Analysis of a hepatitis C screening programme for US veterans.

This study analyses a screening programme for hepatitis C virus (HCV) infection among US veterans in a suburban Veterans Affairs Medical Center, in New York. This is the first study examining all 11 potential risk factors listed in the 2001 National U.S.

Severe babesiosis in Long Island: review of 34 cases and their complications.

Thirty-four consecutive patients were hospitalized with diagnosis of severe Babesia infection over the course of 13 years. The average time from onset of symptoms to diagnosis was 15 days. When compared with uninfected febrile control patients, affected patients complained significantly more often of malaise, arthralgias and myalgias, and shortness of breath (P<.

Pleural perforation of an aspergilloma cavity occurring in a patient with interstitial lung disease.

An aspergilloma is a fungus ball resulting from colonization of pre-existing pulmonary cavities, which usually represents a non-invasive form of aspergillosis. Spontaneous rupture of the cavity containing the fungi into the pleural space is an unusual complication that has been reported occasionally in patients with leukemia and invasive aspergillosis. We report on this unusual complication occurring in a patient with underlying interstitial lung disease, in whom the aspergilloma cavity abruptly ruptured into the pleural space with subsequent hydropneumothorax and pleural spillage of the fungi.

Enterococcus faecalis endocarditis presenting as meningitis.

Although Enterococcus faecalis is a relatively common cause of infective endocarditis, it rarely causes meningitis. A case of Enterococcus faecalis endocarditis presenting as meningitis in a 74-year-old diabetic man on chronic hemodialysis is reported. A review of the literature showed that the association of enterococcal meningitis and endocarditis has rarely been reported.

Role of prolonged surveillance in the eradication of nosocomial scabies in an extended care Veterans Affairs medical center.

Although general guidelines for control of institutional outbreaks of scabies have been published, little information is available on the long-term efficacy of these measures in extended care facilities. An epidemic of scabies occurred in a comprehensive care Veterans Affairs facility as a result of an unrecognized case of crusted scabies, with a total of 112 persons affected during a 12-month period. The initial outbreak occurred in the acute care units, with highest attack rates among roommates of the index patient (11/14, 78%) and nursing staff (27/55, 49%).

Adult respiratory distress syndrome associated with disseminated toxoplasmosis.

Diffuse lung injury may result as a complication of disseminated toxoplasmosis in patients with AIDS. We report the case of an AIDS patient who had multiple organ failure associated with disseminated toxoplasmosis. The patient died because of ventilatory failure, and at autopsy findings in regard to the lungs were consistent with adult respiratory distress syndrome.

Endogenous endophthalmitis due to Fusarium: case report and review.

Endogenous fungal endophthalmitis is being increasingly recognized in susceptible individuals. We report a case of endogenous endophthalmitis due to Fusarium solani that occurred as the sole clinical manifestation of fungal disease in an immunocompromised host. Four previously reported cases of endogenous fusarial endophthalmitis are also reviewed.

Heterogeneity of lipopolysaccharide phenotype among Salmonella typhi strains.

Comparison of the Vi antigen, lipopolysaccharide, and protein components of the cell surface of three strains of Salmonella typhi showed that differences in lipopolysaccharide contributed most to distinctions in serum survival, whereas differences in Vi antigen content had no apparent effect.

Cryptococcus neoformans, Candida albicans, and other fungi bind specifically to the glycosphingolipid lactosylceramide (Gal beta 1-4Glc beta 1-1Cer), a possible adhesion receptor for yeasts.

The role of glycosphingolipids as adhesion receptors for yeasts was examined. Cryptococcus neoformans, Candida albicans, and Saccharomyces cerevisiae, as well as Histoplasma capsulatum and Sporotrichum schenckii (in their yeast phases), bound specifically to lactosylceramide (Gal beta 1-4Glc beta 1-1Cer), as measured by overlaying glycosphingolipid chromatograms with 125I-labeled organisms. An unsubstituted galactosyl residue was required for binding, because the yeasts did not bind to glucosylceramide (Glc beta 1-1Cer) derived from lactosylceramide by treatment with beta-galactosidase or to other neutral or acidic glycosphingolipids tested that contained internal lactosyl residues.

C3b generation is affected by the structure of the O-antigen polysaccharide in lipopolysaccharide from salmonellae.

Salmonellae differing in the O-antigen side chain of their lipopolysaccharide were previously shown to activate the alternative pathway of complement to different extents. We now examine the generation of the major cleavage fragment of the complement component C3 (C3b) on these bacteria in a system that contains the purified components C3, B, D, and P but lacks the regulatory proteins H and I. The deposition of C3b in this system reproduces the same pattern obtained earlier with the use of whole serum, with the expected differences among the strains bearing different O-antigen.

Isoniazid and ethambutol as a cause of optic neuropathy.

A well-recognized complication of ethambutol use is optic neuropathy, but the potential ocular toxicity of isoniazid is often overlooked. A patient developed optic neuropathy while being treated with isoniazid and ethambutol. The optic neuropathy subsided only when both drugs were discontinued, suggesting an additive toxic effect.

Lipopolysaccharide size and distribution determine serum resistance in Salmonella montevideo.

The survival of Salmonella montevideo during serum treatment depends on the presence of an O antigen (O-Ag) associated with the lipopolysaccharide molecule. In this organism, the O antigen is a polysaccharide composed of 0 to more than 55 subunits, each containing 4 mannose residues together with glucose and n-acetylglucosamine. We used a mutant strain of S.

Failure of therapy in pseudomonas endocarditis: selection of resistant mutants.

Despite optimal use of available antibacterial agents, endocarditis due to Pseudomonas aeruginosa is commonly associated with poor response to medical treatment. Two patients are described in whom emergence of resistance to beta-lactam antibiotics was associated with clinical failure. A subpopulation of resistant mutants (10(-7)) was found within the initial, apparently sensitive population of bacteria.

Pneumococcal psoas abscess.

Primary extrapulmonary pneumococcal disease has become a rarity in modern times. We describe a 40-year-old patient who developed an abscess of the psoas muscle as the only evidence of pneumococcal disease. A predisposing local condition was prior trauma of the psoas muscle, documented by the existence of myositis ossificans circumscripta.

Dengue with hemorrhagic manifestations: an imported case from the Middle East.

We report a case of imported dengue with hemorrhagic manifestations seen in a patient who had recently returned from South Yemen. Conspicuous laboratory findings were marked thrombocytopenia and increase in the number of "transformed" lymphocytes. Hemagglutination-inhibition and complement-fixation antibody titers suggest a secondary heterotypic type of infection.