Jose Montero

Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment

Klebsiella producing carbapenemase is an emerging pathogen. We report transmission of this organism by contaminated endoscopic instruments. Quick identification of source, staff education, contact precautions, and emphasis on hand and environmental hygiene led to case control and prevention of outbreak.

Minocycline as A Substitute for Doxycycline in Targeted Scenarios: A Systematic Review

Doxycycline remains on intermittent shortage. Evidence supports the substitution of minocycline in skin and soft-tissue infections and carefully selected cases of pneumonia. Minocycline may be carefully considered in Lyme disease prophylaxis and Rickettsial disease in the complete absence of doxycycline.

Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes

Background The outcomes and optimal management of cirrhotic patients who develop cryptococcosis before transplantation are not fully known. Methods We conducted a multicenter study involving consecutive patients with cirrhosis and cryptococcosis between January 2000 and March 2014. Data collected were generated as standard of care. Results In all, 112 patients were followed until death or up to 9 years. Disseminated disease and fungemia were present in 76.8% (86/112) and 90-day mortality was 57.1% (64/112). Of the 39 patients listed for transplant, 20.5% (8) underwent liver transplantation, including 2 with active but unrecognized disease before transplantation. Median duration of pretransplant antifungal therapy and posttransplant therapy was 43 days (interquartile range, 8-130 days) and 272 days (interquartile range, 180-630 days), respectively. Transplantation was associated with lower mortality (P = 0.002). None of the transplant recipients developed disease progression during the median follow-up of 3.5 years with a survival rate of 87.5%. Conclusions Cryptococcosis in patients with cirrhosis has grave prognosis. Our findings suggest that transplantation after recent cryptococcal disease may not be a categorical exclusion and may be cautiously undertaken in liver transplant candidates who are otherwise deemed clinically stable.

Mycobacterium abscessus ventriculoperitoneal shunt infection and review of the literature

A 30-year-old man with history of neonatal hydrocephalus requiring ventriculoperitoneal shunt placement presented with Mycobacterium abscessus shunt infection despite no shunt manipulation over 10xa0years prior to presentation. Cure was not achieved until complete removal of all CNS shunt foreign body was performed despite initial adequate antimicrobial therapy.

Fecal microbiota transplantation outcomes in immunocompetent and immunocompromised patients: A single-center experience

Clostridium difficile infection (CDI) is a major infectious disease focus for which fecal microbiota transplantation (FMT) has been used with success in various patient populations.

The HIV Virologic Outcomes of Different Interventions Among Treatment-Experienced Patients With 2 Consecutive Detectable Low-Level Viremia.

Background: Approaches to treatment-experienced HIV-infected patients with persistent low-level viremia are limited by current commercial resistance genotyping assays when the viral load (VL) is <500 copies/mL. The best intervention to achieve virologic suppression in this population is unclear. Methods: This is a case control retrospective chart review study of 149 HIV-infected patients with a VL of 50 to 1000 copies/mL. Patients were in either regimen unchanged group or intervention group (intensification of regimen or switch without guidance from resistance testing). End point was VL < 100 copies/mL. Results: At 6 months post change, 30.8% of patients with intervention versus 36.6% with no intervention achieved a complete virologic suppression. There were no statistically significant differences between these 2 groups (P = .254). The majority of patients without regimen change eventually progressed to complete virologic failure. Conclusion: Patients with persistent low levels of viremia are likely to progress to have virologic failure. This supports the adoption of a more proactive approach to treatment and more sensitive technique to identify drug resistance.

Recurrent Cellulitis With Group G Streptococcus Bacteremia in a Cancer Patient: A Case Report.

Beta-Hemolytic streptococcal infections can be categorized into Lancefield groups A to H and K to V. Groups A, B, C, D, and G are most often involved in human disease. Group A (Streptococcus pyogenes), one of the most common causes of pharyngitis, produces a variety of skin and soft-tissue infections including cellulitis, erysipelas, and necrotizing fasciitis. Group B (S. agalactiae) has been associated with a history of breast cancer and with sepsis and meningitis in neonates and peripartum fever in women. Group D includes the nonenterococci (ie, S. bovis) that are associated with gastrointestinal neoplasms and the enterococci (ie, Enterococcus faecalis, E. faecium) that are associated with urinary tract infections and polymicrobial intra-abdominal infections. Less commonly, beta-hemolytic streptococcal infections are caused by Lancefield groups C and G.

The Mysterious Hand

CASE REPORTA 50-year-old man with medical history of hepatitis C (with a low viral load treated a decade prior) initially presented to an outside provider with a progressive rash, digit swelling, and joint pain and was evaluated for oligoarticular synovitis. Joints affected included the right knee,

Antiretroviral Therapy: Brain Penetration

The central nervous system (CNS) can act as a compartment in which HIV can replicate independently from plasma. HIV infection of the brain and the ongoing immune response leads to neurocognitive impairment. Therefore, besides optimally suppressing HIV viral load in the plasma, it is essential to reach adequate concentrations of antiretrovirals (ARVs) in the CNS to prevent and improve neurocognitive impairments. ARVs have limitations in their ability to enter the brain due the blood-brain barrier (BBB) and different efficient efflux mechanisms. Moreover, ARVs exposed to the CNS show variability and distinctiveness of their characteristics including molecular weight, lipophilicity, protein binding, and on their capacity as substrates for efflux transporters.

Opportunistic Neurologic Infections in Patients Infected with Human Immunodeficiency Virus

Neurologic opportunistic infections in individuals with human immunodeficiency virus remain significant causes of morbidity and mortality despite the availability of highly active antiretroviral therapy. These pathogens are generally ubiquitous or are very commonly acquired by humans but reactivate during periods of profound immunosuppression. Diagnosis can be very challenging, relying on a combination of recognition of clinical syndromes, radiographic findings, and cerebrospinal fluid analysis. Newer molecular tests provide means for diagnosis at times when culture-based diagnosis is limited. With experience, guidance in treating these infections has been published focusing on therapies and immune reconstitution utilizing antiretroviral therapy. Prevention of these neurologic infections relies mostly on restoring or preserving cell-mediated immunity but can be enhanced in a few by avoidance of primary infection, treatment, or suppression of infection and at times screening for early detection and treatment.