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
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.
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.
Since the licensure of the heptavalent pneumococcal
conjugate vaccine (PCV7) in 2000, the prevalence of
invasive pneumococcal disease (IPD) among children
in the United States has decreased significantly. The
incidence of IPD caused by pneumococcal serotypes associated
with PCV7 among children younger than 5 years
decreased from 80 cases per 100,000 population in 1998 to
1999 to 4.6 cases per 100,000 population in 2003.1 Various
studies have demonstrated that nasopharyngeal colonization
with pneumococcal serotypes covered by the
vaccine also has decreased. However, several studies suggest
that in some settings, these bacterial populations
have been replaced with Streptococcus pneumoniae serotypes
not covered by the vaccine.2,3
Kawasaki syndrome (KS) is a common and serious disorder
that most often affects children aged 1 to 8 years but mimics
a range of other diseases of childhood. Diagnosis of KS is
based on physical examination findings coupled with the
exclusion of other causes. To provide optimal care for patients,
it is important to be aware of the differential diagnosis of KS.
We report a case of a 4-year-old boy who presented with
persistent fever and cervical lymphadenitis; later, mucous
membrane changes, rash, and conjunctival injection
characteristic of KS developed. [Infect Med. 2008;25:320-322]