Juan C. Sarria

Clinical characteristics of linezolid-resistant staphylococcus aureus infections

Case reports have previously identified linezolid resistance in 6 clinical isolates of Staphylococcus aureus. We describe an additional case and discuss clinical characteristics of these patients. Invasive procedures, deep organ involvement, and presence of foreign material were predominant in these cases. Resistance followed prolonged (>21 days) linezolid therapy in most cases. The development of resistance to linezolid should be taken into account when selecting this drug as a therapeutic option.

Candida glabrata Endophthalmitis Treated Successfully with Caspofungin

A 39-year-old man with Candida glabrata endophthalmitis was successfully treated with a 28-day course of intravenous caspofungin. Presence of underlying renal insufficiency and infection with a drug-resistant strain precluded use of amphotericin B or fluconazole. Intravitreal administration of antifungals and vitrectomy were not required. The role of caspofungin in Candida endophthalmitis is discussed.

Five-Year Outbreak of Community- and Hospital-Acquired Mycobacterium porcinum Infections Related to Public Water Supplies

ABSTRACT Mycobacterium porcinum is a rarely encountered rapidly growing Mycobacterium (RGM). We identified M. porcinum from 24 patients at a Galveston university hospital (University of Texas Medical Branch) over a 5-year period. M. porcinum was considered a pathogen in 11 (46%) of 24 infected patients, including 4 patients with community-acquired disease. Retrospective patient data were collected, and water samples were cultured. Molecular analysis of water isolates, clustered clinical isolates, and 15 unrelated control strains of M. porcinum was performed. Among samples of hospital ice and tap water, 63% were positive for RGM, 50% of which were M. porcinum. Among samples of water from the city of Galveston, four of five households (80%) were positive for M. porcinum. By pulsed-field gel electrophoresis (PFGE), 8 of 10 environmental M. porcinum were determined to belong to two closely related clones. A total of 26 of 29 clinical isolates subjected to PFGE (including isolates from all positive patients) were clonal with the water patterns, including patients with community-acquired disease. Fifteen control strains of M. porcinum had unique profiles. Sequencing of hsp65, recA, and rpoB revealed the PFGE outbreak clones to have identical sequences, while unrelated strains exhibited multiple sequence variants. M. porcinum from 22 (92%) of 24 patients were clonal, matched hospital- and household water-acquired isolates, and differed from epidemiologically unrelated strains. M. porcinum can be a drinking water contaminant, serve as a long-term reservoir (years) for patient contamination (especially sputum), and be a source of clinical disease. This study expands concern about public health issues regarding nontuberculous mycobacteria. Multilocus gene sequencing helped define clonal populations.

Central nervous system pseudallescheriasis after near-drowning

BACKGROUND Clinical characteristics of central nervous system (CNS) pseudallescheriasis after near-drowning have not been systematically analyzed. METHODS Review of cases reported in the English-language literature. RESULTS Sixteen patients were identified. The average period between the near-drowning episode and onset of clinical manifestations was 37 days. Common manifestations included fever, altered mental status, headache, seizures, and hemiparesis. All patients developed brain abscesses; however, imaging studies were normal at presentation in 6 patients. Cerebrospinal fluid neutrophilic pleocytosis, elevated protein, and decreased glucose were commonly observed. Most patients were treated with surgical resection and systemic amphotericin B or miconazole. Voriconazole was used in 2 patients. Twelve patients (75%) died. The average time between the near-drowning episode and death was 12 weeks. Four survivors received prompt treatment. CONCLUSIONS CNS pseudallescheriasis after near-drowning is highly lethal. Early diagnosis and aggressive medical and surgical interventions may improve survival.

Immune Reconstitution Inflammatory Syndrome Presenting as Pericarditis and Pericardial Effusion

Immune reconstitution inflammatory syndrome (IRIS) affects 30–43% of HIV and tuberculosis (TB) co-infected patients after starting highly active antiretroviral therapy (HAART). Pericarditis and pericardial effusion are rare manifestations of IRIS. We report a case of HIV-TB related IRIS that developed pericardial involvement. This complication resolved after treatment with ibuprofen. Antituberculous treatment and HAART were not interrupted.

HIV-1 Genotypic Resistance Testing on Low Viral Load Specimens Using the Abbott ViroSeq HIV-1 Genotyping System

Background: The Abbott ViroSeq HIV-1 Genotyping System requires a minimum viral load of 2,000 copies/mL. The aim of this study was to evaluate the performance on samples of a viral load <2,000 copies/mL. Method: We performed a retrospective analysis of 780 genotypic tests performed at the University of Texas Medical Branch (UTMB) Molecular Diagnostics Laboratory between April 2007 and January 2008. Results: A quarter of the samples (25.5%, 199/780) had HIV viremia <2,000 copies/mL. Of the 199 specimens with plasma HIV RNA <2,000 copies/mL, genotyping was completed in 111 of 118 (94%) samples with quantifiable HIV RNA, but only in 48 of 81 (59%) specimens with a viral load <75 copies/mL. Conclusion: Our data does not support the conclusion of some investigators that HIV-1 genotypic resistance testing is technically unreliable on low viral load specimens.

Intra-abdominal fungal infections.

Purpose of review The clinical spectrum of intra-abdominal fungal infections has not been systematically analyzed in the literature. Recent findings Even though intra-abdominal fungal infections have been recognized with increasing frequency in the recent years, most clinical experience is limited to case reports or uncontrolled case series. These infections are more common than clinically recognized disease. The clinical presentation varies broadly depending on the organism and hosts immune status, but it is frequently severe, difficult to treat, and associated with significant morbimortality. Predisposing factors, clinical characteristics, and advances in the management are discussed. Summary Intra-abdominal fungal infections are increasingly important in clinical practice. Early recognition and a combined treatment approach, usually consisting of surgical intervention and systemic antifungal therapy, are required for improved outcomes.

Laryngeal tuberculosis in the United States of America: A forgotten disease

Abstract Laryngeal tuberculosis (TB) was a common manifestation of TB in the early twentieth century, but now represents only 1% of all cases. Most modern case series of laryngeal TB originate outside the USA. We report a case of laryngeal TB from our institution and review other US cases published between 1970 and 2012. One hundred twenty-seven cases were identified. The mean patient age was 49 y and 28% were female. The mean duration of symptoms was 19 weeks. Dysphonia and weight loss were the most common manifestations, seen in 96% and 47% of cases, respectively. These symptoms were usually attributed to malignancy initially. Most cases involved the vocal cords. Eighty-six percent of cases had underlying pulmonary involvement. Mortality was 3%. In the USA, laryngeal TB is rarely suspected and often confused with malignancy. This infection should be considered in patients with unexplained dysphonia and weight loss.

Pulmonary mycobacterium abscessus in an AIDS patient

Mycobacterium abscessus is an unusual pathogen in HIV/AIDS patients. We report a case of M abscessus with review of the literature, which revealed 1 confirmed case in an HIV/AIDS patient. Preliminary diagnosis was presumed to be pulmonary tuberculosis secondary to positive acid-fast bacilli in sputum stain. After initial treatment failure, sputum stains were repeated, and the species was identified; therefore the antibiotic regimen was tailored for M abscessus. Early recognition and treatment of nontuberculous mycobacteria is vital in the reduction of complications and mortality in HIV/AIDS patients. M abscessus is a highly virulent and should be considered as a potential offending pathogen on differential diagnosis in an immunocompromised host.

Disseminated histoplasmosis presenting as granulomatous epididymo-orchitis.

Genital involvement is an unusual manifestation of histoplasmosis. We report a case of histoplasmosis presenting as granulomatous epididymo-orchitis and review 4 cases reported in the literature. Diagnosis of this infection is suggested by a compatible clinical picture and results of specific serology or antigen testing, but confirmation ultimately requires analysis of pathologic specimens. Surgical drainage or resection of involved tissues and systemic antifungals typically result in resolution of infection and improved outcomes.