ABSTRACT
We report a case of bacillus Calmette-Guérin (BCG) infection of an axillary-femoral bypass graft presenting approximately 10 months after the initiation of intravesicular bacillus Calmette-Guérin for the treatment of bladder cancer. The patient's clinical course included removal of the bypass graft and antimycobacterial treatment with isoniazid, rifampin, and ethambutol for 9 months.
Subject(s)
Axillary Artery/surgery , BCG Vaccine/adverse effects , Femoral Artery/surgery , Tuberculosis, Cardiovascular/etiology , Urinary Bladder Neoplasms/therapy , Administration, Intravesical , Arterial Occlusive Diseases/surgery , Humans , Iliac Artery , Male , Middle AgedABSTRACT
There is high demand for care among the Hispanic population in states along the U.S.-Mexico border. The objective is to describe the standard of care received by people living with HIV/AIDS (PLWH/A) at enrollment into one of five Special Projects of National Significance (SPNS) Sites located along the U.S.-Mexico border. This cross-sectional study describes the presence of opportunistic infections (OIs), AIDS status and two types of standard of care received by 707 PLWH/A participating in SPNS. Patients receiving care through SPNS in one of the five sites between June 1, 2002 and December 31, 2003 were invited to participate to the medical chart review component of the study. The association between sociodemographic variables and the prevalence of OIs and AIDS at enrollment was estimated using multivariate hierarchical logistic models. More than one quarter of the 707 participants had at least one OI recorded and 58% of new and 60% of existing patients had AIDS at enrollment in SPNS. The association between being Hispanic and having higher prevalence of OI and AIDS at entry varied by SPNS site. Standard of care was well followed overall. This is the first study describing HIV stage and OI prevalences and standard of care in PLWH/A in all U.S.-Mexico bordering states. Being of Hispanic ethnicity may not fully explain discrepancy in access to care along the border.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , HIV Infections/epidemiology , Quality of Health Care , AIDS-Related Opportunistic Infections/ethnology , AIDS-Related Opportunistic Infections/etiology , AIDS-Related Opportunistic Infections/therapy , Adolescent , Adult , Cross-Sectional Studies , Federal Government , Female , HIV Infections/ethnology , HIV Infections/therapy , HIV-1 , Health Services Accessibility , Hispanic or Latino , Humans , Interviews as Topic , Male , Mexico , Middle Aged , Prevalence , United States , Young AdultABSTRACT
OBJECTIVE: To report a case of Pasteurella multocida cellulitis and bacteremia treated successfully with aztreonam. CASE SUMMARY: An 81-year-old white man with multiple antibiotic allergies was admitted with severe cellulitis of the left arm and bacteremia due to P. multocida. The patient was treated for 14 days with aztreonam and had complete resolution of the infection. DISCUSSION: To our knowledge, this is the first published case describing successful treatment of P. multocida cellulitis and bacteremia with aztreonam. Antimicrobials recommended for use in P. multocida infections include penicillin, ampicillin, amoxicillin, second- and third-generation cephalosporins, tetracyclines, fluoroquinolones, and trimethoprim/sulfamethoxazole. There is very little information in the current literature regarding the activity of aztreonam toward P. multocida. CONCLUSIONS: This case demonstrates the potential use of aztreonam for P. multocida cellulitis and bacteremia in those instances where antibiotics of choice cannot be given.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Aztreonam/therapeutic use , Bacteremia/drug therapy , Cats , Cellulitis/drug therapy , Pasteurella Infections/drug therapy , Pasteurella multocida/isolation & purification , Aged , Aged, 80 and over , Animals , Anti-Bacterial Agents/pharmacology , Aztreonam/pharmacology , Bacteremia/microbiology , Bites and Stings , Cellulitis/microbiology , Humans , Male , Microbial Sensitivity Tests , Pasteurella Infections/microbiology , Pasteurella multocida/drug effectsABSTRACT
Bacterial pathogens have been identified as agents that have been, or could be, used as weapons of biological warfare and/or biological terrorism. These agents are relatively easily obtained, prepared, and dispersed, either as weapons of mass destruction or for more limited terrorist attacks. Although phylogenetically diverse, these agents all have the potential for aerosol dissemination. Physicians in the United States and most of the developed world have never encountered most of these agents and the diseases they produce. Public health programs must be prepared, and individual primary care providers must be able to recognize, diagnose, treat, and prevent infection with these agents.
Subject(s)
Bacterial Infections/transmission , Bioterrorism , Anthrax/prevention & control , Anthrax/transmission , Brucellosis/prevention & control , Brucellosis/transmission , Humans , Plague/prevention & control , Plague/transmission , Q Fever/prevention & control , Q Fever/transmission , Tularemia/prevention & control , Tularemia/transmissionABSTRACT
Multiple viral agents have been classified by the CDC as potential weapons of mass destruction or agents for biologic terrorism. Agents such as smallpox, viral hemorrhagic fever viruses, agents of viral encephalitis, and others are of concern because they are highly infectious and relatively easy to produce. Although dispersion might be difficult, the risk is magnified by the fact that large populations are susceptible to these agents and only limited treatment and vaccination strategies exist. Although the risk of large-scale bioterrorism using viral agents is small, public health programs and health care providers must be prepared for this potentially devastating impact on public health.