An Avid Imitator

We present a case of disseminated cryptococcal disease, coexisting with and mimicking lymphoma. Determination of serum cryptococcal antigen should be considered for lymphopenic patients with hematologic malignancies, presenting with unexplained fever, and/or lymphadenopathy and/or pulmonary findings. Patients with hematologic malignancies treated with chemotherapy regimens are susceptible to diverse opportunistic infections. Therefore, in this patient population, it is often necessary to obtain a definitive pathologic diagnosis, to diagnose uncommon syndromes and guide management

Far-infrared photometry of OJ 287 with the Herschel Space Observatory

Context: The blazar OJ 287 has shown a approximate to 12 year quasi-periodicity over more than a century, in addition to the common properties of violent variability in all frequency ranges. It is the strongest known candidate to have a binary singularity in its central engine.Aims: We aim to better understand the different emission components by searching for correlated variability in the flux over four decades of frequency measurements.Methods: We combined data at frequencies from the millimetric to the visible to characterise the multifrequency light curve in April and May 2010. This includes the only photometric observations of OJ 287 made with the Herschel Space Observatory: five epochs of data obtained over 33 days at 250, 350, and 500 mu m with Herschel-SPIRE.Results: Although we find that the variability at 37 GHz on timescales of a few weeks correlates with the visible to near-IR spectral energy distribution, there is a small degree of reddening in the continuum at lower flux levels that is revealed by the decreasing rate of decline in the light curve at lower frequencies. However, we see no clear evidence that a rapid flare detected in the light curve during our monitoring in the visible to near-IR light curve is seen either in the Herschel data or at 37 GHz, suggesting a low-frequency cut-off in the spectrum of such flares.Conclusions: We see only marginal evidence of variability in the observations with Herschel over a month, although this may be principally due to the poor sampling. The spectral energy distribution between 37 GHz and the visible can be characterised by two components of approximately constant spectral index: a visible to far-IR component of spectral index alpha = -0.95, and a far-IR to millimetric spectral index of alpha = -0.43. There is no evidence of an excess of emission that would be consistent with the 60 mu m dust bump found in many active galactic nuclei.</p

Polarization and Spectral Energy Distribution in OJ 287 during the 2016/17 Outbursts

We report optical photometric and polarimetric observations of the blazar OJ 287 gathered during 2016/17. The high level of activity, noticed after the General Relativity Centenary flare, is argued to be part of the follow-up flares that exhibited high levels of polarization and originated in the primary black hole jet. We propose that the follow-up flares were induced as a result of accretion disk perturbations, traveling from the site of impact towards the primary SMBH. The timings inferred from our observations allowed us to estimate the propagation speed of these perturbations. Additionally, we make predictions for the future brightness of OJ 287.</p

Far-infrared photometry of OJ 287 with the Herschel Space Observatory

Context. The blazar OJ 287 has shown a ≈ 12 year quasi-periodicity over more than a century, in addition to the common properties of violent variability in all frequency ranges. It is the strongest known candidate to have a binary singularity in its central engine. Aim. We aim to better understand the different emission components by searching for correlated variability in the flux over four decades of frequency measurements. Methods. We combined data at frequencies from the millimetric to the visible to characterise the multifrequency light curve in April and May 2010. This includes the only photometric observations of OJ 287 made with the Herschel Space Observatory: five epochs of data obtained over 33 days at 250, 350, and 500 μm with Herschel-SPIRE. Results. Although we find that the variability at 37 GHz on timescales of a few weeks correlates with the visible to near-IR spectral energy distribution, there is a small degree of reddening in the continuum at lower flux levels that is revealed by the decreasing rate of decline in the light curve at lower frequencies. However, we see no clear evidence that a rapid flare detected in the light curve during our monitoring in the visible to near-IR light curve is seen either in the Herschel data or at 37 GHz, suggesting a low-frequency cut-off in the spectrum of such flares. Conclusions. We see only marginal evidence of variability in the observations with Herschel over a month, although this may be principally due to the poor sampling. The spectral energy distribution between 37 GHz and the visible can be characterised by two components of approximately constant spectral index: a visible to far-IR component of spectral index α = -0.95, and a far-IR to millimetric spectral index of α = -0.43. There is no evidence of an excess of emission that would be consistent with the 60 μmdust bump found in many active galactic nuclei.Peer reviewe

Opportunistic Infections (OIs) in Patients with Hematologic Malignancies (HM) Treated with Bruton’s Tyrosine Kinase (BTK) and Phosphoinositide 3 Kinase (PI3K) Inhibitors: An 8-Year Retrospective Cohort Study

Abstract Background: BTK and PI3K inhibitors are increasingly used for treatment in patients with HM. OIs when these agents were used as first line therapy signaled an increased level of immunosuppression beyond what was expected from the mechanism of action of these drugs. The epidemiology of OIs in the setting of BTK and PI3K inhibitor use has not been characterized. Methods: We retrospectively studied a cohort of patients with HM who received BTK (ibrutinib, acalabrutinib, spebrutinib) or PI3K (idelalisib, duvelisib, TGR-1202) inhibitors as part of clinical trials at our center between March 2008 and November 2016. Patients were followed up until April 30, 2017. Incident infectious complications were recorded. Cohort baseline characteristics, underlying malignancy, stage of disease, type of therapy and use of antimicrobial prophylaxis were recorded. Results: 148 patients who received BTK or PI3K inhibitors as first or second line therapy were included in the study. Median age was 64.5 years, 32% were female, 95.9% had chronic lymphocytic leukemia (CLL), 4.1 % had Non-Hodgkin Lymphoma (NHL). Sixty-three percent received BTK inhibitors and 37% received PI3K inhibitors as first line therapy. Pneumocystis and HSV/VZV prophylaxis were used in 82.4% and 85.8% of patients, respectively. Twenty-seven OIs occurred in 24 patients. The most common OIs were pneumocystosis (7), aspergillosis (5) HSV (3), VZV (3), CMV (2), Cryptococcal meningitis (2), candidiasis (2) and other invasive mold infections (3). Seventy-one patients (48%) had infectious episodes not considered OIs. Median time to onset of OIs after start of therapy was 78 days (range, 6–323). Twelve OIs (8.1 %) occurred after first line therapy with BTK inhibitors, 11 OIs (7.4 %) occurred after first line PI3K inhibitors. Conclusion: The use of BTK and PI3K inhibitors as first or second line treatment of CLL or NHL are associated with incident OIs. Clinical awareness of these complications and the use of adequate prophylactic and/or monitoring strategies are essential in preventing serious OIs in this population. Disclosures J. Brown, Pharmacyclics, Janssen, Celgene, Gilead, Infinity, Genentech, and Pfizer, Roche and Sun BioPharma, Janssen, Gilead, Sun BioPharma, and Pfizer: Consultant, Consulting fee; F. Marty, Astellas Pharma US: Consultant and Grant Investigator, Consulting fee and Grant recipient; Chimerix: Consultant and Grant Investigator, Consulting fee and Grant recipient; Fate Therapeutics: Scientific Advisor, Consulting fee; Gilead Sciences: Consultant and Grant Investigator, Consulting fee and Grant recipient; LFB: Consultant, Consulting fee; Merck: Consultant, Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Roche Molecular Systems: Consultant, Consulting fee; Shire: Consultant and Grant Investigator, Consulting fee and Grant recipien

Recent Advances in Diagnostic Approaches for Mucormycosis

Mucormycosis, an invasive fungal infection caused by members of the order Mucorales, often progresses fulminantly if not recognized in a timely manner. This comprehensive review discusses the latest developments in diagnostic approaches for mucormycosis, from traditional histopathology and culture-based methods to advanced and emerging techniques such as molecular assays, imaging, serology, and metabolomics. We discuss challenges in the diagnosis of mucormycosis and emphasize the importance of rapid and accurate identification of this life-threatening infection