A case of liver abscess and fusobacterium septicemia.

species are well described as the causative pathogen in Lemierre's syndrome, a suppurative thrombophlebitis of the jugular vein. However, they are less recognized for a unique variant of Lemierre's syndrome presenting with invasive intraabdominal infection and associated portal vein thrombosis. We describe a case of with hepatic abscess and septic pylephlebitis.

Donor-derived Coccidioides immitis fungemia in solid organ transplant recipients.

We report disseminated coccidioidomycosis in 3 transplant recipients from a donor in an endemic area found to have unrecognized meningeal coccidioidomycosis. All 3 transplant recipients presented within 3 weeks of receipt of their organ. Only 1 organ recipient survived the acute presentation of coccidioidomycosis.

Control of disseminated scedosporium prolificans infection and endophthalmitis.

Purpose: To report a case of endogenous endophthalmitis as the presenting sign of a disseminated Scedosporium prolificans infection.

Methods: A 38-year-old woman on chronic immunosuppressive treatment for a cardiac transplant was examined for blurry vision in her right eye. Dilated fundus examination in the right eye revealed a large serous retinal detachment with subretinal cream-colored masses.

Abacavir-lamivudine versus tenofovir-emtricitabine for initial HIV-1 therapy.

Background: The use of fixed-dose combination nucleoside reverse-transcriptase inhibitors (NRTIs) with a nonnucleoside reverse-transcriptase inhibitor or a ritonavir-boosted protease inhibitor is recommended as initial therapy in patients with human immunodeficiency virus type 1 (HIV-1) infection, but which NRTI combination has greater efficacy and safety is not known.

Methods: In a randomized, blinded equivalence study involving 1858 eligible patients, we compared four once-daily antiretroviral regimens as initial therapy for HIV-1 infection: abacavir-lamivudine or tenofovir disoproxil fumarate (DF)-emtricitabine plus efavirenz or ritonavir-boosted atazanavir. The primary efficacy end point was the time from randomization to virologic failure (defined as a confirmed HIV-1 RNA level > or = 1000 copies per milliliter at or after 16 weeks and before 24 weeks, or > or = 200 copies per milliliter at or after 24 weeks).

Paromomycin: no more effective than placebo for treatment of cryptosporidiosis in patients with advanced human immunodeficiency virus infection. AIDS Clinical Trial Group.

To evaluate the efficacy of paromomycin for the treatment of symptomatic cryptosporidial enteritis in human immunodeficiency virus-infected adults, we conducted a prospective, randomized, double-blind, placebo-controlled trial before the widespread introduction of highly active antiretroviral therapy (HAART). Seven units under the auspices of the AIDS Clinical Trials Group enrolled 35 adults with CD4 cell counts of < or = 150/mm(3). Initially, 17 patients received paromomycin (500 mg 4 times daily) and 18 received matching placebo for 21 days.

Tuberculosis in physicians. Compliance with preventive measures.

Compliance with public health recommendations for tuberculosis control was evaluated by a survey of 4,417 physicians who had not contracted tuberculosis during medical school nor during the 4 decades after graduation through 1981. Thirty-one percent of the cohort had been vaccinated with bacille Calmette-Guérin (BCG) and 47% considered themselves tuberculin-positive. Thirty-two percent of 1,088 physicians who graduated after 1974 had been exposed to 3 or more patients with infectious tuberculosis in the previous year.

Efficacy of pneumococcal vaccine in high-risk patients. Results of a Veterans Administration Cooperative Study.

We conducted a randomized, double-blind, placebo-controlled trial to test the efficacy of the 14-valent pneumococcal capsular polysaccharide vaccine in 2295 high-risk patients (patients with one or more of the following: age above 55 years and the presence of chronic cardiac, pulmonary, renal, or hepatic disease, alcoholism, or diabetes mellitus). Seventy-one episodes of proved or probable pneumococcal pneumonia or bronchitis occurred among 63 of the patients (27 placebo recipients and 36 vaccine recipients). Vaccine-serotype Streptococcus pneumoniae strains were recovered in association with 11 infections in the placebo group and 14 infections in the vaccine group.

Tuberculosis in physicians: a continuing problem.

We evaluated the occurrence of active tuberculosis in 4,575 physicians who graduated between 1938 and 1981 from the same medical school. There were 66 cases. Fifteen (23%) cases were detected after 1970 including 4 diagnosed in 1981.

Antibiotic-resistant isolates of Streptococcus pneumoniae from clinical specimens: a cluster of serotype 19A organisms in Brooklyn, New York.

Ten of 294 isolates of Streptococcus pneumoniae from patients enrolled in a Veterans Administration Cooperative Studies Program trial of pneumococcal vaccine efficacy were moderately resistant or resistant to penicillin. Nine of these organisms were serotype 19A isolated from patients at the Brooklyn (New York) V.A.

Dosage of antituberculous drugs in obese patients.

There are no published data defining efficacious drug therapy for obese patients with active tuberculosis. Current dosage recommendations are based on total body weight (TBW); drug toxicity might result in obese patients receiving TBW doses. Peak and trough serum levels were measured for rifampin, streptomycin, ethambutol, and pyrazinamide in an obese patient (166 kg TBW, 87 kg ideal body weight (IBW] with miliary and meningeal tuberculosis.

Evaluation of Gonozyme, an enzyme immunoassay for the rapid diagnosis of gonorrhea.

A new indirect enzyme immunoassay (EIA), Gonozyme (Abbott Laboratories), was assessed for rapid detection of gonococcal antigens. A correlation of optic density (OD) readings by EIA with colony counts of serial dilutions of Neisseria gonorrhoeae ATCC 19424 disclosed that EIA detected 10(3) CFU/ml at OD readings of 0.1 to 0.

Failure of medical therapy in tricuspid endocarditis due to Staphylococcus aureus.

A patient with isolated tricuspid endocarditis due to Staphylococcus aureus had persistent bacteremia despite antibiotic therapy for 47 days until surgery. Cultures of the resected valve disclosed 1.4 X 10(8) colony forming units per gram of valve.

Rapid diagnosis of septic arthritis by coagglutination.

Pneumococcal capsular antigens were detected and serotyped by coagglutination in joint fluids and serum of a patient with septic arthritis within 1 h of obtaining the specimens. Pneumococcal antigens continued to be detected by coagglutination for 3 days, whereas cultures and Gram stains were negative after 1 day of antibiotic therapy.

Coagglutination for detection and serotyping of bacterial antigens: usefulness in acute pneumonias.

Staphylococcal coagglutination was evaluated for detection of Streptococcus pneumoniae and Haemophilus influenzae antigens in vitro and in the clinical setting of acute pneumonia. Coagglutination testing was performed with Phadebact reagents and with polyvalent and type-specific reagents for pneumococci prepared in the laboratory. Purified capsular antigens of 10 of 14 pneumococcal serotypes (included in the current pneumococcal vaccine formulation) were detected by coagglutination in the range of 0.

Bacterial meningitis without clinical signs of meningeal irritation.

A clinical diagnosis of meningitis in neonates is difficult because of paucity of physical findings. In older infants and children, nuchal rigidity, Kernig's or Brudzinski's sign, or bulging fontanelles are sought. A review of 1,064 cases of bacterial meningitis beyond the neonatal period revealed that 16 (1.

Nosocomial outbreak of nitrate-negative Serratia marcescens infections.

Bacteremia due to multiply-antibiotic-resistant Serratia marcescens occurred within 1 week in four patients who were in adjacent beds in an intensive care unit. The strains were serotyped as O14:H12 and were nitrate negative. This unusual biochemical marker was useful in the investigation of the outbreak.

Community-acquired purulent meningitis of unknown etiology. A continuing problem.

The clinical features and hospital course of 132 patients with purulent meningitis of unknown etiology (PMU) were compared with those of 1,032 patients with proven bacterial meningitis; all patients were admitted to a major referral center for meningitis treatment between 1954 and 1976. Most patients had no major underlying illnesses. Patients with PMU were more frequently older, "pretreated" with antibiotics, had longer duration of symptoms, evidenced less marked alterations of mental status, and died later in the hospitalization; however, the mortality and frequency of neurologic complications were similar to those in patients with bacterial meningitis.

Unusual aspects of Salmonella meningitis.

Two cases of salmonella meningitis that demonstrate unusual clinical and epidemiologic features are reported. The first case was a two-month-old infant with relapsing salmonella meningitis in whom ECHO 2 virus and S. enteritidis grew in mixed culture from cerebrospinal fluid.

Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976.

This review of 1,316 cases of purulent meningitis assessed changes in the etiology, clinical features, and fatality rate during the antibiotic era. Hemophilus influenzae was the most frequent cause of purulent meningitis (458 cases), Neisseria meningitidis the second most frequent (396 cases), and Streptococcus pneumoniae the third most frequent (178 cases). No bacterial etiology was found for 148 patients with purulent meningitis, the fourth major category of meningitis throughout the 23 years surveyed.