Recent Publications by CFE Educators

is a saprophytic fungus that causes fatal disseminated infections in immunocompromised hosts. Since the onset of the COVID-19 pandemic, multiple cases of secondary viral, bacterial, and fungal infections have been reported in patients after SARS-CoV-2 infection. We describe here a case of severe cryptococcal meningitis that developed in a previously healthy patient one week after treatment of SARS-CoV-2 infection with dexamethasone. This case adds to the growing knowledge of emerging secondary infectious complications including opportunistic pathogens after SARS-CoV-2 infection. While few reports allude to depressed T-cell function and lymphopenia due to SARS-CoV-2 infection, further studies are needed to evaluate the effects of this infection and its treatment on the immune system and its contribution to the emergence of secondary opportunistic infections.

In order to effectively control spread of coronavirus 2019 (COVID-19), it is essential that jurisdictions have the capacity to rapidly trace close contacts of each and every case. Best practice guidance on how to implement such programs is urgently needed. We describe the early experience in the City and County of San Francisco (CCSF), where the City's Department of Health expanded contact tracing capability in anticipation of changes in San Francisco's 'shelter in place' order between April and June 2020. Important prerequisites to successful scale-up included a rapid expansion of the COVID-19 response workforce, expansion of testing capability, and other containment resources. San Francisco's scale-up offers a model for how other jurisdictions can rapidly mobilize a workforce. We underscore the importance of an efficient digital case management system, effective training, and expansion of supportive service programs for those in quarantine or isolation, and metrics to ensure continuous performance improvement.

PURPOSE

Mantle cell lymphoma is a rare aggressive subtype of non-Hodgkins B cell lymphoma. It typically presents with asymptomatic monoclonal lymphocytosis, lymphadenopathy or bulky extranodal disease. Mantle cell lymphoma rarely affects the central nervous system. We present two cases in which vision loss was the initial symptom of central nervous system involvement by the malignancy.

OBSERVATIONS

Both patients initially received high dose intravenous steroids with notable improvement in their vision.

CONCLUSIONS AND IMPORTANCE

Early detection and management of optic nerve infiltration by mantle cell lymphoma is essential as it improves visual outcomes and enables prompt management of the patient's systemic disease.