A 28-year-old man presented with a 1-year history of nodular, plaque-like, nontender, pruritic lesions on his face, ears, elbows, and feet. He was born in Mexico but had been residing in the United States for the past 6 years. He worked in construction, was an active smoker, and denied use of alcohol or illicit drugs. The patient had not been taking any oral medications and had no recent history of trauma.
Infections In Medicine Journal
Morbidity and mortality attributed to Candida and Aspergillus
infections can be quite high in immunocompromised hosts.
The epidemiology and clinical manifestations as well as clinical
pearls on prevention of infections caused by Candida and
Aspergillus are discussed in this second installment of a 3-part
series on opportunistic infections in immunosuppressed
patients. [Infect Med. 2008;25:498-505]
Herpes zoster is a painful, blistering rash that typically manifests in a dermatomal distribution and is caused by reactivation of varicella-zoster virus infection. A classic presentation of herpes zoster involving the right T4 dermatome is illustrated in Figure 1. The patient was a 90-year-old man who experienced severe pain on the right side of his neck and chest followed by development of maculopapular lesions. The lesions, which ranged from macular to vesicular, resolved with no scarring or postherpetic neuralgia following 10 days of therapy with oral acyclovir and intramuscular injections of γ-globulin.
Opportunistic fungal infections are increasingly common in
patients who undergo hematopoietic stem cell transplant
(HSCT). Voriconazole is frequently used in allogeneic
SCT recipients who receive immunosuppressant therapy for
graft versus host disease to prevent invasive aspergillosis.
Indications for voriconazole use include invasive aspergillosis,
candidemia, Scedosporium apiospermum infection, and fusariosis.
We describe a case in which disseminated Fusarium infection
developed in an HSCT recipient who was receiving voriconazole
therapy. [Infect Med. 2008;25:528-530]
Mycobacterium goodii infection is uncommon and probably
occurs via disruption of skin and bone integrity or the
introduction of a foreign body into viscera, namely implantation
of a prosthetic device. We describe a case of nosocomial,
total knee arthroplasty–associated M goodii infection that
required combined antibiotic and surgical therapy for clinical
management. An infection control investigation revealed that
the source of the organism might have been the water in the
operating room scrub faucets. [Infect Med. 2008;25:522-525]
Posaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunosuppressed patients aged 13 years or older and for treatment of oropharyngeal candidiasis (Table 1), is like other triazole antifungals in that it blocks ergosterol biosynthesis. 1 Its chemical structure is most similar to that of itraconazole (Figure), which may confer efficacy even against strains resistant to fluconazole and voriconazole.2
A 55-year-old man with no past medical problems presented with headache, difficulty in walking, and loss of balance of 3 days' duration. Physical examination findings and laboratory test results were unremarkable except for lethargy, slurred speech, positive Romberg sign, hyponatremia, and leukocytosis with left shift.
Community-acquired pneumonia is a frequent cause of
hospital admission in adults. It usually results from infection
with pathogens such as Streptococcus pneumoniae, Haemophilus
influenzae, Mycoplasma, and Chlamydia, among others. In a few
cases, pneumonia develops from infection with unusual
pathogens, such as Pasteurella multocida, a gram-negative
organism commonly found in the mouths of cats and dogs.
We report a case of P multocida pneumonia associated with skin
trauma caused by cat scratches in a woman with a history of
chronic obstructive pulmonary disease. [Infect Med. 2008;25:
Fungal infections are a major cause of morbidity and mortality
in immunosuppressed hosts, such as patients with HIV-1 infection
and those who are otherwise neutropenic. Thus, antifungal
prophylaxis has become important in the care of patients with
AIDS, transplant recipients, persons receiving chemotherapy,
and other at-risk persons. This first installment in a 3-part series
on opportunistic fungal infections in the immunocompromised
person reviews the pathogenesis of opportunistic fungal infections
in select at-risk populations and the pharmacotherapeutic
armamentarium available for prophylaxis and treatment.
[Infect Med. 2008;25:448-456, 473]
Fonsecaea species have been reported as causative agents of
chromoblastomycosis, eumycetoma, and fungal pneumonitis.
However, Fonsecaea rarely involves the CNS, with few cases of
cerebral infection reported in the literature. Fonsecaea monophora
may have greater neurotropic potential than other species of
this genus. We describe a rare presentation of brain abscess
caused by F monophora in an immunocompromised renal
transplant patient. [Infect Med. 2008;25:469-473]