Background: Community-acquired pneumonia (CAP), which is classified as pneumonia acquired outside healthcare settings, can progressively develop into sepsis—a leading cause of death in children if not properly managed. The risk factors for CAP-induced sepsis may vary with age due to differences in immune maturity, developmental factors, and the underlying causes of pneumonia. This study aims to identify the risk factors associated with CAPinduced sepsis, focusing on the demographic and clinical characteristics. Objective: This study aimed to determine the risk factors associated with the occurrence of sepsis in pediatric patients with CAP, with an emphasis on both the demographic and clinical risk factors. Methods: This cohort study included cases of CAP in children aged 1 month to 17 years, and their disease progression was followed up to determine whether or not they developed sepsis. The univariate analysis was performed using the chi-square and Fische's exact tests, while the multivariate analysis was performed using multiple logistic regression. Results: Of the 107 pediatric patients with CAP, 90 children met the inclusion criteria. Of them, 20 developed sepsis, while 70 recovered. The data analysis from this study identified two factors that significantly increase the risk of a child with CAP developing sepsis. These factors were temperature (RR 3.5 [95% confidence interval (CI) 1.269~9.652]; p = 0.007) and absolute neutrophil count (ANC) (RR 3.5 [95% CI 1.708~7.171]; p = 0.021). Conclusion: Temperature and ANC were found to be significant independent risk factors that may increase the likelihood of sepsis in children with CAP. Although these factors were significant in this study, future research is needed to determine how these risk factors vary by age, and CAP etiology can further refine early sepsis risk identification and improve targeted management strategies

Mucormycosis is a rare and life-threatening fungal infection that predominantly affects immunocompromised individuals, particularly those with poorly controlled diabetes mellitus. Achieving an accurate diagnosis remains a significant challenge in clinical practice. We report a case of mucormycosis in a 25-year-old woman who presented with an altered mental status and a 5 × 2 cm necrotic lesion on the left nasal septum, characterized by indistinct borders, during admission. Prolonged diagnostic investigations ultimately led to the identification of nasal mucormycosis attributable to Rhizomucor pusillus, a rare species within the Mucorales order, which complicates the diagnostic process. Unfortunately, the patient's clinical condition rapidly deteriorated, resulting in her demise prior to the administration of systemic antifungal therapy. Although the comprehensive evaluations facilitated the identification of the causative agent, the time required for this process did not favor the patient's prognosis. The atypical symptoms, swift progression, and infrequent occurrence of mucormycosis underscore the critical importance of its timely and accurate diagnosis to ensure favorable patient outcomes. Proper identification of the pathogen and immediate administration of therapeutic interventions can considerably enhance the likelihood of patient recovery and survival.

Mycobacterium lepromatosis is the primary cause of diffuse lepromatous leprosy and has previously been linked to the Lucio phenomenon in Mexico. In this study, we demonstrate that M. leprae and M. lepromatosis are responsible for many of the leprosy infections in which the Lucio phenomenon occurs. A 47-year-old female presented with chief complaints of erythematous and purpuric lesions on her left lower extremity and bilateral upper extremities. Over the past month, she had experienced recurrent tingling sensations in both legs. The patient had widespread infiltration, no nodules, madarosis (eyelash loss), and thickening in both ears. An acid-fast bacilli analysis revealed a bacterial index of 4+ and a microscopy index of 7%. Biopsy tissue was lacking the epidermal layer, and there was a dermal layer of dilated blood vessels, an area of bleeding, and infiltration of neutrophil inflammatory cells, perivascular plasma cells, foam cells, histiocytes, lymphocytes, the endothelium, and perivascular regions by acid-fast bacilli. A polymerase chain reaction identified the presence of both M. leprae and M. lepromatosis. The patient's symptoms worsened rapidly and she developed ulcers on both hands and both legs, extending to the soles of the feet. She was admitted to the hospital 3 days after presentation. Based on the clinical symptoms, examination of tissue samples, and the polymerase chain reaction identification of coinfection with M. leprae and M. lepromatosis, a diagnosis of diffuse lepromatous leprosy was made. The M. leprae bacteria were verified by DNA sequencing.

Background: Among women who can have children, bacterial vaginosis (BV) is the most common cause ofabnormal vaginal discharge. Due to its high prevalence and morbidity, it is crucial to prevent BV by addressing its risk factors. Objective: This study aimed to determine the incidence and determinants of BV in the sexually transmitted infection (STI) division of the Dermatovenereology Department at Dr. Soetomo Hospital in Surabaya. Methods: This retrospective analytical observational study was conducted using a cross-sectional approach. Electronic data from 56 patients were included in the study, covering the period from 2019 to 2022. The patients were divided into two groups: BV patients and controls. BV patients were diagnosed with BV by fulfilling three out of four Amsel criteria, while controls with typical vaginal discharge. Results: The study included 34 BV patients and 22 control patients. Bivariate analysis showed a significant correlation between the incidence of BV and the number of sexual partners (p = 0.009) and the use of intrauterine devices (IUD) (p = 0.002). Multivariate analysis confirmed that both factors were determinants of BV incidence, with IUD use being the most dominant determinant (95% CI 1.86~135.02, p = 0.01). Conclusion: The study found that the use of IUDs and the number of sexual partners significantly determined BV incidence.

Pediculosis capitis, commonly known as head lice infestation, is caused by head lice, a type of ectoparasite that affects the human scalp. Excessive scratching of the scalp due to itching can lead to skin damage and bacterial infection. In severe cases of infestation, it can cause iron deficiency anemia. This case report presents a 29-yearold female with pediculosis capitis and secondary infection. The patient had a low hemoglobin level of 7.8 g/dL, indicating anemia despite no history of bleeding. The patient was successfully treated with permethrin 1% lotion, antibiotics, ferrous sulfate, and folic acid. Proper treatment of pediculosis capitis, including its complications, and educating the patients are equally essential to combat the infestation and prevent the spread of the parasites.

Aspergillus spp., one of the most common nondermatophyte molds (NDMs) that cause onychomycosis, are saprophytic fungi that can act as zoonotic agents and cause various health issues, including onychomycosis, in humans. Predisposing factors for onychomycosis include nail trauma, immunosuppression, and occupation. Nails in patients with leprosy are prone to change and develop onychomycosis due to unrecognized trauma to the nail area. Here, we report the case of a 25-year-old woman with 2-month history of white patches in fingernails and toenails, which were also brittle and damaged. She was a veterinarian who had frequent, direct interaction with animals, particularly dogs and cats. She denied trauma prior to the manifestation of symptoms and was undergoing leprosy treatment, including corticosteroids for leprosy reactions. Examination with potassium hydroxide revealed hyphae, and the nail culture revealed growth of fungal colonies with the characteristics of A. flavus. She received four cycles of itraconazole at 400 mg/day. Two of the three afflicted nails showed complete cure, whereas one nail showed mycologic cure. A. flavus is frequently found in animals, including dogs and cats and might have been a source of Aspergillus transmission, suggesting the patient's occupation and immunosuppression as risk factors for onychomycosis. Onychomycosis due to Aspergillus, particularly A. flavus, responds well to itraconazole pulse monotherapy.

Basidiobolomycosis is a rare deep fungal infection caused by Basidiobolus ranarum and characterized by the development of swollen erythematous nodular lesions. Several azoles have been shown to be an effective treatment for this condition. Herein, we report a case of basidiobolomycosis that was initially misdiagnosed as a different disease and resolved after itraconazole medication. A 25-year-old man presented with a 2.5-year history of extensive swelling on his right arm, face, and neck. Initially, he was diagnosed with lipoma and scapular tuberculosis; however, no improvements were observed post-surgery and with tuberculosis medication. Histopathological examinations revealed giant cells, aseptate hyphae, and the Splendore-Hoeppli phenomenon. Fungal culture confirmed the isolate to be Basidiobolus ranarum. The patient was given oral itraconazole 200 mg twice daily, and the complete resolution was achieved after 25 months of treatment.

Background: Erythema nodosum leprosum (ENL) is an acute immunologic complication of multibacillary leprosy (MB) that causes systemic inflammation in various organs. It is a major factor contributing to morbidity, mortality, and financial hardship. ENL is diagnosed clinically, and objective indicators for severe conditions remain unexplored. Simple blood biomarkers that differentiate between different ENL disease severity levels are required. Neutrophilto-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been widely studied as severity biomarkers of numerous neoplastic and inflammatory disorders. Objective: We examined NLR and PLR values at various ENL severities and their role as severe disease indicators for ENL. Methods: This cross-sectional retrospective study examined 246 patients with multibacillary leprosy—with and without ENL reactions and aged 18 and above—and calculated their NLR and PLR values. Then, we compared patients with mild and severe disease states to those without ENL. The severity classification was based on the ENLIST ENL Severity Score (EESS). To determine the NLR and PLR cutoff points of mild and severe ENL, a receiver operating characteristic (ROC) curve was constructed. Results: The NLR value for severe ENL was significantly higher than that for mild ENL (p < 0.05), with a severe disease cutoff point of 5.71 (95.7% sensitivity, 68.7% specificity). No significant differences were found in PLR between patients with mild and severe ENL. Conclusion: While PLR is not an effective assay for evaluating ENL severity, NLR is a potential biomarker for severe ENL reactions in patients with multibacillary leprosy.