Mark K. Huntington

Leclercia adecarboxylata in an immunocompetent patient.

Leclercia adecarboxylata is a rarely reported human pathogen, most commonly affecting immunocompromised individuals. In reported cases of immunocompetent patients infected with this organism, it is seen exclusively in the context of polymicrobial infections. We report here the case of an abscess in an immunocompetent patient that grew out L. adecarboxylata as a pure culture. The limited literature available on this organism is reviewed, and the potential implication of this finding is discussed.

Nutritional Treatment of Obesity

The focus of this article is nutritional strategies for weight loss. Following a review of general nutritional principles, the evidence behind specific nutritional weight-loss strategies is presented. These strategies include nutritional supplements, nutrient-limited diets, and energy-limited diets. A brief discussion of nutritional considerations relevant to other weight-loss strategies--pharmacologic, surgical, and exercise-based--is included. Specific evidence-based recommendations are presented.

Community-Based Intervention to Manage an Outbreak of MRSA Skin Infections in a County Jail

This article describes a community-based intervention to manage an outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections in a midwestern county jail. A systematic investigation conducted by a family medicine residency program identified 64 total cases and 19 MRSA cases between January 1 and December 31, 2007. Factors contributing to MRSA transmission included inadequate surveillance, lack of antibacterial soap, and a defective laundry process. All 19 isolates were CA-MRSA and all seven tested by pulsed-field gel electrophoresis (PFGE) were USA300. Four of the seven isolates showed variation of their PFGE patterns. A primary care approach using community-based resources effectively reduced the number of cases in this heterogeneous outbreak of CA-MRSA, with the last MRSA being isolated in October 2007.

Bullous impetigo associated with Abiotrophia defectiva in an immunocompetent adult.

Infection of humans by Abiotrophia defectiva, a nutritionally variant streptococcus, most commonly takes the form of endocarditis, though a variety of other manifestations ranging from central nervous system abscesses to orthopaedic infections have been seen. We report here what we believe is the first case of bullous impetigo associated with this organism.

Q fever hepatitis and endocarditis in the context of haemochromatosis

Hereditary haemochromatosis is associated with increased susceptibility to some infections. We report here a case of Q fever in a patient with coexistent haemochromatosis. The literature is reviewed in regard to the effect of haemochromatosis on susceptibility to infectious disease in general and Q fever in particular. Although there is documented increased risk in these patients for some infectious conditions, a specific association with Q fever has not been previously reported. The present report raises the possibility of such a clinically relevant connection.

Diffuse alveolar haemorrhage associated with aerosol propellant use

Diffuse alveolar haemorrhage (DAH) is a clinical syndrome resulting from injury to the alveolar microcirculation, most commonly associated with not only autoimmune disorders or connective tissue disease, but also a variety of infections, neoplasms and toxins. We report here a case of an otherwise healthy young man with DAH attributable to an inhalation injury resulting from use of aerosol spray paint.