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Infections In Medicine Journal

Infections In Medicine Journal

Many advances and challenges have occurred in
the field of pediatric infectious disease medicine
during the past 10 years. Because this is the 10th
anniversary of this column, a summarization of what, in
my opinion, are the most clinically significant developments
is presented here.

Third-degree perineal lacerations reputedly occur in
2.2% to 19% of vaginal deliveries in the United
States.1,2 Breakdown of a third- or fourth-degree
perineal repair can lead to incontinence of stool or flatus,
rectovaginal fistula, or sexual dysfunction.3,4 Infection at
the operative site occurs in up to 12% of cases,5 and a key
factor in successful anal sphincter repair is the absence of
infection.6

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.

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

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]

A 38-year-old HIV-infected man with a CD4+ cell count of 4/?L and an HIV RNA level of more than 750,000 copies/mL was admitted to the hospital after 1 month of painful right neck swelling and 1 week of dysphagia. His history was also notable for methicillinresistant Staphylococcus aureus (MRSA) bacteremia, which occurred 2 months earlier; adrenal insufficiency; chronic hepatitis C; remote Cytomegalovirus retinitis; and recurrent bacterial pneumonia.

ALTHOUGH ENDEMIC MEASLES
transmission has been eliminated
thanks to vaccination efforts,
measles outbreaks nevertheless are
becoming increasingly common because
of importation of measles via
international travel and a growing
population of unvaccinated children
in the United States. That the number
of reported cases of measles in
the first half of 2008 was the highest
year-to-date since 1996-131 cases-
is a cause for alarm. The CDC noted
that measles is one of the first diseases
to reemerge when rates of vaccination
coverage decline. In its report
and commentary in the August
22 issue of Morbidity and Mortality
Weekly Report (Update: Measles-
United States, January-July 2008.
MMWR. 2008;57:893-896), the CDC
suggested that these outbreaks reflect
a trend among parents to opt
out of having their children vaccinated
for either religious or philosophical
reasons.

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