A case of Streptococcus canis bacteremia, osteomyelitis, sacroiliitis, myositis, and abscess.

BACKGROUND: Streptococcus canis is a group G beta-hemolytic Streptococcus species which normally resides on the skin and mucosal surfaces of dogs. Although it rarely causes infection in humans, our case and review of relevant literature demonstrate that this multi-host pathogen may be responsible for metastatic infection. We present an appropriate management strategy in such cases. CASE PRESENTATION: A previously healthy 26-year-old male presented to the emergency department with a 2-day history of erythema, pain, and swelling of the left ankle and foot, consistent with acute cellulitis. The patient was initially discharged home with a plan to complete a course of IV cefazolin as an outpatient, but later recalled after two sets of blood cultures grew gram positive cocci. Blood cultures speciated as Streptococcus canis. This was performed by identifying beta hemolytic strep on blood agar, then typed as Lancefield group G, followed by MALDI-TOF which distinguished S. canis. History was unremarkable except for a 2-week history of lower back pain precipitated by a wrestling injury. There was no canine bite or scratch wound, although the patient lives with a dog. CT spine was obtained which demonstrated right piriformis myositis and S1 osteomyelitis. MRI additionally demonstrated right erector spinae myositis, right sacroiliitis, and multiple collections in the right posterior paraspinal soft tissues. Transthoracic echocardiogram did not demonstrate valvular vegetations. The S. canis isolate was pan-susceptible and the patient was ultimately discharged home and completed a 8-week course of IV penicillin G. After completion of therapy, his symptoms, repeat imaging, and biochemical markers suggested resolution of infection on follow-up. CONCLUSIONS: We suggest that management of S. canis bacteremia should involve consideration of screening for metastatic infection and infectious diseases consultation. However, despite its potential for systemic involvement, S. canis is often susceptible to narrow spectrum antibiotics, and may be treated with penicillins.

Attitudes and behavior of HIV-infected patients concerning dental care.

This preliminary, descriptive study investigated the behavior and attitudes of HIV-infected patients concerning dental care. A self-administered, anonymous questionnaire was completed by 101 of 102 consecutive HIV-infected adults (mean age 36 years). Since the diagnosis of HIV infection, 81 respondents reported that they had sought dental care; 54 reported visiting a dentist at least once a year; 41 had changed dentists; and 62 reported current mouth problems, for which 45 were receiving treatment. Forty per cent of all respondents were receiving treatment in a hospital dental department. The use of hospital facilities was not associated with advanced HIV disease. Seventy per cent of participants were satisfied with the dental treatment they had received since they were diagnosed with HIV (18 per cent had no opinion, and 12 per cent were dissatisfied). Twelve per cent were concerned that their HIV seropositivity would not be kept confidential. While 87 per cent of participants had disclosed their HIV-seropositivity to their current dentist, 29 per cent believed that the dentist could be reluctant to provide treatment if they did so. Some patients reported changing dentists or not seeking care based on their fear that dentists would be reluctant to provide treatment. Fifteen per cent of patients who had sought dental care reported that they were refused treatment because they had HIV. Participants were more likely to have received dental care within the previous year if they reported being able to afford treatment, or had dental insurance (p < 0.01). Because more than 33 per cent of respondents had incomes below the poverty line, it is likely that economic factors limit the access to dental care for patients with HIV. More research is required using a larger sample and a random selection of participants.

HIV-infected patients and dental care: nondisclosure of HIV status and rejection for treatment.

OBJECTIVE: To investigate reports of nondisclosure of HIV-seropositivity to dentists by HIV-infected patients and their rejection for dental treatment. STUDY DESIGN: An anonymous self-administered questionnaire was completed by 101 consecutive consenting HIV-infected patients. RESULTS: Eighty percent of respondents (mean age, 36 years) had visited a dentist since their HIV diagnosis; 15% of these reported that they had been refused treatment because the dentist did not want to treat HIV-infected patients. Rejection was reported by 25% of respondents with heterosexual and 14% with homosexual risk factors, 11% of recipients of blood or blood products, and 8% with unknown or multiple risk factors. Refusal was not associated with economic factors. Nondisclosure of HIV-seropositivity to their current dentist was reported by 13% of respondents. No respondents attending hospitals or health units reported nondisclosure, compared with 18% of respondents attending private dental offices (p < 0.05). CONCLUSION: More research is required with a larger sample to improve generalizability and to permit subgroup analysis.

The politics of despair: AIDS and the failure of treatment.

The recent AIDS-related death of a friend forced Dr. Iain Mackie to think about the disease and the lack of positive news about it. Despite a flood of recent studies that brought pessimistic news about the treatments now in use, Mackie tries to remain optimistic. "I may be treating only myself as I feed off the politics of optimism," he says, "but at least I will not be feeding off the politics of despair." The article appears as Canada marks another National AIDS Week Oct. 2-8.

AIDS, the female patient, and the family physician.

Women constitute the most rapidly growing population with human immunodeficiency virus infection in Canada. Problems unique to women and related to HIV include gynecological disorders such as recurrent candidiasis, cervical dysplasia, and neoplasia. Women also face unique psychosocial issues related to their socioeconomic status, pregnancy, and sex. This article addresses these issues.

Thoracic magnetic resonance imaging in the evaluation of HIV-1/AIDS pneumonitis.

Magnetic resonance imaging of the thorax was performed on ten occasions in eight HIV-positive patients with a clinical picture suggestive of Pneumocystis carinii pneumonia. The diagnosis of PCP was subsequently confirmed on six occasions. Patients without PCP had low MRI profusion scores, while four of six patients with PCP had MRI profusion scores greater than 6/21. Neither the chest roentgenogram appearance nor computer-generated T1 and T2 relaxation times could reliably distinguish between these two groups. Magnetic resonance imaging may be useful in the early and noninvasive diagnosis of PCP in HIV-positive patients.

Factors associated with increased frequency of HIV-related oral candidiasis.

HIV-related oral candidiasis was investigated in 71 HIV-seropositive patients who received interviews, oral examinations and hematologic investigation. Diagnosis of candidiasis was based on clinical signs and examination of PAS-stained smears. The frequency of candidiasis was 24/71 (34%). The clinical presentations were pseudomembranous 8 (11%), erythematous 14 (20%), angular cheilitis 3 (4%). Twenty-six patients (37%) had candidiasis or were receiving antifungal treatment for recurrent pseudomembranous type. Twelve of 13 (92%) patients with AIDS and 14/58 (24%) without AIDS were affected. Bivariate analyses showed significant associations with AIDS, the use of zidovudine, low T4-count, xerostomia; marital status (sometime married), restricted performance status and age of greater than 35 yr. Multivariate logistic regression analysis showed that the presence of xerostomia was an independent and statistically significant predictor of HIV-related oral candidiasis. T4-count and restricted performance status were the second and third most important predictors.