Neisseria Cinerea Bacteremia Secondary to a Retropharyngeal Abscess.

is a commensal bacteria of the human oropharynx, not thought to be pathogenic, and is rarely associated with serious infections, including bacteremia. Case reports involving invasive infections are uncommon in the literature. Retropharyngeal abscesses are unusual in adults, and are usually attributable to local trauma.

Extragenital chlamydia infection among active-duty women in the United States Navy.

Background: Pharyngeal and anorectal reservoirs of gonorrhea (GC) and chlamydia (CT) are increasingly recognized among heterosexual women. While a number of studies performed at sexually transmitted disease (STD) clinics have found a high prevalence of extragenital GC/CT infection, such screening is typically not offered during routine primary care visits for women. We sought to define the prevalence of and factors associated with extragenital GC/CT among women in the U.

Severe CNS angiostrongyliasis in a young marine: a case report and literature review.

Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis worldwide. Infection typically occurs through ingestion of undercooked molluscs or vegetables contaminated by infective larvae. Endemic regions were previously limited to southeast Asia and the Pacific basin; however, this parasite is seeing an alarming increase in global distribution with reported cases in more than 30 countries, including several states in the USA.

Primary Care of Men Who Have Sex With Men in the U.S. Military in the Post-Don't Ask, Don't Tell Era: A Review of Recent Progress, Health Needs, and Challenges.

Background: With repeal of "Don't Ask, Don't Tell" (DADT) in 2011 and the Supreme Court decision regarding Section 3 of the Defense of Marriage Act (DOMA) in 2013, military providers are now able to openly address unique health needs of lesbian, gay, and bisexual (LGB) service members and their same-sex spouse beneficiaries. These federal laws created health care barriers, either real or perceived, between providers and patients and often limited medical research involving LGB patients in the Military Health System (MHS). Men who have sex with men (MSM), the largest proportion of LGB service members, represent a segment of the population with the highest risks for disparities in primary care with regard to sexual health and mental health disorders.

Characterizing the Association Between Alcohol and HIV Virologic Failure in a Military Cohort on Antiretroviral Therapy.

Background: The effects of at-risk drinking on HIV infection remain controversial. We investigated the impact of self-reported alcohol consumption on surrogate markers of HIV progression among individuals initiated on highly active antiretroviral therapy (HAART).

Methods: We analyzed individuals who were surveyed on alcohol use within a year of HAART initiation between 2006 and 2014.

Specific Behaviors Predict Staphylococcus aureus Colonization and Skin and Soft Tissue Infections Among Human Immunodeficiency Virus-Infected Persons.

Background.  Few data exist on the incidence and risk factors of Staphylococcus aureus colonization and skin and soft tissue infections (SSTIs) among patients infected with human immunodeficiency virus (HIV). Methods.

Self-administration of intranasal influenza vaccine: Immunogenicity and volunteer acceptance.

Background: In outbreak settings, mass vaccination strategies could maximize health protection of military personnel. Self-administration of live attenuated influenza vaccine (LAIV) may be a means to vaccinate large numbers of people and achieve deployment readiness while sparing the use of human resources.

Methods: A phase IV, open-label, randomized controlled trial evaluating the immunogenicity and acceptance of self-administered (SA) LAIV was conducted from 2012 to 2014.

Randomized, Double-Blind, Placebo-Controlled Study on Decolonization Procedures for Methicillin-Resistant Staphylococcus aureus (MRSA) among HIV-Infected Adults.

Background: HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIV-infected persons.

Methods: 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period.

Malaria in a returning traveler from Jamaica.

Malaria in Jamaica is a real, but uncommon entity and poses a health risk to our Department of Defense personnel, which should not be overlooked in returning travelers. Malaria in Jamaica was actually considered eradicated in the 1960s, but there has been a reemergence attributed to the combination of Haitian nationals as well as endemic Anopheles mosquitoes in the Kingston area. Our facility recently admitted a 33-year-old Marine who had two Emergency Department visits before being evaluated for malaria.

HIV outcomes in Hepatitis B virus coinfected individuals on HAART.

Background: Understanding the impact of hepatitis B virus (HBV) coinfection on HIV outcomes in the highly active antiretroviral therapy (HAART) era continues to be a critical priority given the high prevalence of coinfection and the potential for impaired immunologic, virologic, and clinical recovery.

Methods: Participants from the US Military HIV Natural History Study with an HIV diagnosis on HAART and serologically confirmed HBV infection status at HAART initiation (HI) were classified into 4 HBV infection (HB) groups. HIV virologic, immunologic, and clinical outcomes were evaluated by HB status.

The VACS index predicts mortality in a young, healthy HIV population starting highly active antiretroviral therapy.

Background: The Veterans Aging Cohort Study (VACS) index is a weighted combination of age and 8 clinical variables. It has been well correlated with all-cause mortality among HIV-infected patients. The US Military HIV Natural History Study (NHS) cohort provides a different validation population profile, being younger and healthier.

Prevalence and factors associated with asymptomatic gonococcal and chlamydial infection among US Navy and Marine Corps men infected with the HIV: a cohort study.

Objectives: Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) can facilitate transmission of HIV. Men who have sex with men (MSM) may harbour infections at genital and extragenital sites. Data regarding extragenital GC and CT infections in military populations are lacking.

Delayed lower urinary tract symptoms and erectile dysfunction after acute episode of coccidioidal meningitis.

We present an interesting case of a 27-year-old male with coccidioidal meningitis who developed permanent erectile dysfunction (ED) and lower urinary tract symptoms 3 months after initiation of therapy. The patient presented to the urology clinic with a complaint of a weak stream, urinary urgency and frequency, as well as enuresis which were only moderately controlled with anti-cholinergics. His ED responded well to phosphodiesterase-5 inhibitors.

Postpartum herpes simplex virus endometritis and disseminated infection in both mother and neonate.

Background: Herpes simplex virus (HSV) is an unusual cause of postpartum endometritis. We describe a rare case of primary disseminated maternal HSV in the postpartum period associated with endometritis.

Case: A previously healthy patient developed fundal tenderness and postpartum fevers after an uncomplicated vaginal delivery.

E. coli O157:H7 and other toxigenic strains: the curse of global food distribution.

It is estimated that there are approximately 76 million illnesses, 325,000 hospitalizations, and 5,200 deaths in the US each year attributed to foodborne outbreaks with a total cost of 10-83 billion US dollars a year. While the rates of foodborne disease have remained relatively constant over the last few years, there have been large outbreaks associated with either a component of commercially prepared food or outbreaks that span between states or even countries. With the world population expecting fresh produce year round, organic produce, and exotic foods, these global outbreaks have the potential to increase in number and severity.

Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostatic biopsy infection rates.

Objective: To test our hypothesis that a targeted rectal screening protocol before transrectal ultrasound (TRUS)-guided biopsy would potentiate streamlined prophylaxis, thereby reducing postbiopsy infectious rates while minimizing unnecessary broad-spectrum antibiotic use. To this end, we instituted preprocedure rectal cultures in an effort to identify fluoroquinolone (FQ)- resistant flora using selective media to optimally direct targeted prophylactic antibiotic administration. The inexorably increasing prevalence of multidrug-resistant microorganisms, notably extended spectrum beta lactamase (ESBL)-producing and FQ-resistant Enterobacteriaceae has increased the post-TRUS prostatic biopsy infection rates, including life-threatening sepsis.

Gonorrhoea or chlamydia in a U.S. military HIV-positive cohort.

Objectives: To investigate the epidemiology and risk factors of gonorrhoea (GC) or chlamydia (CT) coinfection in an HIV-positive US military cohort, focusing on the time after participants' knowledge of HIV diagnosis.

Methods: The authors analysed data from 4461 participants enrolled in the U.S.

Hand infections.

Hand infections are commonly seen by orthopedic surgeons as well as emergency room and primary care physicians. Identifying the cause of the infection and initiating prompt and appropriate medical or surgical treatment can prevent substantial morbidity. The most common bacteria implicated in hand infections remain Staphylococcus aureus and Streptococcus species.

Two cases illustrating successful adjunctive interferon-γ immunotherapy in refractory disseminated coccidioidomycosis.

Protective immunity and host resistance to coccidioidomycosis require a robust cell-mediated immunity with adequate production of Th1 cytokines including interleukin-12, and IFN-γ and appropriate regulation and coordinated functionality of Th1/Th2 responses and IL-12/IFN-γ cytokine axes. IFN-γ augments the anti-fungal activity of effector immune cells against a variety of fungi. Numerous animal models have demonstrated the potential efficacy of adjunctive IFN-γ in treatment of invasive mycoses.

High dose atorvastatin decreases cellular markers of immune activation without affecting HIV-1 RNA levels: results of a double-blind randomized placebo controlled clinical trial.

Background: 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) exhibit antiviral activity against human immunodeficiency virus type 1 (HIV-1) in vitro and may modulate the immune response to HIV infection. Studies evaluating the antiviral activity of statins have yielded conflicting results.

Methods: We conducted a randomized, double-blind, placebo-controlled crossover trial to investigate the effect of atorvastatin on HIV-1 RNA (primary objective) and cellular markers of immune activation (secondary objective).

Clinical and epidemiologic characteristics of an outbreak of novel H1N1 (swine origin) influenza A virus among United States military beneficiaries.

Background: A novel swine-origin influenza A (H1N1) virus was identified in March 2009 and subsequently caused worldwide outbreaks. The San Diego region was an early focal point of the emerging pandemic. We describe the clinical and epidemiologic characteristics of this novel strain in a military population to assist in future outbreak prevention and control efforts.

Prevalence and factors associated with liver test abnormalities among human immunodeficiency virus-infected persons.

Background & Aims: Liver disease is a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected persons. We evaluated the prevalence, etiology, and factors associated with liver dysfunction in patients during the highly active antiretroviral therapy era.

Methods: We performed liver tests (baseline and after a 6-month follow-up period) in HIV-infected patients treated at a large clinic.

Escherichia coli O157: what every internist and gastroenterologist should know.

Infections with Escherichia coli O157:H7 have gained media attention in recent years because of cases associated with unusual sources (eg, produce and swimming pools). Although most adults recover without sequelae, children and the elderly are more likely to develop complications (eg, hemolytic uremic syndrome and death). The diagnosis typically has been made by culture; however, newer hand-held immunoassays and polymerase chain reaction technology have led to more rapid detection of this important pathogen in stools, food, and water.

Recurrent community-associated methicillin-resistant Staphylococcus aureus infections among HIV-infected persons: incidence and risk factors.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are well described among the general population, but little is known regarding the incidence of and predictors for recurrent CA-MRSA infections among HIV-infected persons. We retrospectively evaluated HIV-infected patients seen at the Naval Medical Center San Diego from January 1, 2000 to June 30, 2007 for wound culture-proven MRSA infections defined as community-associated based on Centers for Disease Control and Prevention (CDC) criteria. Data on skin/soft tissue infections (SSTIs) following an initial CA-MRSA infection were collected by review of medical records and culture results.