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Infections In Medicine Journal

Infections In Medicine Journal

A 52-year-old woman presented with a 12-day history of diarrhea and mild stool incontinence that began 2 to 3 hours after a routine screening colonoscopy. Six or 7 bowel movements of liquid, orange-yellow feces occurred each day for 12 days. The patient reported that associated nausea, flatulence, and severe abdominal cramping were relieved by the bowel movements. She also reported that a small amount of mucus was occasionally observed in the stool and that bright red blood streaks appeared on used toilet paper, although the stool itself was not bloody. She was able to tolerate a full diet, although food exacerbated the urgency. She was afebrile during this illness.

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]

A zoonosis is any disease-bacterial, mycotic, viral, or parasitic-that is transmissible from an animal to a human. More than 200 zoonoses have been identified. The newly emerging zoonosis that has achieved star status in the medical press is avian influenza. Another emerging threat is Nipah virus, which is transmitted from pigs to humans in the agricultural setting and causes encephalitis. But animal to human transmission of zoonoses are multimodal: from exposure to animal secretions in the agricultural setting, to transmission through insect vectors and ingestion of contaminated animal products, to more insidious routes, such as petting or being scratched or nipped at by one's pet dog, bird, cat, lizard, or other creature. A few interesting cases are presented here.

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]

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:
487-489]

Because widespread use of highly active antiretroviral therapy
has made it possible for persons with HIV infection to live
longer, the epidemiology of HIV/AIDS has shifted in several
ways. The number of persons 50 years and older living with
HIV/AIDS has risen in recent years, and there has been a
substantial increase in common comorbidities associated with
aging in this population. These changes place new emphasis on
the important role of primary care in HIV/AIDS management.
[Infect Med. 2008;25:477-480]

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]

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