PURPOSE:Sepsis is common in critically ill COVID-19 patients and is associated with high mortality.However, the diagnosis of sepsis and the prediction of mortality are challenging in COVID-19 patients, especially in the early stage of sepsis.Research about the performance of SIRS criteria and qSOFA score in patients with COVID sepsis is limited.Therefore, this study aimed to compare the performance of SIRS, qSOFA, and a combination of both in hospitalized COVID-19 adult patients regarding the diagnosis of sepsis and the prediction of in-hospital mortality.METHODS: Retrospective data analysis included 341 patients who were hospitalized with laboratory-confirmed COVID-19 infection during April 2020 and January 2021 (the peaks of the first and second waves in New York state) at a 242-bed universityaffiliated community-based hospital.Data from the initial patient encounter at the emergency room was collected by reviewing the electronic health records.SIRS criteria, qSOFA score, and a combination of both (SIRSþqSOFA) were analyzed by the MATLAB software.SIRSþqSOFA includes 5 parameters: tachypnea (respiratory rate $ 22), tachycardia (heart rate >90/min), fever or hypothermia (temperature >38 C (100.4 F) or < 36 C (96.8 F)), leukocytosis, leukopenia or bandemia (WBC > 12000/ mm 3 , < 4000/mm 3 , or > 10% bands), altered mentation, and hypotension (systolic blood pressure #100 mmHg).The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the performance of SIRS, qSOFA, and SIRSþqSOFA. RESULTS:In 341 COVID-19 patients, 128 patients were diagnosed with sepsis (37.5%), which included 77 expired patients (60.2%); 213 patients were not diagnosed with sepsis (62.5%), which included 50 expired patients (23.5%).The AUCs for the diagnosis of sepsis with SIRS, qSOFA, and SIRSþqSOFA were 0.739, 0.731, and 0.793, respectively.The AUCs for the prediction of mortality with SIRS, qSOFA, and SIRSþqSOFA were 0.593, 0.665, and 0.646, respectively.For diagnosing sepsis, the sensitivity of SIRS ($ 2), qSOFA ($ 2), and SIRSþqSOFA ($ 3) were 82.0%, 48.4%, and 68.8%, respectively; the specificity of SIRS ($ 2), qSOFA ($ 2), and SIRSþqSOFA ($ 3) were 54.9%, 85.4%, and 76.5%, respectively.For predicting mortality, the sensitivity of SIRS ($ 2), qSOFA ($ 2), and SIRSþqSOFA ($ 3) were 68.5%, 42.5%, and 55.9%, respectively; the specificity of SIRS ($ 2), qSOFA ($ 2), and SIRSþqSOFA ($ 3) were 46.7%, 81.8%, and 68.7%, respectively.CONCLUSIONS: For diagnosing sepsis in COVID-19 patients, the performance of SIRSþqSOFA with 5 parameters (AUC¼0.793) is better than either SIRS (AUC¼0.739)or qSOFA (AUC¼0.731).For predicting mortality, the performance of qSOFA (AUC¼0.665) is superior to either SIRS (AUC¼0.593)or SIRSþqSOFA (AUC¼0.646).CLINICAL IMPLICATIONS: This study will facilitate the diagnosis of sepsis and the prediction of mortality in the hospitalized COVID-19 adult patients.

Strongyloidiasis is an emerging parasitic infection with intriguing epidemiology, presentation, and clinical management. We report a case of hyperinfection syndrome complicated by E. coli bacteremia and meningitis with one of the isolates showing a unique resistance pattern recently being recognized. This report describes the aspect of invasive bacterial infections in strongyloidiasis and highlights the unique susceptibility pattern of the E. coli isolate and the extreme caution required during the antibiotic therapy.

HIV has been linked to several autoimmune disorders since its emergence in the 1980s. By affecting different cells and pathways in the immune system, HIV induces the development of certain autoimmune diseases while prohibiting the emergence of others. Dermatomyositis has been rarely described in patients with HIV. We present a case of dermatomyositis in a patient with HIV and explore the pathogenesis of autoimmune disorders in HIV focusing on dermatomyositis.

Invasive pulmonary aspergillosis ( IPA) is a severe fungal infection with a high mortality rate. The incidence of IPA is on the rise due to an increase in the number of patients undergoing transplants and receiving chemotherapy and immunosuppressive therapy. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of an elderly woman presenting with acute bronchitis and asthma exacerbation, who succumbed to overwhelming IPA. It is uncommon for IPA to develop in patients on short-term steroid therapy for asthma exacerbation. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.

Group F streptococcus is a commensal of the gastrointestinal tract. A 68-year-old man had persistent fever following endoscopic biopsy of a subcarinal lymph node. He subsequently developed group F streptococcal bacteremia and a mediastinal abscess. The patient was successfully treated with administration of vancomycin and aztreonam and incision drainage. Group F streptococci are an emerging source of procedure-related infection with a predilection for abscess formation. This is a rare case of postprocedure group F streptococcus mediastinal abscess.

Eikenella corrodens septic arthritis is commonly seen in “clenched fist injuries” as well as in those who are chronic finger or nail biters. In these cases, contamination of the open wound with saliva along with the proximity of joint to the skin results in septic arthritis. We report a case of septic arthritis of the hip joint with Eikenella corrodens, with no obvious portal of entry.