Craig B. Brown, DO

In 2004, 391 cases of West Nile virus (WNV) infection werereported in Arizona. This represented an epidemic thatchallenged area clinicians. We treated 34 patients with WNVinfection and reviewed their medical records. They werehospitalized at 3 community hospitals during the epidemic.These patients represented 9% of all WNV infection casesreported in Arizona. Meningitis was diagnosed in 13 patients,encephalitis in 12, fever of unknown origin in 5, transversemyelitis in 3, and carditis in 1. Respiratory failure requiringmechanical ventilation developed in 6 patients. Five of thesickest patients were empirically treated with interferon alfa 2band ribavirin. The epidemic and associated clinical challengesprompted evaluation of the available diagnostic and treatmentstrategies to optimize care of very ill patients. The consensusamong clinicians was that they were poorly prepared todiagnose and treat WNV infection in hospitalized patients.All patients survived hospitalization, although 4 patientsdied after discharge because of factors attributable to WNVinfection. [Infect Med. 2008;25:430-434]

Life-threatening heart failure associated with itraconazoleantifungal therapy developed in a patient with disseminatedCoccidioides immitis infection. This was documented bycardiac studies that demonstrated a deterioration of cardiacfunction during therapy and an improvement after itraconazoletherapy was discontinued. Heart failure associatedwith itraconazole can be missed by those unfamiliar with thiscomplication. In any patient with a fungal infection who isbeing treated with itraconazole, this serious complication canoccur; however, it can be reversible with discontinuation ofthe drug. [Infect Med. 2008;25:292-293]