In 2004, 391 cases of West Nile virus (WNV) infection were
reported in Arizona. This represented an epidemic that
challenged area clinicians. We treated 34 patients with WNV
infection and reviewed their medical records. They were
hospitalized at 3 community hospitals during the epidemic.
These patients represented 9% of all WNV infection cases
reported in Arizona. Meningitis was diagnosed in 13 patients,
encephalitis in 12, fever of unknown origin in 5, transverse
myelitis in 3, and carditis in 1. Respiratory failure requiring
mechanical ventilation developed in 6 patients. Five of the
sickest patients were empirically treated with interferon alfa 2b
and ribavirin. The epidemic and associated clinical challenges
prompted evaluation of the available diagnostic and treatment
strategies to optimize care of very ill patients. The consensus
among clinicians was that they were poorly prepared to
diagnose and treat WNV infection in hospitalized patients.
All patients survived hospitalization, although 4 patients
died after discharge because of factors attributable to WNV
infection. [Infect Med. 2008;25:430-434]
Infections In Medicine Journal
In 2004, 391 cases of West Nile virus (WNV) infection were
Every day, patients seek treatment for eye infections, which have a variety of causes and can affect any part of the eye. Eye infections usually are treated aggressively, because seemingly benign infections can quickly become serious and threaten vision. Symptoms that indicate an eye infection include chronic redness, persistent pruritus, flaking of the eyelid, eye discomfort or pain, blurred vision, eye discharge, and edema of ocular tissue. The following disease descriptions and case vignettes highlight a variety of eye infections, both common and uncommon, with which patients may present.
The case concerns a patient with eosinophilic meningitis
attributed to the helminthic parasite Angiostrongylus
cantonensis. Before the onset of illness, our patient had a
history of travel to Hawaii, the only area in the United States
where A cantonensis is endemic. Finding eosinophils in the
cerebrospinal fluid (CSF) can narrow the differential diagnosis
in a patient with meningitis. In our patient, the proportion of
eosinophils in the CSF was 55%. The case is unique because the
patient was a strict vegetarian. This infection usually develops
in persons who inadvertently ingest snails or slugs that contain
the parasite. [Infect Med. 2008;25:366-368]
Rhodococcus equi is an emerging human pathogen. It is most
frequently associated with pulmonary infections; however,
manifestations may be protean. It can be easily mistaken for
a diptheroid-like contaminant or a mycobacterium. Therefore,
a high suspicion of R equi infection and specialized testing are
encouraged. Vancomycin-based therapy is recommended.
Because human infection with this organism is uncommon,
thorough reporting will help identify further characteristics
of infection and will help in devising treatment guidelines.
[Infect Med. 2008;25:391-393
A 41-year-old African American man presented with the chief complaint of a constant, dull headache for 3 days. The headache had a gradual onset and was associated with nausea and mild neck stiffness that was not relieved by acetaminophen. The man denied experiencing visual disturbances, fever, night sweats, weight loss, cough, shortness of breath, emesis, or weakness. He had no recent history of trauma or sick contacts.
AS IF WE DID NOT ALREADY
know, overcrowding and understaffing
in hospitals play key roles
in the spread of methicillin-resistant
Staphylococcus aureus (MRSA) infection.
Data culled from a literature
review of 140 articles suggest that
overcrowding and understaffing
result in having too few staff members
serving too many patients
without sufficient time resources.
The consequences are overexposure
of a single health care worker to
patient contacts and lapses in
hygiene on the part of health care
personnel who literally have too
much responsibility-among other
things-on their hands.
Most travelers to third-world countries encounter healthrelated
problems during their stay and may require medical
attention on returning home. Although malaria is still the
most common diagnosis among travelers to the developing
world, several other infectious diseases, such as avian influenza,
dengue fever, chikungunya fever, leishmaniasis, and
multidrug-resistant tuberculosis, are growing in importance.
Clinicians need to stay informed about travel requirements
and vaccine recommendations for US citizens. [Infect Med.
A new study confirmed the value of real-time polymerase chain reaction (PCR) assay as a rapid method of screening for group B streptococci (GBS) colonization during parturition.1 Using real-time automated PCR assay, DNA amplification testing, and standard culture, Edwards and colleagues1 comparatively looked at the detection of GBS colonization in women who were in the 35th to 37th week of pregnancy and in women who were about to give birth. A true-positive result was defined as a positive molecular test and a positive culture finding. Compared with culture, the sensitivity rate of PCR was 91.1%, the specificity was 96.0%, the predictive value was 87.8%, the negative predictive value was 97.1%, and the accuracy was 94.8%. As anticipated, PCR assay was more sensitive than DNA amplification testing (91.1% vs 79.3%). Neither specificity, positive predictive value, nor detection of GBS prevalence was statistically divergent.
A 45-year-old Hispanic man who acquired HIV infection in April 2003 presented with a 24-hour history of worsening right lower quadrant pain accompanied by fever, decreased appetite, nausea, and vomiting. The pain was described as sharp, constant, and nonradiating. He denied any accompanying diarrhea, constipation, urinary frequency, dysuria, dyspepsia, reflux symptoms, or previous episodes of abdominal pain. There was no history of recent travel. His current CD4+ cell count was 239/?L. In May 2003, he had a CD4+ cell count nadir of 133/?L. His HIV RNA level has remained undetectable at less than 50 copies/mL since starting firstline antiretroviral therapy in June 2003. Therapy consists of coformulated zidovudine/lamivudine/abacavir and efavirenz. He has never had opportunistic infections or other major medical illnesses.
Drug-induced aseptic meningitis should be included in the
differential diagnosis of viral/aseptic meningitis. Clinicians
should use historical clues in patients presenting with signs and
symptoms of viral meningitis to aid in the differentiation of
drug-induced aseptic meningitis from other causes of aseptic
meningitis. Viruses are the most common cause of aseptic
meningitis, with enteroviruses being the most common among
viruses in cases presenting as aseptic meningitis. Ibuprofen is
currently the most common cause of drug-induced aseptic
meningitis. Drug-induced aseptic meningitis is a benign condition
without long-term sequelae. The diagnosis of druginduced
aseptic meningitis is made by establishing a causal
relationship between the use of the drug and the onset of signs
and symptoms, supported by negative tests for infectious
causes of symptoms and rapidity of resolution after the drug
is discontinued. [Infect Med. 2008;25:331-334]