Optimization of time to initial vancomycin target trough improves clinical outcomes.

Background: Outcomes data for the efficacy of interventions designed to decrease the time to initial target vancomycin troughs are sparse.

Objective: A vancomycin therapeutic drug monitoring (TDM) program was initiated to reduce the time to initial target troughs and to examine the impact on clinical outcomes.

Methods: Single-center, pre- and post-intervention observational study in a 250 bed teaching facility.

Rapid multiplex PCR assay to identify respiratory viral pathogens: moving forward diagnosing the common cold.

Upper respiratory tract infections (URIs) can be a serious burden to the healthcare system. The majority of URIs are viral in etiology, but definitive diagnosis can prove difficult due to frequently overlapping clinical presentations of viral and bacterial infections, and the variable sensitivity, and lengthy turn-around time of viral culture. We tested new automated nested multiplex PCR technology, the FilmArray(®) system, in the TAMC department of clinical investigations, to determine the feasibility of replacing the standard viral culture with a rapid turn-around system.

A case of severe septicemia following traditional Samoan tattooing.

Traditional Samoan tattoos, or tatau, are created by master tattooists, or tufuga ta tatau, and their assistants using multi-pointed handmade tools. These tools are used to tap tattoo pigment into the skin, usually over several days. This traditional process is considered an honor to the one receiving the tatau.

Antibiotic desensitization therapy in secondary syphilis and Listeria infection: case reports and review of desensitization therapy.

Two adult cases, one of secondary syphilis and one of Listeria monocytogenes bacteremia, in which antibiotic desensitization therapy was utilized to assist treatment of active infection in the face of severe penicillin allergy. Clinical considerations are discussed that led to the decision to employ a formal desensitization procedure. Antibiotic desensitization protocols can facilitate optimal and safe antibiotic therapy in the appropriate clinical setting.

Artesunate: investigational drug for the treatment of severe falciparum malaria in Hawai'i.

Introduction: There are hundreds of millions of cases of malaria each year worldwide resulting in a million deaths. These deaths are mostly due to Plasmodium falciparum. The only Federal Drug Administration approved treatment for severe malaria is intravenous quinidine gluconate.

Expect the unexpected: two cases of penetrating head and neck trauma from Operation Iraqi Freedom.

The protocol for treating penetrating head and neck trauma in a war zone differs from the standard protocol. Rather than first securing an airway, as is standard in civilian trauma cases, the primary emphasis is on assessing and controlling hemorrhage because it is the leading cause of morbidity and mortality in a battlefield setting. Once that has been addressed, we shift to standard advanced-trauma life-support protocols.

Coccidioidomycosis and tuberculosis coinfection at a tuberculosis hospital: clinical features and literature review.

Tuberculosis (TB) and coccidioidomycosis can have similar clinical and radiologic presentations but require different treatments. Coinfection with TB and Coccidioides immitis is uncommonly reported and may be underdiagnosed in endemic areas.We performed a retrospective review of the medical records of all patients admitted to a TB referral hospital between 1995 and 2007, and selected all cases of TB and coccidioidomycosis coinfection in patients aged 18 years or older.

Persistent and relapsing babesiosis in immunocompromised patients.

Background: Human babesiosis is a tickborne malaria-like illness that generally resolves without complication after administration of atovaquone and azithromycin or clindamycin and quinine. Although patients experiencing babesiosis that is unresponsive to standard antimicrobial therapy have been described, the pathogenesis, clinical course, and optimal treatment regimen of such cases remain uncertain.

Methods: We compared the immunologic status, clinical course, and treatment of 14 case patients who experienced morbidity or death after persistence of Babesia microti infection, despite repeated courses of antibabesial treatment, with those of 46 control subjects whose infection resolved after a single course of standard therapy.

Absence of erythrocyte sequestration in a case of babesiosis in a splenectomized human patient.

Background: The importance of vascular occlusion in the pathogenesis of human haemoprotozoal disease is unresolved.

Methods: Giemsa-stained tissue sections from a human case of Babesia microti infection in a splenectomized patient with chronic lymphocytic leukaemia and colon cancer were examined to ascertain the distribution of parasitized erythrocytes within the vascular lumen.

Results: No evidence of sequestration was observed.