International Journal of Infectious Diseases - Articles in Press

Safety and immunogenicity of an investigational quadrivalent meningococcal CRM197 conjugate vaccine, MenACWY-CRM, compared with licensed vaccines in adults in Latin America - Corrected Proof

2010-07-26

Summary: Background: This study compared the investigational quadrivalent meningococcal CRM197 conjugate vaccine, MenACWY-CRM, with licensed quadrivalent polysaccharide (MPSV4) and conjugate (MenACWY-D) meningococcal vaccines.Methods: In this phase III multicenter study, 2505 adults (aged 19–55 years) were randomized to receive either MenACWY-CRM or MenACWY-D, and 326 adults (aged 56–65 years) were randomized to receive either MenACWY-CRM or MPSV4. Sera obtained pre-vaccination and at 1-month post-vaccination were tested for serogroup-specific serum bactericidal activity using human complement (hSBA) for immunogenicity non-inferiority and superiority analyses.Results: The vaccines in all groups were well tolerated. In the 19–55 years age group, post-vaccination geometric mean titers (GMTs) were consistently higher for MenACWY-CRM than for MenACWY-D for all four serogroups. MenACWY-CRM was non-inferior to MenACWY-D for all serogroups, and superior for serogroup Y. In the 56–65 years age group, post-vaccination GMTs were 1.2- to 5.4-fold higher for MenACWY-CRM than for MPSV4 for the four serogroups.Conclusions: MenACWY-CRM is well tolerated and immunogenic in adults aged 19–65 years, with at least non-inferior immunogenicity compared with the currently licensed meningococcal vaccines.

Prevalence of human papillomavirus genotypes in HIV-1-infected women in Seattle, USA and Nairobi, Kenya: results from the Women's HIV Interdisciplinary Network (WHIN) - Corrected Proof

2010-07-23

Summary: Background: HIV-infected women have a high prevalence of human papillomavirus (HPV) infection and are more likely to be infected with HPV genotypes that are considered high-risk and have the potential for progressing to cervical cancer. The currently available HPV vaccines protect against specific HPV genotypes that may not be the most important causes of dysplasia and potentially of cervical cancer in HIV-1-infected women. African women have been underrepresented in the studies of global prevalence of HPV genotypes.Methods: We compared the HPV genotype distribution in HIV-1-infected women from Seattle, Washington, USA and Nairobi, Kenya. The reverse line blot assay and DNA sequencing on cervicovaginal lavage (CVL) specimens were carried out.Results: The most commonly detected HPV types among the women from Seattle were HPV 56, 66, MM8, and 81; in contrast HPV 53, 33, and 58 were the most common HPV genotypes detected in the CVL specimens from the women in the Nairobi cohort. The HPV types associated with low-grade squamous intraepithelial lesions (LSIL) were HPV 53 and HPV 56. HPV types 58, 52, and 16 were associated with high-grade squamous intraepithelial lesions (HSIL).Conclusions: A better understanding of HPV genotype distribution in the most affected regions of the world is essential to planning effective vaccine strategies if we are unable to demonstrate cross-protection between HPV genotypes included in the present vaccines and those prevalent in the different populations.

Decrease in CD4+CD25+FoxP3+ Treg cells after pulmonary resection in the treatment of cavity multidrug-resistant tuberculosis - Corrected Proof

2010-07-23

Summary: Objectives: Immune regulatory mechanisms may limit the immunopathologic condition of infection with Mycobacterium tuberculosis and suppress cellular immune responses in the host. We investigated the CD4+CD25+FoxP3+ circulating regulatory T cells (Treg) in patients with cavity multidrug-resistant tuberculosis (MDR-TB) before and after surgery.Methods: We compared the proportion of Treg cells in 13 patients with cavity MDR-TB pre- and postoperatively and in 10 healthy control subjects by flow cytometry using three specific markers in peripheral blood lymphocytes: cell-surface CD4 and CD25 expression and intracellular FoxP3 expression.Results: The proportion of CD4+CD25high and CD4+CD25+FoxP3+ Treg was significantly higher in patients with cavity MDR-TB and at 1-month postoperatively than in healthy controls (p<0.001). The proportion of CD4+ and CD4+CD25− cells was significantly lower in patients with cavity MDR-TB than in controls (p<0.001). Pre- and postoperative proportions of CD4+CD25high and CD4+CD25+FoxP3+ Treg cells showed a positive correlation (r=0.878, p<0.001).Conclusion: Circulating Treg cells are increased in proportion in patients with cavity MDR-TB and decreased after surgery. Infection with M. tuberculosis may induce Treg cell-surface molecular changes with increased numbers of cells.

Necrotizing myositis of the deltoid following intramuscular injection of anabolic steroid - Corrected Proof

Stephen Grant, Jonathan Dearing, Sujoy Ghosh, Andrew Collier, Abhijit M. Bal — 2010-07-21

A 25-year-old male bodybuilder was admitted in septic shock. He had marked limitation of left shoulder movement with non-fluctuant swelling extending from the acromio-clavicular joint to the postero-lateral and anterior deltoid. Lesions consistent with herpes labialis were also noted. A computed tomography scan demonstrated collections of both gas and fluid within the deltoid muscle and numerous pockets of gas within the soft tissues conforming to the fascial planes (). On further questioning he admitted to injecting himself with anabolic steroids into the left deltoid region six days prior to admission. He underwent emergency drainage with debridement of large areas of necrotic muscle and a fasciotomy of the upper arm. Gemella morbillorum and Veillonella were isolated from culture of pus. Dialister pneumosintes was grown from blood cultures. The strains were identified by 16s rDNA sequencing. He was treated with benzyl penicillin and clindamycin. Histology showed necrotic skeletal muscle tissue with mixed inflammatory infiltrate. Despite extensive muscle debridement he retained excellent shoulder function.

The effect of Helicobacter pylori infection on growth velocity in young children from poor urban communities in Ecuador - Corrected Proof

2010-07-21

Summary: Objective: To characterize the potential effects of Helicobacter infections on growth velocity in low socioeconomic status young children in a developing country.Methods: Children were recruited in poor suburbs of Quito, Ecuador. Normally nourished, mildly and substantially malnourished children (defined using weight-for-age Z-scores at recruitment) formed equal strata. Six height and weight measurements were collected during one year. Enrollment and exit serum samples were analyzed for anti-Helicobacter IgG and exit non-diarrheal feces tested for Helicobacter antigen.Results: Among 124 participants (enrollment age 19±9 months), 76 (61%) excreted fecal antigen at exit (were infected). Of these, 44 were seropositive at least once (chronic infections) and 32 tested seronegative both times (new or acute phase infections). The adjusted linear growth velocity during follow-up in children with new infections was reduced by 9.7 (3.8, 15.6) mm/year compared to uninfected controls and 6.4 (0.0, 12.9) mm/year compared to children with chronic infections. The effects of Helicobacter infections on ponderal growth were not significant.Conclusion: These results suggest that linear growth velocity is reduced in young children during the initial phase of Helicobacter infection.

Same influenza vaccination strategies but different outcomes across US cities? - Corrected Proof

Claudia Taylor, Achla Marathe, Richard Beckman — 2010-07-21

Summary: Objectives: This research aimed to determine if the same influenza vaccination strategies would have the same level of effectiveness when applied to two different US metropolitan areas, Miami and Seattle, where the composition of the population differs significantly in age distribution and household size distribution.Methods: We used an individual-based network modeling approach in which every pair of individuals connected in the social network is represented. Factorial design experiments were performed to estimate the impact of age-targeted vaccination strategies to control the transmission of a ‘flu-like’ virus.Results: The findings showed that: (1) age composition of the city matters in determining the effectiveness of a vaccination strategy and (2) vaccinating school children outperforms every other strategy.Conclusions: The most significant policy implication of this research is that there may not be a universal vaccination strategy that works across all cities with the same level of effectiveness. Secondly, given the important role of school children in the transmission of influenza, the US Government should consider the vaccination of school children a top priority.

Invasive squamous cell carcinoma arising from a human papillomavirus genotype 16-associated verrucous cyst - Corrected Proof

Teresa Pusiol, Francesco Piscioli, Maria Grazia Zorzi — 2010-07-20

We have recently observed the first case of invasive squamous cell carcinoma arising from a human papillomavirus genotype 16 (HPV16)-associated verrucous cyst. The lesion was found in the perineal area of an 86-year-old woman. Using in situ hybridization (ISH), we detected the presence of HPV16 in the cystic wall. HPV16 DNA sequences were detected in formalin-fixed, paraffin-embedded tissue sections using the DNA–DNA ISH method, as described previously. For immunohistochemical analysis, a p16 monoclonal antibody (clone E6H4, CINtec p16INK4a Histology Kit; mtm laboratories AG, Heidelberg, Germany) was used. p16INK4a immunostaining showed diffuse and intense positivity throughout the dysplastic epithelium and in the areas of invasive carcinoma ().

Increasing resistance in community-acquired urinary tract infections in Latin America, five years after the implementation of national therapeutic guidelines - Corrected Proof

P.H.A. Bours, R. Polak, A.I.M. Hoepelman, E. Delgado, A. Jarquin, A.J. Matute — 2010-07-16

Summary: Background: The worldwide increasing resistance to antibiotics has complicated antimicrobial treatment of urinary tract infections (UTIs), especially in Latin America. This study aimed to report the present etiology and antimicrobial susceptibility of UTIs, and the effects of the national guidelines for UTIs introduced in 2003.Methods: Urine samples were collected from 304 patients with a clinical suspicion of UTI at the university hospital and primary health centers of León, Nicaragua. When bacterial growth was reported, antimicrobial susceptibility tests for nine frequently used antibiotics were performed.Results: Ninety-one (29.9%) patients had a positive urine culture. The most frequently isolated microorganisms were Escherichia coli (n=44), Serratia spp (n=11), and Escherichia fergusonii (n=10). High resistance rates were observed in E. coli to ampicillin (61.4%), cefalothin (45.5%), trimethoprim–sulfamethoxazole (38.6%), ciprofloxacin (31.8%), and ceftriaxone (20.5%). Amikacin and nitrofurantoin were the only drugs to which >90% of E. coli were susceptible. E. fergusonii and Serratia spp showed comparable high resistance patterns. Thirteen strains (29.5%) of E. coli were suspected to produce extended-spectrum beta-lactamase (ESBL).Conclusions: Resistance rates in community-acquired UTIs in Nicaragua are increasing. The introduction of therapeutic guidelines with ceftriaxone recommended for upper UTIs and nitrofurantoin for lower UTIs, has led to increasing resistance against both antibiotics. The emergence of ESBL-producing E. coli is worrisome, along with the appearance of Serratia spp in the population.

Welders are at increased risk for invasive pneumococcal disease - Corrected Proof

2010-07-16

Summary: Background: Welders are at increased risk of pulmonary infection and lobar pneumonia, likely due to significant occupational exposure to metal fumes. We hypothesized that welders would be at increased risk for invasive pneumococcal disease (IPD) compared to the general population.Methods: A retrospective chart review of all patients with IPD in the province of Alberta, Canada (population approx. 3.3 million) was conducted from 2000 to 2004 to study the epidemiology of IPD.Results: There were 18 cases identified in welders, giving an attack rate of 22.7 cases per 100 000 population per year (95% confidence interval (CI) 12.23–33.23). Compared with an attack rate of 8.7 cases per 100 000 population per year (95% CI 8.10–9.26) for the general adult population between ages 18 and 65 years, there was a 2.7-fold greater incidence of IPD in welders (95% CI 1.67–4.22, p<0.001). There was an increased prevalence of serotypes 4 and 8 compared to the general population. Eight of 18 cases were caused by serotypes in the 7-valent pneumococcal conjugate vaccine, 11 of 18 cases by serotypes in the 13-valent pneumococcal conjugate vaccine, and 18 of 18 cases by serotypes in the 23-valent pneumococcal polysaccharide vaccine. Seventeen patients had bacteremic pneumococcal pneumonia and one had meningitis; one person died due to infection. Fifteen of 18 patients were either current or former smokers, which was a higher rate than the general population adjusted for age and gender (odds ratio 2.976, 95% CI 0.908–9.729, p=0.084).Conclusions: Welders, particularly those who smoke, are at increased risk of IPD and should be considered for routine administration of the pneumococcal polysaccharide vaccine. Ongoing workplace measures to reduce exposure to metal fumes and promote smoking cessation should be reinforced.

Risk factors of poultry outbreaks and human cases of H5N1 avian influenza virus infection in West Java Province, Indonesia - Corrected Proof

Yuni Yupiana, Sake J. de Vlas, Nana M. Adnan, Jan Hendrik Richardus — 2010-07-16

Summary: Background: The purpose of this study was to determine the association of potential risk factors to the spread and maintenance of the highly pathogenic avian influenza (HPAI) H5N1 virus in poultry and humans at the district level in West Java Province, Indonesia.Methods: The association of demography and environmental risk factors including poultry density, human density, road density, percentage of paddy field, and percentage of swamp, dyke and pond with both HPAI human cases and HPAI outbreaks in poultry were assessed using a descriptive epidemiological design. We also assessed the association of HPAI outbreaks in poultry with HPAI human cases. Poisson regression (generalized linear modeling and generalized estimating equations) was used to analyze the data corrected for over-dispersion.Results: There were 794 HPAI outbreaks in poultry covering 24 of the 25 districts in our study during 2003–2008 and 34 HPAI human cases involving 12 districts during 2005–2008. We found that two risk factors – poultry density and road density – had a statistically significant correlation with the number of HPAI outbreaks in poultry. The number of poultry outbreaks had a negative association with poultry density (29% effect) and a positive association with road density (67% effect). The number of human cases was significantly associated with the number of poultry outbreaks (34% effect), but with none of the other risk factors considered.Conclusions: We conclude that the most effective way to prevent human HPAI cases is to intervene directly in the poultry sector. Our study further suggests that implementing preventive measures in backyard chicken farming and limiting transport of live poultry and their products are promising options to this end.

Protective effects of Sm-p80 in the presence of resiquimod as an adjuvant against challenge infection with Schistosoma mansoni in mice - Corrected Proof

Gul Ahmad, Weidong Zhang, Workineh Torben, Zahid Noor, Afzal A. Siddiqui — 2010-07-14

Summary: Objectives: To determine the prophylactic efficacy of an Sm-p80-based vaccine formulation against challenge infection with Schistosoma mansoni in mice using an approach comprising of initial priming with DNA and boosting with recombinant protein in the presence of resiquimod (R848) as an adjuvant.Methods: In the first experiment (prime–boost approach), mice were primed with Sm-p80–pcDNA3 (week 0) and boosted at weeks 4 and 8 with recombinant Sm-p80 formulated in resiquimod (R848). Each mouse in the control group first received only pcDNA3 and was boosted with R848. In the second set of experiments (recombinant protein approach), mice were immunized (week 0) and boosted (weeks 4 and 8) with rSm-p80 formulated in R848. Animals of the control group in this series of experiments received only R848 at 0, 4, and 8 weeks. All of the animals from both the ‘prime–boost’ and ‘recombinant protein’ groups were challenged with cercariae of S. mansoni, 4 weeks after the last immunization. The mice were sacrificed 6 weeks post-challenge and the reductions in worm burden and egg production were determined. Sm-p80-specific antibody titers were estimated in the mice sera by ELISA. Cytokine mRNA and protein production by proliferating splenocytes in response to in vitro stimulation with Sm-p80, were estimated via RT-PCR and ELISA, respectively.Results: Vaccination with Sm-p80 (prime–boost approach) showed 49% reduction in worm burden; with the recombinant protein approach the protection was found to be 50%. The protection levels were correlated with antibody production. Upon antigenic stimulation with recombinant Sm-p80, splenocytes secreted significant levels of interferon (IFN)-γ and interleukin (IL)-2, indicating that the immune responses were Th1-biased and this was further supported in terms of distribution of antibody isotypes and mRNA expression of cytokines.Conclusions: In conclusion the present study clearly demonstrates that Sm-p80 consistently maintained its protective nature, and resiquimod as an immunopotentiating agent slightly boosted the protective effects of Sm-p80 in both ‘DNA prime–protein boost’ and ‘recombinant protein’ immunization approaches in a murine model.

Suspected oseltamivir-induced bradycardia - Corrected Proof

R. Karplus, S. Sanset, R. Zaidenstein, D. Schneider, M. Berkovitch — 2010-07-09

Data from the ongoing influenza A(H1N1) pandemic have shown that early antiviral treatment is crucial to reduce morbidity and mortality. The numbers likely to receive oseltamivir over future influenza seasons make it imperative to be aware of any oseltamivir-related severe adverse effects, given that the winter is by now long over. We report two patients with suspected oseltamivir-induced bradycardia.

Clinical and economic burden of pneumonia among adults in Latin America - Corrected Proof

Raul E. Isturiz, Carlos M. Luna, Julio Ramirez — 2010-07-08

Summary: The clinical and economic burden of adult community-acquired pneumonia (CAP) in Latin America is not well known. We conducted a literature review to describe the etiology, incidence, hospitalization, morbidity and mortality, antibiotic resistance, costs associated with care, and the potential benefits of pneumococcal vaccination in the reduction of adult CAP in Latin America. Data that were published during the period from January 1970 through August 2008 were identified via the Web sites and databases of the Pan American Health Organization, Latin American health agencies, and the US National Institutes of Health, National Library of Medicine (MEDLINE). Streptococcus pneumoniae was identified as the most common pathogen, accounting for up to 35% of CAP cases. The mean rate of CAP due to penicillin-resistant S. pneumoniae was 39%. The mortality in Latin America due to lower respiratory tract infections has been reported to be 6%, compared with 4% in developed regions, and CAP was the third most frequent cause of death in adults in 31 Latin American countries in 2001–2003. Although S. pneumoniae caused the majority of CAP, similar to other regions of the world, mortality due to CAP in Latin America was substantially greater than that in developed countries. This review demonstrates the need to facilitate standardized surveillance and reporting systems to monitor the burden of CAP and to implement prevention strategies to decrease the clinical and economic burden of CAP in Latin American adults.

Pathogenesis of the hyperlipidemia of Gram-negative bacterial sepsis may involve pathomorphological changes in liver sinusoidal endothelial cells - Corrected Proof

2010-07-08

Summary: The Gram-negative bacterium Pseudomonas aeruginosa is one of the most common opportunistic pathogens, especially after liver transplantation. Pathophysiological alterations of liver sinusoidal endothelial cells (LSECs) have far-reaching repercussions on the liver and on metabolism. LSECs are perforated with fenestrations, pores that facilitate the transfer of lipoproteins and macromolecules between blood and hepatocytes. Gram-negative bacterial endotoxin (lipopolysaccharide, LPS) and the P. aeruginosa toxin, pyocyanin, have marked effects on LSECs. Initial loss of LSEC porosity (defenestration) induced by P. aeruginosa pyocyanin and LPS may confer subsequent immune tolerance to circulating bacterial antigens and toxins. This review collates the known immune responses of the liver to Gram-negative bacterial toxins, with a focus on LSECs. Hyperlipidemia is an important response to Gram-negative bacterial sepsis. The mechanisms proposed for sepsis-associated hyperlipidemia include tissue lipoprotein lipase inhibition and upregulated hepatic triglyceride production. In this review, we propose defenestration of the LSECs by bacterial toxins as an additional mechanism for the hyperlipidemia of sepsis. Given the role of LSECs in hyperlipidemia and liver allograft rejection, LSEC changes induced by P. aeruginosa toxins including LPS and pyocyanin may have significant clinical implications.

Spontaneous recovery from progressive multifocal leukoencephalopathy in a patient with non-active sarcoidosis - Corrected Proof

2010-07-05

Summary: We report the case of a 50-year-old female patient with non-active sarcoidosis and no kind of immunosuppression, admitted to our hospital because of increasing confusion and focal neurological deficits. Initially a tumor, herpes encephalitis, or neurosarcoidosis were suspected, but surprisingly biopsy revealed progressive multifocal leukoencephalopathy, additionally confirmed by JC-positive PCR in cerebrospinal fluid. Cases of sarcoidosis and progressive multifocal leukoencephalopathy have been reported before. This is the first case of a patient with no sign of active sarcoidosis and without immunosuppressive therapy who recovered spontaneously with a follow-up time of nearly 3 years.

Re: Rapid diagnosis and successful drug therapy of primary parotid tuberculosis in the pediatric age group: a case report and brief review of the literature - Corrected Proof

Ashu Seith Bhalla, Ankur Gadodia, Raju Sharma — 2010-07-05

We read with great interest the article entitled “Rapid diagnosis and successful drug therapy of primary parotid tuberculosis in the pediatric age group: a case report and brief review of the literature” by Nag et al. They have described a rare case of parotid tuberculosis in a pediatric patient with a review of the literature. We would like to report a similar case of parotid tubercular abscess in a 14-year-old female. We would also like to highlight the role of imaging and ultrasound-guided aspiration in diagnosis. The pre-operative diagnosis of tuberculosis helps to avoid unnecessary surgery.

Clostridium tertium bacteremia: contamination or true pathogen? A report of two cases and a review of the literature - Corrected Proof

2010-07-05

Summary: We observed two cases of Clostridium tertium bacteremia three months apart in the sterile unit of our department of hematology and oncology. One patient was being treated for first-relapse acute myeloblastic leukemia, while the second was receiving high-dose chemotherapy with hematopoietic stem cell support for non-Hodgkin lymphoma. At the time that C. tertium was identified, the first patient was completely asymptomatic, while the second was highly febrile. Both responded biologically and/or clinically to antibiotherapy. We discuss the epidemiology and pathology of C. tertium in the general and cancer patient population.

Parvovirus B19 infection mimicking juvenile myelomonocytic leukemia - Corrected Proof

2010-07-05

We read with great interest “Transient leukoerythroblastosis in a very low birth weight infant with parvovirus B19 infection” by Duran et al. The authors describe a preterm infant with transient leukoerythroblastosis associated with a parvovirus B19 infection.

The enterovirus 71 epidemic in 2008—public health implications for Hong Kong - Corrected Proof

Edmond Ma, King Chun Chan, Peter Cheng, Christine Wong, Shuk Kwan Chuang — 2010-07-05

Summary: Objectives: We compared the epidemiological, clinical and laboratory characteristics of enterovirus 71 (EV71) cases recorded in the epidemic year of 2008 with those of the past decade.Methods: We estimated the annual incidence rates in the general population and in different age groups. We reviewed the clinical and epidemiological information of the cases. The complication and case fatality rates (CFR) were compared with the corresponding average rates for the period 1998–2007. The molecular strains of EV71 isolates were determined.Results: The estimated annual incidence was 1.4/100 000 in the general population, with the highest incidence (27.9/100 000) reported among children aged under 5 years. The seasonal peak occurred from May to July. The majority (92.9%) presented with hand-foot-mouth disease (HFMD; 90.8%) or herpangina, and 11.2% had complications including meningitis or encephalitis (6.1%), pneumonia (3.1%), acute flaccid paralysis (1.0%), and shock (1.0%). The CFR was 1.0%. Nearly half (45.9%) of school-aged cases had concurrent HFMD outbreaks at their schools/institutions. There was no statistically significant difference in the complications rate and CFR when compared to those of the past decade. Molecular analysis showed that the majority were genogroup C4 strains, similar to the past circulating strains.Conclusions: The cyclical high activity has had significant public health and social implications. To strengthen public health surveillance and control, EV71 infection was made a statutory notifiable disease in 2009.

Etiology and significance of hypoglycemia in pneumococcal septicemia - Corrected Proof

Michael Eisenhut — 2010-07-02

Jan I-Shiow and colleagues found that hypoglycemia in pneumococcal disease was associated with high mortality. The authors listed increased glucose utilization and depressed gluconeogenesis as causes, without elaborating on the etiology of these phenomena. It is not clear from the investigation how these abnormalities of glucose processing are linked to increased mortality.

False-positive seroreactivity to Borrelia burgdorferi in a patient with thyroiditis - Corrected Proof

Ann R. Garment, Byron P. Demopoulos — 2010-07-02

A 32-year-old woman presented to an outpatient medicine practice complaining of fevers for four nights. She had delivered a healthy baby eight months earlier and was recently outdoors in the suburbs of New Jersey, but otherwise she had no prior medical history. She reported fatigue but denied recent preceding illness, cough, headaches, gastrointestinal distress, urological complaints, rashes, or joint pains. Her vital signs were normal, and her exam was non-focal except for a tender, non-fluctuant fullness to her right anterior neck. Over the next two weeks, her neck tenderness worsened, and her fevers became higher and more frequent.

Pott's spine with ‘bird nest’ appearance - Corrected Proof

2010-07-02

A 26-year-old male presented with a history of cough, low-grade fever, backache, dry cough, reduced appetite, and weight loss of four-month duration. On examination he had pallor and diffuse tenderness in the cervical and dorso-lumbar spine. The straight leg raise test was restricted bilaterally. Neurological examination did not reveal any motor or sensory deficits. The deep tendon reflexes were exaggerated bilaterally and a hamstring spasm was noticed. The plantar reflex was flexor bilateral. Investigations revealed hemoglobin of 83g/l, total leukocyte count of 6.6×109/l, and erythrocyte sedimentation rate of 112 at the end of one hour. Liver function tests revealed alkaline phosphate of 273 U/l. All other parameters, such as renal function, serum electrolytes, calcium and phosphorous, were normal. The Mantoux test was strongly positive. An X-ray of the spine revealed a fusiform radiodense shadow in the region of the thoracic spine, typically described as ‘bird nest’ appearance (). Magnetic resonance imaging (MRI) of the spine revealed a diffuse globular lesion suggesting paravertebral abscess along with multiple vertebral destruction (). Blood IgM and PCR for tuberculosis were positive. An X-ray of the cervical spine revealed destruction of C5, C6, and C7 vertebrae. HIV ELISA and hepatitis B surface antigen (HBsAg) were negative. He was treated with anti-tubercular drugs with drainage of the paravertebral abscess.

Two decades of battle against polio: opening a window to examine public health in China - Corrected Proof

Li-Ping Zou, Guang Yang, Ying-Xue Ding, Hang-Yan Wang — 2010-07-01

Summary: During a two-decade battle against polio, the Chinese government has saved more than one million children from physical disability caused by wild poliovirus infection. Today, the Chinese government still faces an arduous task in (1) preventing the entry and transmission of wild poliovirus from surrounding polio-endemic countries, (2) finding and stopping the outbreak of polio caused by the recycling of vaccine-derived poliovirus, (3) reducing vaccine-associated paralytic poliomyelitis (VAPP) cases, and (4) improving the State compensation system. The scientific monitoring system established in China and the immunity strategy implemented not only allow children in China to avoid lifelong disability or premature death due to polio infection, but also provide success stories for the World Health Organization that can be used for the specification of quality control indices for monitoring polio, classification and diagnosis criteria for acute flaccid paralysis cases, and identification and emergency treatment principles for imported wild poliovirus.

Primary localized histoplasmosis with lesions restricted to the mouth in a Chinese HIV-negative patient - Corrected Proof

Lan Ge, Cunjian Zhou, Zhiqiang Song, Yin Zhang, Li Wang, Baiyu Zhong, Fei Hao — 2010-07-01

Summary: Histoplasmosis is a deep mycosis caused by Histoplasma capsulatum, which is endemic in many areas of the world but is relatively rare in China. Although the majority of cases present as a mild to moderate flu-like disease requiring only supportive therapy, approximately 1% of patients experience more serious pulmonary and extrapulmonary disease, which can be life-threatening if diagnosis is delayed or the treatment is not initiated rapidly. Definitive diagnosis is usually made by a combination of culture, detection of the organism in tissues, measurement of antibodies, and detection of antigen. We present the case of a 51-year-old patient who presented with histoplasmosis only, with several ulcerated lesions in the oral cavity and without HIV infection, who did not show any detectable signs and symptoms of systemic disease or extra-oral manifestations. Histopathological analysis indicated a chronic inflammatory process with granulomas with yeast-like organisms. Isolation of H. capsulatum and molecular identification provided the definitive diagnosis. Treatment with oral itraconazole led to remission of the oral lesions. This is the first Chinese case report of localized histoplasmosis with lesions restricted to the mouth in an HIV-negative patient.

Invasive sinonasal disease due to dematiaceous fungi in immunocompromised individuals: case report and review of the literature - Corrected Proof

Catherine Derber, Kara Elam, Gonzalo Bearman — 2010-07-01

Summary: Invasive dematiaceous fungal sinusitis is an uncommon and aggressive disease in immunocompromised individuals. We report a unique case of invasive Exserohilum sinusitis in a pregnant, immunocompromised woman. After treating the woman with pregnancy-induced aplastic anemia and invasive Exserohilum sinusitis and pulmonary disease, we performed a Medline/PubMed review of invasive dematiaceous fungal sinonasal disease in immunocompromised individuals. Twelve cases of proven and one case of probable invasive sinonasal dematiaceous fungal disease in immunocompromised patients are reported in the English-language literature. The majority of patients had underlying hematological conditions. The crude mortality was high, with over half of the patients dying from presumed complications of the underlying immunosuppression. Successful outcomes were associated with surgical debridement, aggressive antifungal use, and a reduction of immunosuppression. The optimal treatment for immunocompromised patients with invasive dematiaceous fungal disease is not known. The role of newer triazoles, posaconazole and voriconazole, appears promising, however more clinical data are needed. Definitive diagnosis requires tissue biopsy and successful treatment is associated with reduction of immunosuppression, aggressive surgical debulking, and systemic antifungal therapy.

A description and illustration of a necrotizing fasciitis by John Bell in 1801, hypothetically caused by Vibrio vulnificus - Corrected Proof

Robert-Jan Hassing, Yorick J. de Groot, Erwin J. Kompanje — 2010-07-01

Summary: We present an overlooked and noteworthy historical case and illustration of a necrotizing fasciitis, observed and written by John Bell (1763–1820), first published in 1801. Considering the setting and the clinical presentation, we hypothesize that the pathogen responsible was the species Vibrio vulnificus. The typical clinical course of a rapidly progressive illness preceded by saltwater exposure shortly followed by the development of a hemorrhagic skin lesion, with a fatal outcome, should strongly suggest a V. vulnificus infection. To our knowledge, there are few historical case reports with illustrations included describing cases of necrotizing fasciitis, particularly with V. vulnificus as the suggested pathogen.

Radiographic improvement and its predictors in patients with pulmonary tuberculosis - Corrected Proof

Saurabh Kumar Singh, Rakesh Bhargava, Vibhanshu Gupta — 2010-07-01

We read with great interest the article by Heo et al. entitled “Radiographic improvement and its predictors in patients with pulmonary tuberculosis”. We would like to make one comment on this. They have categorized the pulmonary lesions on chest X-ray as mass-like (>3cm), nodules (<3cm) with patchy opacity, fibrotic, cavitary, linear, and miliary pattern. However, they have not mentioned whether any X-ray showed atelectasis. Atelectasis in tuberculosis occurs due to narrowing of the bronchus either as a result of extrinsic compression by the enlarged lymph node or due to endobronchial tuberculosis. Although atelectasis is less commonly seen in adults (18%), we have seen many tubercular patients presenting with atelectasis on X-ray.

Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis - Corrected Proof

R. Vivancos, I. Abubakar, P.R. Hunter — 2010-06-28

Summary: Objectives: With increasing international travel it is important to understand how frequent casual travel sex and unprotected intercourse are, and what impact this may have on the risk of acquiring sexually transmitted infections (STIs).Methods: We conducted a systematic review, and where appropriate meta-analyses, to ascertain the influence of foreign travel on behavior, including new partnerships, unprotected intercourse, and STI acquisition.Results: The pooled prevalence of travel-associated casual sex was 20.4% (95% confidence interval (CI) 14.8–26.7%), with 49.4% (95% CI 38.4–60.5%) of these having unprotected intercourse. The predominant characteristics of people who had new sexual partners abroad were: young age, male gender, single status, and traveling alone or with friends, with a previous history of multiple sexual partners or an STI. People who travel or stay abroad for longer periods and men who have sex with men are at higher risk of developing new sexual partnerships and having unprotected intercourse. The risk of developing an STI is increased up to 3-fold in people who experience casual travel sex.Conclusions: New sexual partnerships and unprotected intercourse abroad are relatively common. People who develop new sexual partnerships and have unprotected intercourse abroad have an increase risk of STIs. There is, however, a paucity of information related to strategies to prevent the risk of STI acquisition during foreign travel.

Human cowpox virus infection acquired from a circus elephant in Germany - Corrected Proof

2010-06-28

Summary: A 40-year-old Asian circus elephant developed mouth and trunk ulcers. Three weeks later, her 19-year-old animal warden noticed a vesicle on his forearm, evolving into a scab. Identical cowpox strains were isolated from lesions of the elephant and the warden. Cowpox virus could no longer be isolated after the scab disappeared, but PCR still revealed orthopox DNA. Healing was complete seven weeks later, leaving a 1cm scar.

Reply - Corrected Proof

H.Y. Heo, J.-J. Yim — 2010-06-28

We thank Drs Singh, Bhargava, and Gupta for their interest in our recent work. They underscored the importance of atelectasis as a possible parameter for treatment response among tuberculosis patients. Although we agree that the presence of atelectasis is one of the important radiographic findings associated with tuberculosis, we do not think that atelectasis could be used as a marker for treatment response. As Drs Singh, Bhargava, and Gupta explained, atelectasis is caused by endobronchial tuberculosis or extrinsic compression of enlarged lymph nodes. Given that endobronchial tuberculosis and tuberculous lymphadenitis are very difficult to improve despite sterilization of tuberculous bacilli, atelectasis might not be a proper candidate for a surrogate of treatment response.

Brucellosis infection presenting with cholestasis - Corrected Proof

2010-06-25

Summary: Brucellosis is a relatively common disease in the Mediterranean area and may present with prolonged fever without focus, however it remains an important diagnostic challenge to most pediatricians. We report the case of a 10-year-old male patient who presented with fever without a focus of 10-day duration, hepatomegaly, ascites, a small elevation in transaminases and acute-phase reactants indicating cholestasis, leukopenia, and thrombocytopenia. Imaging tests showed many small, rounded, hypodense focal lesions in the liver and spleen. After eliminating a wide range of diseases, positive results for the Rose Bengal test and indirect immunofluorescence assay for Brucella melitensis made it possible to establish a diagnosis of hepatosplenic brucellosis. A review of the family history revealed direct contact with farm animals. The patient made good progress on treatment with doxycycline and streptomycin, with complete resolution of both clinical symptoms and imaging signs. The prevalence of brucellosis is gradually increasing, mainly due to migratory movements. It should always be eliminated as a source of unknown fever in endemic areas and should also be taken into account in other geographical areas where it is not common whenever a patient presents with prolonged fever and unspecific symptoms. Standard therapy is highly effective, even in relapse cases, and early diagnosis leads to a rapid recovery and favorable outcome. The unusual presentation in the case reported here reminds us that it is possible to encounter a Brucella infection in a case of fever without a focus, irrespective of the existence of a clear epidemiological history, which is very often omitted by the family. All differential diagnostic protocols for fever without a focus should include a diagnostic test for Brucella in order to achieve early detection of the disease and initiate therapy promptly.

Prolonged paradoxical response to anti-tuberculous treatment after infliximab - Corrected Proof

2010-06-25

Summary: A 56-year-old woman with ankylosing spondylitis, treated for 3 months with infliximab, developed miliary tuberculosis with mediastinal lymphadenopathies and brain and splenic lesions. After initial improvement under anti-tuberculous therapy, she suffered an unexpectedly prolonged paradoxical worsening with several episodes of lymphadenopathy, including life-threatening ones, over a period of more than 14 months of follow-up. The outcome was favorable as a result of corticosteroid and surgical treatments. This phenomenon reflects a paradoxical reaction precipitated by infliximab withdrawal.

Staphylococcus intermedius is not only a zoonotic pathogen, but may also cause skin abscesses in humans after exposure to saliva - Corrected Proof

Theodoros Kelesidis, Sotirios Tsiodras — 2010-06-21

Summary: Background: Staphylococcus intermedius is a very rare human pathogen. There are only 16 cases in the literature that have described S. intermedius as a cause of infection in humans. Most of these cases have been described in association with exposure to animals, mostly dogs. However, this pathogen can cause infection in healthy individuals even without exposure to animals.Methods: All previous cases of S. intermedius infection included in our literature review were found using a PubMed search (1960–November 2009) of the English-language medical literature applying the terms ‘Staphylococcus intermedius’, ‘abscess’, ‘infection’, ‘humans’. The references cited in these articles were examined to identify additional reports.Results: We describe the first case of skin abscesses caused by S. intermedius in an immunocompetent patient who used intravenous cocaine after coating his syringes with his saliva. We also summarize the literature regarding infections caused by S. intermedius in humans.Conclusions: This case illustrates for the first time that S. intermedius can cause skin abscesses in humans after direct inoculation of this pathogen into the skin and soft tissues. Clinicians should be aware of the fact that although the vast majority of infections from coagulase-positive Staphylococcus infections are secondary to Staphylococcus aureus, S. intermedius is also a potential pathogen in humans.

A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii - Corrected Proof

2010-06-21

Summary: Background: Risk factors and outcome in patients who acquire nosocomial infections due to carbapenem-resistant Acinetobacter baumannii (CRAB) are rarely investigated.Methods: A multicenter retrospective study was conducted to analyze the clinical and microbiological data of patients with nosocomial infections due to A. baumannii in 10 hospitals around Taiwan from May 2004 to December 2006. Comparisons were made between patients with infections due to CRAB and patients with infections due to carbapenem-susceptible A. baumannii (CSAB).Results: One hundred and twenty-one patients carrying CRAB (infections, n=91) and 127 patients carrying CSAB (infections, n=97) were recruited for analysis. Compared with patients with CSAB infections, patients with CRAB infections had a longer duration of hospital stay before A. baumannii was isolated (median 48 vs. 21 days, p<0.001) and were more likely to have had exposure to a carbapenem (adjusted odds ratio (AOR) 2.57, 95% confidence interval (95% CI) 1.43–5.35; p=0.02) and an intensive care unit (ICU) stay (AOR 3.42, 95% CI 1.76–5.26; p=0.008). Risk factors associated with CRAB bacteremia included duration of hospital stay before onset of bacteremia (AOR 1.009 per 1-day longer, 95% CI 1.03–1.24; p=0.049), prior colonization with A. baumannii (AOR 3.27, 95% CI 1.99–5.93; p=0.002), and hospitalization in the ICU (AOR 6.12, 95% CI 1.58–13.68; p=0.009). Patients with CRAB bacteremia had a higher mortality rate than patients with CSAB bacteremia (46.0% vs. 28.3%, p=0.04). Multivariate analysis showed that carbapenem resistance (AOR 5.31, 95% CI 1.88–13.25; p=0.002), central venous catheterization (AOR 3.27, 95% CI 1.55–10.56; p=0.009), and ICU stay (AOR 2.56, 95% CI 1.15–8.85; p=0.04) were independent variables associated with mortality in patients with A. baumannii bacteremia.Conclusions: Patients with CRAB infections have a higher mortality rate than those with CSAB infections. Longer hospital stay, colonization with A. baumannii, and admission to the ICU were associated with the development of CRAB bacteremia.

Infective endocarditis caused by Streptococcus bovis complicated by a superior mesenteric artery mycotic aneurysm and systemic septic emboli in a patient with colon diverticulitis - Corrected Proof

Han-Tan Chai, Boon-Lee Tan, Hsu-Ting Yen, Mien-Cheng Chen — 2010-06-21

Summary: To date, Streptococcus bovis endocarditis complicated by a superior mesenteric artery mycotic aneurysm and systemic septic emboli in a patient with colon diverticulitis has never been reported. A 46-year-old man, with a history of colon diverticulitis identified by diagnostic colon fiberscope and with hypertension, presented with a 14-day history of intermittent fever. An echocardiogram revealed severe mitral regurgitation with two large floating vegetations attached to both mitral leaflets. A blood culture grew S. bovis. Abdominal pain and left leg weakness developed 10 days after admission. Computerized tomography identified a 5×3cm mycotic aneurysm, and angiography revealed a saccular aneurysm at the distal branch of the superior mesenteric artery. A duplex study revealed an intravascular mass at the left femoral artery bifurcation. The patient accordingly underwent surgical resection of the mycotic aneurysm, removal of the mycotic thrombi, and mitral valve replacement. The patient's recovery was unremarkable.

Progressive multifocal leukoencephalopathy in Good's syndrome - Corrected Proof

Marco Capobianco, Annalisa Pulizzi, Antonio Bertolotto — 2010-06-21

We read with interest the paper by Squintani et al. on the association between progressive multifocal leukoencephalopathy (PML) and Good's syndrome (GS), which is a combined immunodeficiency syndrome occurring in thymoma.

A case-based learning format for a swine flu ‘hot topic’ learning module - Corrected Proof

Susan M. Perlis, Raymond A. Smego — 2010-06-21

Each year the Association of American Medical Colleges/Liaison Committee for Medical Education (AAMC/LCME) presents a list of ‘hot topics’ in medical education that are particularly timely and relevant for inclusion in medical school curricula. This fall at our new medical school, in the midst of the current swine origin H1N1 influenza A pandemic, we utilized a case-based learning (CBL) course format to provide in-depth knowledge of this novel global pathogen, while simultaneously assisting in the institutional preparedness against this public health threat. The local and statewide outbreak of swine flu provided an opportunity to demonstrate the curricular flexibility of our new school while satisfying the learning objective of addressing several of the 2009 AAMC/LCME hot topics, namely epidemiology, evidence-based education, patient health education, and preventive and health maintenance.

Pulmonary cryptococcosis misdiagnosed as smear-negative pulmonary tuberculosis with fatal consequences - Corrected Proof

2010-06-18

Summary: HIV-associated pulmonary cryptococcosis is under diagnosed, and may progress to fatal meningoencephalitis. We present a case of HIV-associated pulmonary Cryptococcus neoformans infection, initially mis-diagnosed as smear-negative pulmonary TB, which progressed to fatal cryptococcal meningitis. Autopsy series suggest that pulmonary cryptococcosis is common in African AIDS patients, and, due to limited diagnostic capacity, often mis-diagnosed as smear negative TB. Serum cryptococcal antigen testing may facilitate diagnosis in such cases.

Should microbicides be controlled by women or by physicians? - Corrected Proof

Jocelyne Piret, Michel G. Bergeron — 2010-06-18

Summary: In 2007, nearly 7000 new cases of HIV infection occurred each day. There is a constant increase in the proportion of women newly infected with HIV in the global population; this increase is particularly high in some areas of the world such as sub-Saharan Africa. Microbicides are products that are being developed to empower women against HIV. First- and second-generation microbicides are broad-spectrum products that include surface active agents, vaginal defense enhancers, and blocking agents. Third-generation microbicides are HIV-specific and include replication and entry inhibitors formulated as gels or as vaginal rings. However, there is a concern that antiretroviral-based microbicides could lead to drug resistance if they are used by HIV-positive women who are unaware of their HIV status. To reach the highest number of women possible, microbicides should be available over-the-counter, which might not be the case with antiretroviral-based formulations. In contrast, non-antiretroviral-based microbicides will have the advantage of being initiated and controlled by women themselves and they will not jeopardize the use of life-saving drugs.

Coxiella burnetii infection of left atrial thrombus mimicking an atrial myxoma - Corrected Proof

2010-06-18

Summary: Infection of intracardiac thrombi is extremely unusual. Coxiella burnetii is a well-recognized etiologic agent of negative-blood culture endocarditis and vascular graft infection. Herein we describe the first reported case, to our knowledge, of C. burnetii infection of a large left-sided intracardiac thrombus that was initially misdiagnosed as an atrial myxoma. Diagnosis was confirmed by direct immunofluorescence assay, electron microscopy, and C. burnetii-specific polymerase chain reaction analysis performed on tissue sections of the thrombus.

Clinical outcomes in Mexican children with febrile acute upper respiratory tract infections: no impact of antibiotic therapy - Corrected Proof

2010-06-16

Summary: Objective: To compare the clinical outcomes (duration of signs and symptoms) and the microbiology in Mexican children with non-complicated febrile upper respiratory tract infections (URI), with and without the use of antibiotics.Methods: We conducted a prospective cohort study from September 2006 to July 2007. The study population consisted of 880 children aged 6 months to 5 years 11 months, attending four community daycare centers run by the Instituto Mexicano del Seguro Social (IMSS) and three non-IMSS daycare centers. Children with a febrile URI were enrolled before receiving any antimicrobials and were followed up for two weeks. Duration of the fever, cough, runny nose, stuffy nose, irritability, loss of appetite, tiredness, and diarrhea, and isolation of Haemophilus influenzae, Streptococcus pneumoniae, and Streptococcus pyogenes were compared in those children who received antibiotic treatment and those who did not receive antibiotics.Results: During the study period, a total of 145 out of 880 children were enrolled, and among those enrolled, 85/145 (59%) children received antibiotics. There was no significant difference in the duration of the signs and symptoms evaluated in the two groups. Although the proportions of S. pneumoniae, H. influenzae, and S. pyogenes isolated in children with and without antibiotics were comparable, those in whom we isolated S. pneumoniae had both a significantly longer episode of URI, as well as longer lasting diarrhea. Similarly, children receiving trimethoprim–sulfamethoxazole treatment experienced significantly longer durations of fever and diarrhea.Conclusions: The mean duration of signs and symptoms and the microbiological isolates of children with febrile URI were comparable among children treated with or without antibiotics, with the exception of a longer duration of URI and diarrhea in those children with an S. pneumoniae isolate. Our findings suggest that in our population, most cases of febrile URI are caused by viral infections, and demonstrate that antibiotics should not be used routinely in children with non-complicated febrile URI.

Fatal outcome of a disseminated dual infection with drug-resistant Mycoplasma hominis and Ureaplasma parvum originating from a septic arthritis in an immunocompromised patient - Corrected Proof

2010-06-16

Summary: Mycoplasma hominis and Ureaplasma parvum are rare causes of severe and fatal infections. The diagnosis of infection with mycoplasma is dependent on clinical suspicion and microbiological diagnosis, and often relies on molecular methods that do not readily detect antibiotic resistance. This may be of increasing importance as illustrated in the case below.

Mycobacterium marinum infection following kayaking injury - Corrected Proof

Marc Tebruegge, Tom Connell, Nicole Ritz, David Orchard, Nigel Curtis — 2010-06-14

In November 2009, a previously healthy 16-year-old girl was referred to our department with a persistent skin lesion on her left leg. She had sustained a laceration at the same site in May 2008 when she scraped herself on barnacles whilst kayaking in the local Maribyrnong River. The laceration was slow to heal and gradually transformed into a nodular lesion over the following three months. A curettage in November 2008 failed to achieve clinical resolution and cultures revealed no causative organism. An attempt to excise the lesion in February 2009 was also unsuccessful; histology of the excised material showed granulomatous inflammation. Examination revealed a 13mm diameter nodular, erythematous, non-tender lesion on her left lower leg (). There was no regional lymphadenopathy and other physical examination was unremarkable. A biopsy of the lesion was sent for mycobacterial PCR testing. Sequencing of the PCR product revealed close homology with published sequences of Mycobacterium marinum. A QuantiFERON-TB Gold assay was positive. The patient was started on ethambutol and clarithromycin, which resulted in significant improvement within 6 weeks and near complete resolution of the lesion after 4 months.

Time and spatial distribution of multidrug-resistant tuberculosis among Chinese people, 1981–2006: a systematic review - Corrected Proof

2010-06-07

Summary: Objectives: We aimed to investigate trends in the prevalence of multidrug-resistant tuberculosis (MDR-TB) among Chinese people from first report to 2006, and to detect the high prevalence regions in order to guide control efforts.Materials and methods: The CBM, VIP, CNKI, and MEDLINE databases were searched through both keywords and subject headings. The literature was screened, and two investigators assessed the quality and extracted the data. Trends in MDR-TB prevalence in three groups – primary, acquired, and combined MDR-TB – were examined separately, using the Cochran–Armitage trend test. Differences were tested with the Kruskal–Wallis test. High prevalence provinces were explored through comparison of the 95% confidence interval (95% CI) with the national average level.Results: Overall 169 studies were included, with 165 in Chinese and four in English. One hundred and sixteen studies concerned primary MDR-TB, 103 acquired MDR-TB, and 130 combined MDR-TB, with total positive Mycobacterium tuberculosis (MTB) isolates of 110 076, 25 187, and 150 233, respectively. The prevalences of MDR-TB in the three groups in 2005 were 2.64-, 6.20-, and 3.84-times that of 1985, respectively, all showing an upward trend (p<0.05). The prevalences among the three groups were significantly different (p<0.05), with acquired drug resistance (27.5%, 95% CI 26.9–28.1%) much higher than primary drug resistance (4.3%, 95% CI 4.2–4.4%), and combined resistance (9.9%, 95% CI 9.8–10.1%) in between. The top three prevalence regions for primary, acquired, and combined MDR-TB were distributed in the zone from the northeast to the southwest of China, with Hebei, Tibet, and Shanxi having an extremely high prevalence.Conclusions: The prevalence of MDR-TB among the Chinese people has shown an upward trend since 1985. It is necessary to continue to monitor this trend in China. Special attention should be paid to provinces distributed in the zone from the northeast to the southwest of China for MDR-TB surveillance, research, and control.

Optic neuritis associated with Q fever: case report and literature review - Corrected Proof

Chong Ong, Omar Ahmad, Sanjaya Senanayake, Graham Buirski, Christian Lueck — 2010-06-04

Summary: Optic neuritis (ON) is a rare association of Q fever. We report the first case of ON associated with Q fever in Australia and review all previously reported cases in the medical literature. The impact of therapy with antibiotics and steroids on outcome is discussed. Q fever should be considered in the differential diagnosis of patients presenting with apparent acute idiopathic ON.

Allergic fungal sinusitis complicated by fungal brain mass - Corrected Proof

George M. Viola, Richard Sutton — 2010-06-04

Summary: A 36-year-old African American female with a 14-year history of allergic fungal sinusitis (AFS) presented with progressive worsening headache, fevers, proptosis, and a large frontal lobe brain mass. After excisional biopsy, the non-invasive, dematiaceous mold, Bipolaris australiensis, was identified. We review the epidemiology, etiology, pathophysiology, and clinical presentations of fungal sinusitis, as well as the complex management and multifaceted therapeutic modalities of AFS.

Compartmental syndrome of the upper limb due to Moraxella lacunata infection: a link to patera foot syndrome? - Corrected Proof

2010-06-04

Summary: We report a case of compartmental syndrome of the left upper limb secondary to a severe Moraxella lacunata infection, an unusual pathogen, occurring in a young black male immigrant to the island of Gran Canaria, Spain. We propose a pathophysiological relationship with patera foot syndrome.

Cefepime-resistant Gram-negative bacteremia in febrile neutropenic patients with hematological malignancies - Corrected Proof

Yong Chong, Hiroko Yakushiji, Yoshikiyo Ito, Tomohiko Kamimura — 2010-05-17

Summary: Objectives: This study was performed to determine the local etiologic pattern of blood culture isolates and antibiotic resistance in febrile neutropenic patients with hematological malignancies.Methods: A total of 142 blood culture isolates from febrile neutropenic patients admitted to our hematology unit were examined, particularly for the detection of cefepime resistance, because cefepime, a fourth-generation cephalosporin, has been used in our unit as initial therapy for febrile neutropenia.Results: Among all isolates, 67 (47.2%) were Gram-positive bacteria, the majority of which were fully sensitive to vancomycin. Gram-negative bacteria accounted for 68 (47.9%) of the isolates. Cefepime resistance was seen in 24 (35.3%) of the Gram-negative isolates, and had significantly increased in 2007. The cefepime-resistant isolates primarily consisted of Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Approximately 60% of the cefepime-resistant isolates were extended-spectrum β-lactamase (ESBL)-producing organisms. Molecular analysis showed the predominant emergence of CTX-M types. Most of the cefepime-resistant isolates were resistant to third- and various fourth-generation cephalosporins, while having a high susceptibility to carbapenems, particularly meropenem.Conclusions: Cefepime resistance was often detected in the blood culture isolates from febrile neutropenic patients. This result suggests that therapeutic strategies for febrile neutropenia should be modified based on the local antibiotic resistance patterns.

Duration of post-surgical antibiotics in chronic osteomyelitis: empiric or evidence-based? - Corrected Proof

Rachid Haidar, Asdghig Der Boghossian, Bisharah Atiyeh — 2010-05-14

Summary: Chronic osteomyelitis is a relatively common infection and is often a lifelong disease. Traditionally, osteomyelitis has been treated with 4–6 weeks of parenteral antibiotics after definitive debridement surgery. Antibiotic-impregnated cement beads have also been used as adjuvant therapy for chronic osteomyelitis. However, this time frame of antibiotic treatment has no documented superiority over other time intervals, and there is no evidence that prolonged parenteral antibiotics will penetrate the necrotic bone. There is no solid evidence in the medical literature to support the continuous use of long duration antibiotic treatment for chronic osteomyelitis. A small number of comparative trials on the treatment of chronic osteomyelitis have been published. Also, the type of surgical procedures practiced in the past in treating chronic osteomyelitis and the lack of effective muscle flap application might have contributed to the prolonged antibiotic treatment. And although the surgical approach to the treatment of chronic osteomyelitis has advanced markedly, still the same duration of antibiotic treatment is adopted. In this review we question the continuous and traditional use of long-term antibiotic treatment for chronic osteomyelitis in spite of the advances in surgical treatment using flaps. The medical literature, including studies in animals and humans, was searched for evidence to support the use of short courses of antibiotics. We hope this review will provoke the initiation of animal studies and clinical trials assessing the use of short courses of antibiotics for chronic osteomyelitis.

Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants - Corrected Proof

2010-05-11

Summary: Objectives: To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants.Methods: HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed.Results: Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (incidence=0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. The odds of LRTI in infants whose mothers had CD4% <14 at enrollment were 4.4 times those of infants whose mothers had CD4% ≥29 (p=0.003). The odds of LRTI in infants with a CD4+ count (cells/mm3) <750 at hospital discharge were 16.0 times those of infants with CD4+ ≥750 (p=0.002). Maternal CD4+ decline and infant hemoglobin at the 6–12 week visit were associated with infant LRTIs after 6–12 weeks and before 6 months of age.Conclusions: Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed.