M. Mancao

Methicillin-resistant Staphylococcus aureus hepatic abscess in a patient with sickle-cell disease.

We report a case of a 16‐year‐old female patient with sickle‐cell disease with a liver abscess secondary to methicillin‐resistant Staphylococcus aureus (MRSA). She had initially presented with jaundice and abdominal pain and subsequently underwent endoscopic retrograde cholangio‐pancreaticography followed by laparoscopic cholecystectomy for removal of gallstones. However, post‐cholecystectomy she presented with generalized abdominal pain and computed tomography scan of the abdomen revealed a liver abscess. A pigtail catheter was inserted into the abscess and culture of the aspirate yielded MRSA (susceptibility pattern of the organism was compatible with community‐acquired MRSA). She was treated with intravenous clindamycin for 6 weeks with complete resolution of the abscess.

Eastern equine encephalitis virus infection and hemophagocytic lymphohistiocytosis in a 5-month-old infant.

Eastern equine encephalitis virus infection is a rare sporadic central nervous system infection transmitted by a mosquito vector. Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease associated with the inability of an overactive immune system to effectively respond to infections. Many viruses are known to trigger primary, as well as secondary, HLH. We report a pediatric case of eastern equine encephalitis virus-associated HLH which caused severe neurologic injury and death.

Fusobacterium necrophorum Mediastinal Abscess Presenting as an Anterior Chest Wall Mass in a Child: A Case Report

F usobacterium infections in children are quite rare. Infections caused by Fusobacterium sp. have been associated with Lemier re’s syndrome, which is also known as necrobacillosis and postanginal sepsis. Lemierre’s syndrome, which is mainly observed in adolescents and adults, is a suppurative orophar yngeal infection that is associated with Fusobacterium necrophorum bacteremia and thrombophlebitis of the internal jugular vein and subsequent metastatic foci of infection.1 We report a case of an anterior mediastinal abscess due to Fusobacterium necrophorum in a child. Patient Report

Detection by CT scan of Penicillium sp. lesions in a patient with B-precursor acute lymphoblastic leukemia.

E.A. Manci Department of Pathology, University of South Alabama College of Medicine, Mobile, Alabama, USA Sir, The advent of computed tomography (CT) scan-guided aspiration of hepatic abscesses, especially in immunocompromised hosts, has facilitated etiologic diagnosis and prompt initiation of appropriate therapy. Recently, we took care of a 17-year-old male, newly diagnosed with B-precursor acute lymphoblastic leukemia, who succumbed to hepatic abscess from Penicillium sp. The patient had been previously well until 2 days prior to his hospital admission, when he presented to his local physician with a 2-week history of intermittent fever to 102 F (ca 38 C), non-projectile vomiting, and generalized body weakness; he was diagnosed with B-precursor acute lymphoblastic leukemia by bonemarrow aspiration and immediately started on intensive induction chemotherapy. An abdominal ultrasound (US) on the second hospital day revealed a 3.5·3.5 cm anechoic area with a slight echogenic border in the hilar region of the spleen, which was suspicious for an abscess; the liver and kidneys were normal in

An Unusual Cause for Gait Disturbance in a Child

MRI of the brain, which revealed that the cerebellar tonsils were displaced inferiorly through the foramen magnum into the upper cervical canal (Figure 2). Six days after his MRI was performed, he subsequently underwent suboccipital craniectomy, C1-C2 laminectomy, and dural grafting. His postoperative hospital course was significant for aseptic meningitis and adenoviral upper respiratory infection. He was evaluated at the neurosurgery clinic 3 months after his surgery, and he was ambulating without any problems. In addition, 1 year after surgery, the child was evaluated at the pediatric clinic; he was in good health with no complaints; his neurological examination revealed no abnormalities.

139 THE IMPACT OF A MEDICATION ADHERENCE PROGRAM ON THE IMMUNOLOGIC AND VIROLOGIC RESPONSES OF HIV-INFECTED INFANTS AND CHILDREN.

Objective To assess the impact of a medication adherence program started in January 2004 by comparing the immunologic and virologic responses of HIV-infected infants and children followed at the University of South Alabama Family Specialty Clinic (USAFSC) before and after a pharmacist-based educational program was started. Methods A retrospective review was performed on the medical charts of HIV-infected infants and children at the USAFSC from September 2001 through December 2005. The following data were obtained from the charts: epidemiologic information, CD4+ cell counts, plasma HIV-1 RNA levels, antiretroviral drug history, and pharmacist-based medication adherence notes. A comparison of data was then made before (September 2001 through December 2003) and after (January 2004 through December 2005) the pharmacist-based medication adherence was started. A t-test was performed to compare patient groups. Results There were 19 HIV-infected infants and children whose data were available to compare before and after the pharmacist-based medication adherence program was started. The patients9 ages ranged from 1 through 16 years of age; there were 9 females and 10 males. Seven patients had AIDS-defining illness during the study period. There were a mean number of 2.6 visits with pharmacist-based intervention per patient per year. After the medication adherence program started, 14 patients had decreased mean CD4+ cell counts (p = .027), whereas 5 patients had increased plasma HIV-1 RNA levels (p = .173). Conclusions After receiving pharmacist-based medication adherence education, our study revealed that there was a statistically significant decrease in CD4+ cell counts, whereas there was an observed decrease in plasma HIV-1 RNA levels (which was not statistically significant). The reasons for these findings are unclear but could be secondary to the variability of the HIV disease process or any intercurrent illness in a small sample size of patients.

286 IMMUNOLOGICAL AND VIROLOGIC RESPONSE OF A PHARMACIST-MANAGED MEDICATION ADHERENCE PROGRAM IN HIV-INFECTED WOMEN, ADOLESCENTS, AND CHILDREN.

Objective To demonstrate that a pharmacist-managed medication adherence program can increase medication adherence in the treatment of HIV-infected women, adolescents, and children resulting in improvement of their immunological and virologic markers. Methods A retrospective review was conducted of HIV-infected women, adolescents, and children who attended the Family Specialty Clinic from January 2003 through December 2004. The study cohort included patients who received medication adherence counseling from January through December 2004. This group of patients was then compared with patients who were stable on their antiretroviral regimen the year prior to initiation of the medication adherence counseling program (those seen at the clinic from January through December 2003). Epidemiological and laboratory data, including HIV-1 RNA (viral load) and CD4+ T cell counts, were also collected. Results Forty patients were eligible and included in the study. Majority of the patients were female (80%), mainly African American (90%), and most of these women (30%) were between 20 and 29 years of age. A total of 72 medication adherence interventions occurred during the study period. Mean medication adherence interventions by clinical pharmacists occurred 1.8 times. There was a small but not statistically significant improvement between mean viral load and CD4+ T cell count of patients at baseline (16,464 copies/mL and 646 cells/mm3) compared to after medication adherence intervention (14,218 copies/mL and 617 cells/mm3, p = .84 and .39). There were 35 clinic appointments missed at baseline compared to 48 missed visits after medication adherence interventions (p = .15). Conclusion We therefore conclude that our medication adherence program initiated over a period of 1 year did not demonstrate a statistically significant difference in immunological and virologic outcome. However, further study over a longer time interval may be necessary to determine benefit of a medication adherence program in the treatment of HIV-infected women, adolescents, and children.