.76 (rectal), 35.76–37.52 (tympanic), 35.61–37.61 (urine), 35.73–37.41 (oral), and 35.01–36.93 (axillary). Older adults (age ≥60) had lower temperature than younger adults (age <60) by 0.23°C, on average. There was only insignificant gender difference. Compared with the currently established reference point for normothermia of 36.8°C, our means are slightly lower but the difference likely has no physiological importance. We conclude that the most important patient factors remain site of measurement and patient’s age.

Most of the cases of Klebsiella pneumoniae liver abscess reported early on were from Asia, predominantly Taiwan, with a significant number of patients being middle aged diabetic men, and developing metastatic complications, especially endophthalmitis. The entity is now being increasingly recognized in the United States. In this article, the authors review those reported cases, and also the literature regarding the pathophysiology of this intriguing syndrome.

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Background Critically ill patients with coronavirus disease‐2019 (COVID‐19) are at the theoretical risk of invasive pulmonary aspergillosis (IPA) due to known risk factors. Patients/Methods We aimed to describe the clinical features of COVID‐19‐associated pulmonary aspergillosis at a single centre in New York City. We performed a retrospective chart review of all patients with COVID‐19 with Aspergillus isolated from respiratory cultures. Results A total of seven patients with COVID‐19 who had one or more positive respiratory cultures for Aspergillus fumigatus were identified, all of whom were mechanically ventilated in the ICU. Four patients were classified as putative IPA. The median age was 79 years, and all patients were male. The patients had been mechanically ventilated for a mean of 6.8 days (range: 1‐14 days) before Aspergillus isolation. Serum galactomannan level was positive for only one patient. The majority of our cases received much higher doses of glucocorticoids than the dosage with a proven mortality benefit. All four patients died. Conclusions Vigilance for secondary fungal infections will be needed to reduce adverse outcomes in critically ill patients with COVID‐19.

BackgroundMyriad infectious and noninfectious causes of encephalomyelitis (EM) have similar clinical manifestations, presenting serious challenges to diagnosis and treatment. Metabolomics of cerebrospinal fluid (CSF) was explored as a method of differentiating among neurological diseases causing EM using a single CSF sample.Methodology/Principal findings1H NMR metabolomics was applied to CSF samples from 27 patients with a laboratory-confirmed disease, including Lyme disease or West Nile Virus meningoencephalitis, multiple sclerosis, rabies, or Histoplasma meningitis, and 25 controls. Cluster analyses distinguished samples by infection status and moderately by pathogen, with shared and differentiating metabolite patterns observed among diseases. CART analysis predicted infection status with 100% sensitivity and 93% specificity.Conclusions/SignificanceThese preliminary results suggest the potential utility of CSF metabolomics as a rapid screening test to enhance diagnostic accuracies and improve patient outcomes.

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Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP), recommends that COVID-19 vaccination should be a condition of employment for all healthcare personnel.Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law.The consensus statement also supports COVID-19 vaccination of non-employees functioning at a healthcare facility (for example, students, contract workers, volunteers, etc.). This recommendation is based on several points:The COVID-19 vaccines available in the United States (US) under the Food and Drug Administration (FDA) emergency use authorization (EUA) have high efficacy to prevent symptomatic COVID-19, even higher efficacy to prevent serious COVID-19 (i.e., hospitalizations and deaths), and high effectiveness against symptomatic and asymptomatic COVID-19 infection.The COVID-19 vaccines under FDA EUA have similar safety profiles to vaccines that are currently fully FDA-approved, shown by efficacy trials and effectiveness studies.Full vaccination against COVID-19 offers several advantages to patient and healthcare personnel (HCP) safety: individual protection against COVID-19 infection; further protection for patients and HCP who are unable to receive COVID-19 vaccination or are not able to mount an adequate immune response; reduced risk of asymptomatic or pre-symptomatic transmission of SARS-CoV-2 between HCP, and from HCP to patients or patients to HCP; reduced risk of transmitting infection to household members and community contacts; increased protection for the healthcare workforce in the community setting.

36Background: Nosocomial respiratory virus outbreaks represent serious public health challenges. 37Rapid and precise identification of cases and tracing of transmission chains is critical to end outbreaks 38 and to inform prevention measures. 39 Methods: We combined conventional surveillance with Influenza A virus (IAV) genome sequencing to 40 identify and contain a large IAV outbreak in a metropolitan healthcare system. A total of 381 41 individuals, including 91 inpatients and 290 health care workers (HCWs), were included in the 42 investigation.43 Results: During a 12-day period in early 2019, infection preventionists identified 89 HCWs and 18 44 inpatients as cases of influenza-like illness (ILI), using an amended definition, without the requirement 45 for fever. Sequencing of IAV genomes from available nasopharyngeal (NP) specimens identified 66 46 individuals infected with a nearly identical strain of influenza A H1N1 (43 HCWs, 17 inpatients, and 6 47 with unspecified affiliation). All HCWs infected with the outbreak strain had received the seasonal 48 influenza virus vaccination. Characterization of five representative outbreak viral isolates did not show 49 antigenic drift. In conjunction with IAV genome sequencing, mining of electronic records pinpointed 50 the origin of the outbreak as a single patient and a few interactions in the emergency department that 51 occurred one day prior to the index ILI cluster.52 Conclusions: We used precision surveillance to identify and control a large nosocomial IAV outbreak, 53 mapping the source of the outbreak to a single patient rather than HCWs as initially assumed based 54 on conventional epidemiology. These findings have important ramifications for more effective 55 prevention strategies to curb nosocomial respiratory virus outbreaks.56 57