Rathel Nolan

Subacute Disseminated Mucormycosis in a Diabetic Male

Mucormycosis is an opportunistic invasive infection caused by fungi of the order Mucorales. Rhizopus, Absidia, and Mucor are the most commonly encountered genera. Disease is characterized by vascular invasion, thrombosis, and tissue necrosis. Rhinocerebral disease is the most common manifestation but pulmonary, cutaneous, gastrointestinal, and widely disseminated forms have been reported. Pulmonary and disseminated disease are usually seen in neutropenic patients with leukemia or lymphoma. Both present as fever and unexplained pulmonary infiltrates unresponsive to antibacterials and corticosteroids. Disease is usually fulminant and has a high mortality rate. Diagnosis is most commonly made at autopsy. A single case of disseminated disease is reported that is unusual in its subacute course and its occurrence in an otherwise healthy non-neutropenic diabetic male.

Vulvar Vaccinia Infection After Sexual Contact With a Smallpox Vaccinee

Vaccinia (smallpox) vaccine is an effective immunizing agent that brought about global eradication of naturally occurring smallpox, as declared by the World Health Organization in 1980. The United States ceased generalized smallpox vaccination in 1972 but reinstated it in 2002 for military personnel and selected healthcare workers (first responders who may be investigating possible cases of smallpox or caring for patients in selected hospitals) after the 2001 bioterrorism attacks. Since reinstitution of the vaccine, reports of transmission of vaccinia virus through contact with military smallpox vaccinees have been published, including four cases of female genital infection. We report a subsequent case of vulvar vaccinia infection acquired during sexual contact with a military vaccinee.

Evaluation of a Positive Yeast-in-Blood Service

Background:The purpose of this study was to evaluate the effect of a novel “yeast-in-blood” surveillance service on the timeliness of antifungal chemotherapy for candidemia. Methods:Two hundred seven blood cultures positive for Candida species between July 1, 1994, and February 15, 2009, as identified by the microbiology positive culture log, were included in this retrospective chart review. Patients with a positive culture before July 1, 2008, were evaluated by the yeast-in-blood surveillance service and included as intervention cases (IC). After this time, those occurring after discontinuation of the service were included as nonintervention cases (NIC). The primary outcome measure was the time to antifungal therapy from the time of blood culture draw. Secondary outcome measures included antifungal selection and time to antifungal prescription order from culture positivity. Results:Median time to therapy was 58.9 ± 28.4 hours and 41.3 ± 30.5 hours for NIC and IC, respectively (P = 0.001). Median time to prescription order was 3.0 ± 6.9 hours for NIC versus 1.9 ± 3.9 hours for IC. Candida albicans was the predominant organism identified (45.3% of NIC and 54.6% of IC). Treatment agents included an azole in 57.4% of NIC and 47.4% of IC, an echinocandin in 33.3% and 27.3% and a polyene in 5.7% and 27.8%, respectively. Conclusions:Time to therapy and time to prescription were shorter in those evaluated by the surveillance service. These data suggest that a yeast surveillance service improves antifungal medication therapy initiation.

SYPHILITIC AORTITIS PRESENTING WITH ACUTE ISCHEMIC STROKE AND LARGE ASCENDING AORTIC THROMBUS

Comprehensive evaluation including imaging for a cardioembolic etiology is indicated in the workup of acute ischemic stroke. A 57 year old male presented with a 2 day history of aphasia and right hemiparesis. He underwent transthoracic echocardiogram, which was normal except for a mildly dilated