Barry J. Hartman

Practice Guidelines for the Management of Bacterial Meningitis

Allan R. Tunkel, Barry J. Hartman, Sheldon L. Kaplan, Bruce A. Kaufman, Karen L. Roos, W. Michael Scheld, and Richard J. Whitley Drexel University College of Medicine, Philadelphia, Pennsylvania; Weill Cornell Medical Center, New York, New York; Baylor College of Medicine, Houston, Texas; Medical College of Wisconsin, Milwaukee; Indiana University School of Medicine, Indianapolis; University of Virginia School of Medicine, Charlottesville; and University of Alabama at Birmingham

The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America

Guidelines for the diagnosis and treatment of patients with encephalitis were prepared by an Expert Panel of the Infectious Diseases Society of America. The guidelines are intended for use by health care providers who care for patients with encephalitis. The guideline includes data on the epidemiology, clinical features, diagnosis, and treatment of many viral, bacterial, fungal, protozoal, and helminthic etiologies of encephalitis and provides information on when specific etiologic agents should be considered in individual patients with encephalitis.

Neurocysticercosis in an Orthodox Jewish community in New York City.

BACKGROUND AND METHODS From June 1990 through July 1991, intracerebral infection with the larval stage of the pork tapeworm Taenia solium was diagnosed in four unrelated persons in an Orthodox Jewish community in New York City. None of the patients had eaten pork, and only one had traveled to a country in which T. solium infection was endemic. We investigated this outbreak, screened serum samples from family members and household contacts for antibodies to cysticercosis, and examined stool specimens from household employees for eggs of taenia species. RESULTS The four patients had recurrent seizures and brain lesions that were radiologically consistent with the presence of cysticerci. The diagnosis was confirmed in two patients by a brain biopsy, and in two by immunoblot assays for cysticercus antibodies. Of 17 immediate family members screened serologically, 7 from two families had cysticercus antibodies. Magnetic resonance imaging of the brain showed cystic lesions in two of the seropositive family members, one of whom had had a seizure. Examinations of six domestic employees from all four households revealed an active infection with taenia species in one and a positive serologic test in another. Since these women had recently emigrated from Latin American countries where T. solium infection is endemic, they were the most likely sources of infection in the members of these households. CONCLUSIONS A diagnosis of neurocysticercosis should be considered in patients with seizures and radiologic evidence of cystic brain lesions, even in those who do not eat pork and who have not traveled to a country in which T. solium infection is endemic. Recent emigrants from countries in which T. solium infection is endemic should be screened for tapeworm infection in their stools before they are employed as housekeepers or food handlers.

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. This retrospective case-control study was performed in southern New England, New York, and Wisconsin. RESULTS All case patients were immunosuppressed at the time of acute babesiosis, compared with <10% of the control subjects. Most case patients experienced B cell lymphoma and were asplenic or had received rituximab before babesial illness. The case patients were more likely than control subjects to experience complications, and 3 died. Resolution of persistent infection occurred in 11 patients after 2-10 courses of therapy, including administration of a final antimicrobial regimen for at least 2 weeks after babesia were no longer seen on blood smear. CONCLUSIONS Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness. Such patients generally require antibabesial treatment for >or=6 weeks to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.

Endocarditis caused by rhodotorula infection

ABSTRACT Rhodotorula is an emerging opportunistic fungal pathogen that is rarely reported to cause endocarditis. We describe a case involving a patient who developed endocarditis due to Rhodotorula mucilaginosa and Staphylococcus epidermidis, proven by culture and histopathology. The case illustrates the unique diagnostic and therapeutic challenges relevant to Rhodotorula spp.

Localized Renal Aspergillosis with Hairy Cell Leukemia: A Review of Urinary Tract Aspergillosis in Malignant and Nonmalignant Conditions

A case of extensive unilateral renal aspergillosis in a man with hairy cell leukemia is described. This case report is unique because of the long duration of the infection that is more characteristic of patients without malignancy. The degree of unilateral renal involvement found, which included invasion of kidney parenchyma, is uncommon in patients with malignancy. Such patients typically have diffuse disseminated disease with microabscesses. The literature on urinary tract aspergillosis in patients with and without underlying malignancy is reviewed.

Globicatella sanguinis osteomyelitis and bacteremia: Review of an emerging human pathogen with an expanding spectrum of disease

Abstract Background Globicatella sanguinis is an uncommon pathogen that may be misdiagnosed as viridans group streptococci. We review the literature of Globicatella and report 2 clinical cases in which catalase-negative Gram-positive cocci resembling viridans group streptococci with elevated minimum inhibitory concentrations (MICs) to ceftriaxone were inconsistently identified phenotypically, with further molecular characterization and ultimate identification of G sanguinis. Methods Two clinical strains (from 2 obese women; 1 with a prosthetic hip infection and the other with bacteremia) were analyzed with standard identification methods, followed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry, 16S recombinant ribonucleic acid (rRNA), and sodA polymerase chain reaction (PCR). The existing medical literature on Globicatella also was reviewed. Results Standard phenotypic methods failed to consistently identify the isolates. 16S PCR yielded sequences that confirmed Globicatella species. sodA sequencing provided species-level identification of G sanguinis. The review of literature reveals G sanguinis as an increasingly reported cause of infections of the urine, meninges, and blood. To our knowledge, this is the first reported case of an orthopedic infection caused by Globicatella sanguinis. A review of the 37 known cases of G sanguinis infection revealed that 83% of patients are female, and 89% are at the extremes of age (<5 or >65 years). Conclusions Globicatella sanguinis, an uncommon pathogen with elevated minimum inhibitory concentrations to third-generation cephalosporins, is difficult to identify by phenotypic methods and typically causes infections in females at the extremes of age. It may colonize skin or mucosal surfaces. Advanced molecular techniques utilizing 16S rRNA with sodA PCR accurately identify G sanguinis.

Multifocal Osteomyelitis with Streptococcus pneumoniae in a Patient with Waldenström Macroglobulinemia

Waldenstrom macroglobulinemia is a rare hematologic disorder in which a neoplastic clonal proliferation of terminally differentiated B lymphocytes produces excessive immunoglobulin M (IgM)1,2. This condition typically presents with constitutional symptoms including generalized fatigue and weakness, weight loss, and mucosal bleeding3. The known complications of this disorder, first described in 19444, include hyperviscosity, conversion to non-Hodgkin lymphoma, anemia, and hypofibrinogenemia1,2. Additionally, monoclonal proliferation of IgM leads to low concentrations of other immunoglobulins, such as IgG. This impaired antibody response5 renders patients vulnerable to encapsulated organisms such as Haemophilus influenzae type B , Neisseria meningitidis, and Streptococcus pneumoniae, as would be the case in an asplenic patient6. Although the rate of infection with encapsulated organisms in patients with Waldenstrom macroglobulinemia is increased compared with the general population, musculoskeletal infections in these patients are still uncommon. Case reports of septic arthritis are rare in the literature7-9, and we know of only one case of osteomyelitis of a lumbar vertebral body that has been published10. To our knowledge, this is the first report of multifocal pneumococcal osteomyelitis in a patient with Waldenstrom macroglobulinemia. The patient was informed that data concerning the case would be submitted for publication, and she consented. A sixty-eight-year-old woman presented to our orthopaedic office with severe pain in the right shoulder and mild pain in the right knee. She had been diagnosed as having Waldenstrom macroglobulinemia seventeen years earlier during a workup for osteoporosis. She was treated with chemotherapy (rituximab), and the disease remained well controlled. Her medical history was notable only for mild mitral valve prolapse, for which she usually took oral antibiotics before dental procedures. She had not, however, taken antibiotics prior to her most recent dental …