Septic shock due to Pasteurella multocida bacteremia: a case report.

INTRODUCTION: Pasteurella is a Gram-negative coccobacillus that causes a wide spectrum of diseases in humans and is commonly transmitted from cat and dog bites. An increasing number of cats and dogs are kept as pets in American households which increases the risk of pet-related infections. CASE PRESENTATION: An 82-year-old African American woman with multiple comorbidities presented with fever, vomiting and diarrhea; she later developed septic shock requiring vasopressors and intubation. She was found to have Pasteurella multocida bacteremia. Her hospital course was complicated by a pulseless electrical activity arrest. She had exposure to her pet cat at home. We believe that a possible portal of entry was her skin; however, other possibilities such as respiratory tract could not be excluded. She was treated with imipenem-cilastatin and discharged after 25 days. CONCLUSIONS: Studies have shown a mortality range from 7 to 31% in Pasteurella bacteremia. Due to an increasing number of pets and high mortality of this disease, it is important to have a high suspicion for this infection, especially in elderly and immunocompromised patients.

Vaccinating adults who are pregnant, older, or immunocompromised, or have chronic kidney disease.

Patients who have special vaccination needs include pregnant women, people over age 60, people with kidney disease, people with compromised immunity due to underlying illness or medications, and international travelers. By being aware of these needs and implementing a strategy for vaccination, physicians can reduce the rate of vaccine-preventable infections. This article reviews the vaccine requirements in these groups.

Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients.

Objective. To study histopathology of the thyroid and parathyroid glands in HIV-infected African Americans in the United States. Methods. A retrospective review of 102 autopsy cases done by the Department of Pathology at Howard University Hospital from 1980 through 2007 was conducted. The histopathological findings of the thyroid and parathyroid glands were reviewed, both macroscopically and microscopically. A control group of autopsy patients with chronic non-HIV diseases was examined. Results. There were 71 males (70%) and 31 females (30%) with an average age of 38 years (range: 20-71 y). Thirteen patients with abnormal thyroid findings were identified. Interstitial fibrosis was the most common histological finding (4.9%), followed by thyroid hyperplasia (1.9%). Infectious disease affecting the thyroid gland was limited to 2.9% and consisted of mycobacterium tuberculosis, Cryptococcus neoformans, and cytomegalovirus. Kaposi sarcoma of the thyroid gland was present in only one case (0.9%). Parathyroid hyperplasia was the most common histological change noted in the parathyroid glands. Comparing the histological findings of cases and controls, we found a similar involvement of the thyroid, with a greater prevalence of parathyroid hyperplasia in HIV patients. Conclusion. Thyroid and parathyroid abnormalities are uncommon findings in the HIV-infected African American population.

Mycoplasma pneumoniae-Induced-Stevens Johnson Syndrome: Rare Occurrence in an Adult Patient.

Stevens-Johnson syndrome (SJS) is an uncommon occurrence in Mycoplasma pneumoniae (M. pneumoniae) infection (1-5%) and has been mainly reported in children and young adults. We present a case of SJS in a 32-year-old male induced by M. pneumoniae infection. This patient presented with fever, cough, and massive occupation of mucus membranes with swelling, erythema, and necrosis accompanied by a generalized cutaneous rash. He clinically responded after treatment with antibiotics and IVIG. SJS is usually a drug-induced condition; however, M. pneumoniae is the commonest infectious cause and should be considered in the differential diagnosis.

Graves' Disease as a Manifestation of Immune Reconstitution in HIV-Infected Individuals after Initiation of Highly Active Antiretroviral Therapy.

Graves' disease after the initiation of highly active antiretroviral therapy (HAART) in certain HIV-1-infected individuals has been described as an immune reconstitution inflammatory syndrome (IRIS). This phenomenon should be suspected in individuals who present with clinical deterioration and a presentation suggestive of hyperthyroidism despite good virological and immunological response to HAART. Signs and symptoms of hyperthyroidism may be discrete or overt and typically develop 8-33 months after initiating therapy. One to two percent of HIV-infected patients can present with overt thyroid disease. Relatively few cases of Graves' IRIS have been reported in the literature to date. We describe four cases of Graves' IRIS in HIV-infected patients who were started on HAART therapy.

Pulmonary sarcoidosis in an HIV/human T-cell lymphotrophic viruses I/II coinfected patient.

Coexistence of HIV, pulmonary sarcoidosis, and human T-cell lymphotrophic viruses (HTLV) I/II has not been well reported and studied. Although the exact etiology of sarcoidosis is unknown, immunologic abnormalities have been the focus of human immunodeficiency virus (HIV)-related sarcoidosis and it is thought to be a manifestation of immune reconstitution inflammatory syndrome. We report the case of an African American woman with HIV and HTLV I/II coinfection who developed pulmonary sarcoidosis several months after the initiation of antiretroviral therapy. Despite the fact that most common etiologies of pulmonary nodules in HIV patients include mycobacterial and fungal infections, sarcoidosis should be considered in differential diagnosis. This disease may continuously rise due to the increasing number of people who are receiving antiretroviral therapy, leading to an improved immune system.

Lemierre's syndrome resulting from streptococcal induced otitis media and mastoiditis: a case report.

INTRODUCTION: Lemierre's syndrome is an extremely rare and almost universally fatal disease characterized as thrombophlebitis of the internal jugular venous system with subsequent metastatic infection. Fusobacterium necrophorum is the most common organism implicated in causation of Lemierre's syndrome. Group A Streptococcus has mainly been observed as a polymicrobial organism in the syndrome. We report a rare finding of a rare disease where Group A Streptococcus was the sole organism triggering Lemierre's syndrome. To our knowledge, this is only the third recorded patient with such an occurrence. CASE PRESENTATION: We describe a 9-year-old African American boy, who presented with otitis media and mastoiditis that culminated in Lemierre's syndrome. Isolates bore only Group A Streptococcus. The patient was appropriately treated and responded with full recovery from the syndrome. CONCLUSION: Since Lemierre's syndrome is classically detected by clinical diagnosis, these findings should prompt clinicians to consider Group A Streptococcus as an alternative catalyst. It should be pondered that patients who present with typical Group A streptococcal infections have the possibility for developing Lemierre's syndrome. Though this complication appears to be rare, early diagnosis and prompt intervention have proven critical in survival outcome. Indeed, what would seem to be a routine case of strep throat or otitis media easily treated with antibiotics could end up being an unalterable progression to death unless Lemierre's syndrome is immediately diagnosed and treated.

Managing mentally and physically challenged HIV patients.

Management of mentally and physically challenged patients is complex, as it can involve ethical, social, and medical issues, and adding the provision of human immunodeficiency virus (HIV) care further complicates management. There continues to be limited information in the literature in caring for these types of patients. We provide 2 unique HIV cases--one who is mentally challenged and the other who is blind--and how management was approached. A list of select resources to aid both providers and patients is provided.