Prostatic abscess due to community-acquired methicillin-resistant Staphylococcus aureus.

We report what we believe to be the second case of a prostatic abscess due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA). A previously healthy diabetic man presented with dysuria, fatigue, weight loss, a tender prostate, and leukocytosis. Computerized tomography of the abdomen and pelvis demonstrated a large prostatic abscess at the base of the bladder. Blood, urine, and pus obtained by percutaneous aspiration grew MRSA. Percutaneous drainage and prolonged therapy with intravenous vancomycin resulted in cure. Prostatic abscess is most often caused by Gram-negative organisms. Community-acquired MRSA, which usually causes skin and soft tissue infections, may also cause prostatic abscess. The mainstay of treatment of prostatic abscess is drainage, which can be accomplished either percutaneously or transurethrally. Gram stain and culture of the drainage will direct proper antibiotic selection.

Risk of mistaken DNR orders.

A questionnaire study was carried out among attendants at a community cancer center to determine the subjects' preferences and understanding of the meaning of do-not-resuscitate (DNR). Only 34% correctly understood the meaning of DNR, and 66% thought that DNR was administered only to prolong life without realizing that a DNR decision would result in not being resuscitated even if the cause of the sudden death was potentially reversible. We then determined the subjects' preferences if they had developed a treatment complication needing resuscitation and be put on the ventilator machine temporarily. When the subject was not expected to be alive in 6 months, the preference for resuscitation was not related to correct understanding. However, when the chance of cure was 30%, a preference for resuscitation was related to an incorrect understanding of the meaning of DNR. About 70% of respondents who would accept ventilator care had an incorrect understanding of DNR. The adjusted odds for the correct understanding of DNR were less for respondents who preferred resuscitation. The adjusted odds ratio (AOR) was 0.58 (CI: 0.35-0.93) (p=0.02) after adjusting for age and 0.53 (CI: 0.32-0.86) (p=0.01) after adjusting for both age and treatment group. These results suggest that physicians should be open to the possibility that patients may not always understand what DNR means, and they may be placed on DNR by mistake.

Characterization of the immune response to DNA vaccination strategies for schistosomiasis candidate antigen, Sm-p80 in the baboon.

Even though schistosomicidal agents and other control measures, including public hygiene and snail control exist, development of an efficacious vaccine still remains the most potentially powerful method for control of schistosomiasis. In our continuing efforts to develop a vaccine against schistosomiasis, we have selected a vaccine candidate (Sm-p80), which plays an important role in the immune evasion process of the parasite. Sm-p80 has been shown to confer up to 60% protection in mice following experimental infection. In this initial study, we have used Sm-p80 plus the Th1 response promoting cytokine, interleukin-2 (IL-2), in a DNA immunogen formulation. The vaccine was tested for its safety and immunogenicity in a baboon model of schistosomiasis. The vaccine generated a Th1 type Sm-p80-specific response in baboons with IgG(1)/IgG(2) ratios of less than 1.0. No detectable IgG(3) or IgG(4) anti-Sm-p80 responses were present in the immunized baboons. The antibodies to Sm-p80 were able to kill up to 35% schistosomula in vitro in the presence of complement. These results although preliminary suggest the potential of Sm-p80 as a viable vaccine candidate for schistosomiasis.