Christopher W. Ingram

Cryptococcal ventricular-peritoneal shunt infection: clinical and epidemiological evaluation of two closely associated cases.

OBJECTIVE To determine the cause of meningitis associated with Cryptococcus neoformans in two patients with recent ventricular-peritoneal (VP) shunt placement. DESIGN A retrospective review of materials, records, and concurrent cases of VP shunt procedures. Isolates of C neoformans from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis. SETTING Two 400-bed community hospitals. PATIENTS Two immunocompetent patients presented with symptoms of progressive hydrocephalus in August 1991. Each received a VP shunt on the same day by the same surgeon using materials from a common vendor and hospital. RESULTS Both patients presented within six to eight weeks with symptoms of fever, headache, rash, and cultures of cerebrospinal fluid (CSF) that yielded C neoformans. Each patient recovered after therapy with amphotericin B and flucytosine followed by several months of fluconazole, although one required replacement of the VP shunt for cure. Review of each patients history and CSF characteristics at the time of shunt placement suggested reactivation of a preexisting infection. Isolates of C neoformans from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis. Each isolate was found to be unique by chromosomal karyotyping. CONCLUSIONS Our data and previous reports suggest that cryptococcal VP shunt infections appear to be a complication of shunts placed in previously infected persons rather than nosocomial transmission of cryptococcus during placement.

Findings of the 1998 Infectious Diseases Society of America Membership Survey

The Infectious Diseases Society of America (IDSA) conducted a survey in 1998 to characterize its membership and to determine their needs. The response rate was 39%. Although only 23% of the respondents spent most of their time in the field of teaching and research, 62% of the respondents listed an academic institution as their primary employer. According to survey results, 17% of respondents indicated that care of HIV-infected patients comprised one-half or more of their practices. Respondents noted shortcomings in their training as a result of recent changes in the clinical practice arena and the health care system; more than one-fourth of the respondents identified deficits in their preparation for administration, infection control, pharmacoeconomics, quality assurance, transplantation, and outcomes research. This survey discloses that the IDSA membership perceives a need for changes in IDSA-sponsored fellowship training programs and graduate educational activities.

Primary Care of Patients Infected with Human Immunodeficiency Virus

Clinical Affairs Committee: Daniel J. Sexton, Chair, Duke University Medical Center, Durham, North Carolina; Jeffery Band, William Beaumont Hospital, Royal Oak Michigan; Steven Berman, University of Hawaii, Honolulu, Hawaii; John Bradley, Childrens Hospital, San Diego, California; Joseph R. Dalovisio, Ochsner Clinic, New Orleans, Louisiana; Christopher Ingram, Raleigh Infectious Disease Associates, Raleigh, North Carolina; W. Patrick Joseph, ID Medical Group, San Ramon, California; Russell M. Petrak, Metro Infectious Disease Consultants, Hinsdale, Illinois; Thomas G. Slama, Hoosier Infectious Diseases, Indianapolis, Indiana; and Barbara H. Wade, Infectious Disease Associates, Pensacola, Florida.