Ana Paula Velez

Bite-related and septic syndromes caused by cats and dogs

Bite infections can contain a mix of anaerobes and aerobes from the patients skin and the animals oral cavity, including species of Pasteurella, Streptococcus, Fusobacterium, and Capnocytophaga. Domestic cat and dog bite wounds can produce substantial morbidity and often require specialised care techniques and specific antibiotic therapy. Bite wounds can be complicated by sepsis. Disseminated infections, particularly those caused by Capnocytophaga canimorsus and Pasteurella multocida, can lead to septic shock, meningitis, endocarditis, and other severe sequelae. An emerging syndrome in veterinary and human medicine is meticillin-resistant Staphylococcus aureus (MRSA) infections shared between pets and human handlers, particularly community-acquired MRSA disease involving the USA300 clone. Skin, soft-tissue, and surgical infections are the most common. MRSA-associated infections in pets are typically acquired from their owners and can potentially cycle between pets and their human acquaintances.

Histoplasmosis Presenting as Granulomatous Hepatitis: Case Report and Review of the Literature

Background. Histoplasma capsulatum is the most common endemic mycosis in the United States and is a frequent cause of opportunistic infection in immunodeficient hosts. Histoplasmosis is most often self-limiting and goes unrecognized in the immunocompetent population but can progress to disseminated histoplasmosis in patients with an impaired immune system. Liver involvement as a part of disseminated histoplasmosis which usually originates in the lung is well known. However, extrapulmonary hepatic histoplasmosis as a primary manifestation is extremely rare. Case Presentation. We report a rare case of histoplasmosis that presented as persistent fever and abnormal liver function tests in a 66-year-old female with rheumatoid arthritis, receiving infliximab. Conclusion. Emphasizing histoplasmosis as a major cause of acute granulomatous hepatitis and fever of unknown origin in cell mediated immunodeficient population, this case highlights the need for high index of suspicion and the importance of prompt diagnosis since any delay of treatment can be life threatening in this population.

Marijuana Smoking in Patients With Leukemia.

Worldwide, marijuana (cannabis) is a widely used drug. The incidence of marijuana smoking is increasing and is second only to tobacco as the most widely smoked substance in the general population. It is also the second most commonly used recreational drug after alcohol. Some adverse effects of marijuana smoking have been documented; however, the number of studies on the pulmonary effects of marijuana in individuals with leukemia is limited. In our case series, we report on 2 men with acute myeloid leukemia with miliary nodular lung patterns on computed tomography of the chest due to heavy marijuana use. We also report on 2 patients with acute lymphocytic leukemia who had a history of smoking marijuana and then developed lung opacities consistent with mold infection.

Prophylaxis for Infections Following Allogeneic Hematopoietic Stem Cell Transplantation

AbstractThe objectives of this article were to provide data on the current guidelines for the prophylactic therapy with the evidence-based approach in mind and to serve as a reference and guide for the health care providers who care for hematopoietic stem cell transplantation (HSCT) patients and a reference for the HSCT recipients and their family members. Prophylaxis for the various infections, which are commonly encountered in the HSCT patients, is discussed in this article.

Vancomycin-Resistant and Daptomycin-Resistant Enterococcus faecium Bacteremia and Colonization in Patients With Acute Leukemia With Prolonged Neutropenia

BackgroundVancomycin-resistant Enterococcus faecium (VREF) bacteremia has been reported to be increasing in frequency and is associated with significant morbidity and mortality rates in patients with acute leukemia with prolonged neutropenia and VREF colonization. We report our experience with the prophylactic use of varying doses of daptomycin and other antibiotics active against VREF in this patient population and the development of a cluster of daptomycin-resistant E. faecium bacteremia and colonization cases. MethodsA retrospective chart review was conducted of patients with acute leukemia and prolonged neutropenia with positive microbiological data for VREF bacteremia and/or colonization from July 2009 to June 2010. We collected susceptibility data of the VREF, use and dosage of empiric anti-VREF antibacterial therapy, and the incidence of breakthrough VREF bacteremia among patients with colonization. ResultsBreakthrough VREF bacteremia occurred at the following rates in patients with prolonged neutropenia receiving prophylactic anti-VREF therapy: 14.6% (7/48 patients) receiving daptomycin 6 mg/kg per day, 8.3% (2/24 patients) receiving daptomycin 8 mg/kg per day, 0% (0/13 patients) receiving linezolid, 40% (4/10 patients) receiving tigecycline, and 0% (0/3 patients) receiving dalfopristin-quinupristin. ConclusionsBreakthrough VREF bacteremia was observed despite the use of daptomycin 6 mg/kg per day in patients with neutropenia and colonized VREF. Increasing the dosage of daptomycin to 8 mg/kg per day seemed to reduce this occurrence but breakthroughs were seen in the setting of daptomycin-resistant E. faecium colonization. Linezolid seems to be a promising option to prevent or treat VREF bacteremia in these patients. We recommend close monitoring for VREF colonization including susceptibility data to appropriately select empiric or prophylactic antimicrobial therapy directed against VREF in those patients with prolonged neutropenia.

Abacavir and lamivudine combination

Background: Fixed dose antiretroviral combinations (FDC) may improve therapy adherence with reduced pill burden. Abacavir and lamivudine are well-established nucleoside reverse-transcriptase inhibitors available as a once-daily FDC. Abacavir is currently considered an alternative treatment option in most established treatment guidelines based on associations with cardiovascular events and lesser efficacy in patients with higher baseline viremia. Objective: To summarize rigorous clinical trial data and cohort studies that examine efficacy, safety and tolerability of the individual components and the FDC of abacavir–lamivudine. Methods: Clinical trial data, post-marketing research findings and clinical cohort data were reviewed to assess the efficacy, safety and tolerability of the individual components and the FDC of abacavir–lamivudine along with recommendations from published clinical treatment guidelines. Results/conclusion: The efficacy of abacavir–lamivudine is well documented in numerous clinical studies and treatment guidelines. The introduction of laboratory testing to identify patients at risk for hypersensitivity has decreased the incidence of these reactions. Recent findings suggest that abacavir is an alternative treatment agent with baseline HIV RNA > 100,000 copies/ml. Data related to cardiovascular events associated with abacavir are conflicting. Hepatic function should be monitored closely in HIV/HBV co-infected patients who discontinue lamivudine-containing products as severe acute exacerbations of HBV have been reported.

Malignancy Trends in HIV-Infected Patients Over the Past 10 Years in a Single-Center Retrospective Observational Study in the United States

The introduction of antiretroviral therapy (ART) in 1995 had a dramatic impact on the morbidity and mortality of the HIV population, and subsequently, the natural history of cancer has changed. The purpose of our study was to review the prevalence of AIDS-defining malignancies and non-AIDS defining cancers (NADC), taking into consideration racial and gender variations. After the institutional review board approval, the study was conducted as a retrospective chart review of 279 HIV-infected patients who were treated at the Moffitt Cancer Center between January 1, 2000 and December 31, 2010. The demographic characteristics included gender, ethnicity, race, presence or absence of ART, and the type of malignancy reviewed. Of 233 men, 78 (33.5%) had AIDS-defining malignancies. AIDS-related non-Hodgkin lymphoma (NHL) was detected in 49 (21%) patients and Kaposi sarcoma (KS) in 29 (12%) patients. Two-thirds of male patients had NADC, with anal cancer being the most prevalent (8.5%), followed by Hodgkin lymphoma (6%). AIDS-related NHL was also the predominant malignancy for women with a prevalence of 19.5% followed by invasive cervical cancer (ICC) and breast cancer, both with a similar prevalence of 11%. Kaposi sarcoma and anal cancer were equally detected in 2% of women. The prevalence rates of AIDS-defining malignancies among those of white race were 34%, ranging from 21% for NHL to 13% for KS and 1.5% for ICC. Twenty-one (7.7%) patients had anal cancer. AIDS-defining malignancies were found in 36% of patients of black race and 60% had NHL. Non-AIDS-related NHL was the second most common malignancy, followed by breast cancer and anal cancer with a similar prevalence of 6.5%. Of 279 patients, 53% were taking ART; 39.4% were not taking ART; and in 7.5% of the patients, it was unknown if they were taking ART. In the ART era, our study found NADC to be more prevalent than AIDS-defining malignancies with 60% versus 40%, respectively. Non-Hodgkin lymphoma remained the most common AIDS-related malignancy in both genders. Among the patients with NADC, anal cancer was the predominant malignancy. The increasing incidence of some of the NADC is expected as this population is living longer with chronic exposure of viral replication of virus with oncogenic potential such as Human papillomavirus (HPV), Hepatitis B virus (HBV), Epstein-Barr virus (EBV), and Human herpesvirus 8 (HHV-8). Early ART initiation, aggressive vaccination, and judicious cancer screening are the cornerstone of cancer prevention of this growing population.

Pyorubin Producing Pseudomonas Scalp Infection

AbstractWe report a case of advanced basal cell carcinoma and cranial osteomyelitis. His skull bone seemed to be destroyed due to osteomyelitis, and the underlying dura was exposed with a unique color of the wound surface due to pigment-producing bacteria.

Treatment of Infections After Hematopoietic Stem Cell Transplantation

AbstractThe use of hematopoietic stem cell transplant for the treatment of hematological malignancies has continued to grow during the last 10 years. The development of new treatment strategies has minimized the severity and duration of immune suppression after transplantation. This article will review the management and challenges of the most common encountered infections after hematopoietic stem cell transplant.

Streptomyces Pneumonia in an Immunocompromised Patient: A Case Report and a Review of Literature

AbstractOf the 3 main soil-associated bacteria, Nocardia, Actinomyces, and Streptomyces, the latter is the least well known. It rarely causes infection in humans. The most common infection with Streptomyces is mycetoma acquired through traumatic inoculation. Even less common is Streptomyces infection without direct soil exposure. The focus of our study is Streptomyces infections in immunocompromised patients with cancer.