Weil's Disease in an HIV-Infected Patient.

Leptospirosis is a zoonosis caused by the spirochete Leptospira. Most cases of leptospirosis are mild to moderate and self-limited. The course of disease, however, may be complicated by multiorgan dysfunction with liver and kidney failure causing Weil's disease. Leptospirosis is also rare among HIV-infected patients. We report a case of an HIV-infected patient with Weil's disease.

Eosinophilic pneumonia induced by ceftaroline.

PURPOSE: A case of eosinophilic pneumonia in a patient receiving ceftaroline for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is reported. SUMMARY: A 65-year-old woman was admitted to a medical intensive care unit after arriving at the emergency room with complaints of progressively worsening shortness of breath. Her medical history included chronic obstructive pulmonary disease, acute respiratory distress syndrome, recent traumatic brain injury, tobacco use, and alcohol abuse. Within the first few days of hospitalization, the patient was diagnosed with MRSA pneumonia based on microbiological data from bronchoscopy bronchial washings. Her renal function liver enzyme levels were within normal limits. Empirical antibiotic therapy included i.v. vancomycin and meropenem and was narrowed to i.v. linezolid monotherapy based on culture and sensitivity results. After 10 days of treatment with linezolid, the patient was persistently febrile, and cultures remained positive. It was decided to switch therapy to a course of i.v. ceftaroline, an anti-MRSA cephalosporin. On the fifth day of treatment with ceftaroline, the patient developed respiratory decompensation and peripheral eosinophilia of 40%. Bronchoalveolar lavage (BAL) results indicated the presence of pulmonary eosinophilia of 13%. Chest radiographs revealed pulmonary infiltrates, and the computed tomography angiography showed no evidence of pulmonary embolism. Ceftaroline was discontinued, and the patient was started on vancomycin and methylprednisolone. The patient responded to methylprednisolone therapy, with repeat BAL and peripheral blood counts showing resolved eosinophilia. CONCLUSION: A patient with risk factors for respiratory disease developed eosinophilic pneumonia after receiving ceftaroline for the treatment of MRSA pneumonia. Eosinophilia resolved after ceftaroline was discontinued and i.v. methylprednisolone was initiated.

Concomitant surgical treatment of dental and valvular heart diseases.

BACKGROUND: Invasive dental procedures are often indicated before cardiac valve surgery. The purpose of this case-control study was to determine the risks and benefits of concomitant dental and thoracic surgery. METHODS: Critically ill cardiac inpatients requiring cardiac valve surgery were referred by the Department of Thoracic and Cardiovascular Surgery to our Oral Medicine consult service. Those requiring dental extractions were considered for dental treatment during the same general anesthetic as the cardiac surgery. These study patients were compared with control patients who had extractions before valve surgery in a different setting. There was no attempt to analyze the impact of this practice on the development of infective endocarditis. All patients received broad-spectrum antibiotics during dental surgery. RESULTS: Twenty-one patients had concomitant oral and cardiac valve surgery. Seventeen patients were in the control group. There were no statistically significant differences between cases and controls in demographics, length of stay, nature of the dental surgery, mean number of teeth removed, oral bleeding, or postoperative infections. One patient in the control group developed prosthetic valve endocarditis versus none in the concomitant surgery group. CONCLUSIONS: This case-control study suggests that concomitant surgical procedures for dental and valvular heart disease can be accomplished without clinically significant oral complications. Given the risk from poor oral health following cardiac valve surgery, this approach should be considered for patients who would benefit by avoiding a second general anesthetic and/or a delay in cardiac surgery, and by having their oral surgery performed in the safest environment.

The impact of grassland management regime on the community structure of selected bacterial groups in soils.

The impact of long-term grassland management regimes on microbial community structure in soils was assessed using multivariate analysis of polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) banding patterns of selected bacterial groups and PLFA (phospholipid fatty acid) profiling. The management regimes assessed were inorganic nitrogen (N) fertiliser application and soil drainage. PCR-DGGE profiles of the eubacteria, actinomycetes, ammonia oxidisers and pseudomonads were assessed by principal co-ordinate analysis of similarity indices which were generated from binary data using both Dice and Jaccard coefficients. The analysis of binary DGGE data revealed significant impacts of N fertiliser on the eubacterial and actinomycete community structure using the Jaccard coefficient, whilst N fertiliser had a significant impact on the actinomycete community structure only when using similarity indices generated from the Dice coefficient. Soil drainage had a significant impact on the community structures of the actinomycetes and the pseudomonads using both Dice and Jaccard derived similarity indices. Multivariate analysis of principal components derived from PLFA profiling revealed that N fertiliser had a significant impact on the microbial community structure. Although drainage alone was not a significant factor in discriminating between PLFA community profiles of the different treatments, there was a significant interaction with N fertiliser. Analysis of principal component analysis (PCA) loadings revealed that PLFAs i15:0 and i17:0 were partly responsible for the clustering away of the undrained-N fertilised treatment. Although soil management regime influenced some background soil data, correlation analysis using PC1 from PLFA data revealed no significant relationship with soil organic matter, pH, total C and total N. These results provide evidence that grassland management practices impact on the community composition of specific microbial groups in soils.

Disseminated Paecilomyces lilacinus infection in a patient with AIDS.

We describe a case of disseminated Paecilomyces lilacinus infection occurring in a patient with advanced HIV infection. P lilacinus is a ubiquitous environmental fungus that has been associated with infection in various immunocompromised hosts, in patients with invasive medical devices, and in contact-lens wearers. The clinical features, morphologic characteristics, and response to antifungal therapy in our patient are similar to findings reported in disseminated infection due to Penicillium marneffei, another opportunistic fungal infection in HIV-infected patients. We believe this to be the first report of infection with P lilacinus in a patient with AIDS.