Herbaspirillum Infection in Humans: A Case Report and Review of Literature.

Introduction. Herbaspirillum seropedicae are Gram-negative oxidase-positive nonfermenting rods of Betaproteobacteria class, commonly found in rhizosphere. More recently, some Herbaspirillium species have transitioned from environment to human hosts, mostly as opportunistic (pathogenic) bacteria. We present a 58-year-old female with non-small-cell lung cancer (NSCLC) who presented with pneumonia and was found to have Herbaspirillum seropedicae bacteremia. Case History. A 58-year-old woman with NSCLC on Pralsetinib presented with fevers and rigors for 2 days. Coarse breath sounds were auscultated on the right upper lung field. Labs revealed leukopenia and mild neutropenia. CT chest revealed right upper lobe pneumonia. She was admitted for sepsis secondary to pneumonia and placed on broad spectrum antibiotics with intravenous piperacillin-tazobactam and vancomycin. The patient continued to have fever 2 days after admission (max: 102.8°F). Preliminary blood cultures grew Gram-negative rods. The patient continued to have temperature spikes on the 3rd day of antibiotics (T max 101.5°F). Blood cultures revealed oxidase-positive nonfermenting rods. The patient's antibiotic was changed to IV meropenem on the 4th day of hospitalization. Ultimately, on the seventh day of hospitalization, the blood culture was confirmed from outside lab as Herbaspirillum seropedicae. The patient started feeling better and defervesced after about 24 hours. Discussion. More recently, Herbaspirillum spp. have been recovered from humans. Our patient had Herbaspirillum bacteremia, and reported regularly cleaning her pond and weeding her garden with possible exposure to this environmental proteobacterium. Herbaspirillum may be more prevalent than earlier thought owing to misidentification. With the institution of appropriate antimicrobial therapy, the outcomes seem mostly favorable.

The fluctuating population of Sm 4f configurations in topological Kondo insulator SmB6 explored with high-resolution X-ray absorption and emission spectra.

High-resolution partial-fluorescence-yield X-ray absorption and resonant X-ray emission spectra were used to characterize the temperature dependence of Sm 4f configurations and orbital/charge degree of freedom in SmB6. The variation of Sm 4f configurations responds well to the formed Kondo gap, below 140 K, and an in-gap state, below 40 K. The topological in-gap state is correlated with the fluctuating population of Sm 4f configurations that arises via carrier transfer between 3d94f6 and 3d94f5 states; both states are partially delocalized, and the mediating 5d orbital plays the role of a transfer path. Complementary results shown in this work thus manifest the importance of configuration fluctuations and orbital delocalization in the topological surface state of SmB6.

Influence of Fe substitution on the Jahn-Teller distortion and orbital anisotropy in orthorhombic Y(Mn1-xFex)O3 epitaxial films.

Multiferroic YMn1-xFexO3(020) (x = 0.125, 0.25, 0.50) epitaxial thin films with an orthorhombic structure (space group Pbnm) were prepared on a YAlO3(010) substrate by pulsed-laser deposition. Upon Fe substitution, the b-axis was clearly shortened, whereas the a- and c-axes were slightly lengthened based on XRD analysis. To understand the influence of orbital polarization and the Jahn-Teller effect of Mn(3+) on Fe substitution and also the local octahedral-site distortion of Fe(3+) in an environment of Jahn-Teller-active Mn(3+) ions in YMn1-xFexO3 films, we measured the polarization-dependent X-ray absorption spectra at the Mn-L2,3 and Fe-L2,3 edges, and also simulated the experimental spectra using configuration-interaction multiplet calculations. Although Δeg for the Mn(3+) ion decreased from 0.9 eV in pure YMnO3 to 0.6 eV in the half-Fe-substituted sample, a single eg electron was still strongly constrained to the d3y(2)-r(2) orbital for all the Fe concentrations tested. The largest Δeg, 0.5 eV, for the Fe(3+) ion was derived for a sample with 12.5% Fe substitution, and gradually decreased to 0.15 eV for the half-Fe-substituted sample. The local octahedral-site distortion of the Fe(3+) ion inside the YMnO3 lattice was similar to that of the Mn(3+) ion, whereas the Jahn-Teller distortion and GdFeO3-type distortion of the Mn(3+) ion were decreased by the spherical high-spin Fe(3+) ions. The combination of the experimental and theoretical data provides both profound insight into the variation of the Jahn-Teller distortion and orbital anisotropy and instructive information about the magnetic structures in these orthorhombic YMn1-xFexO3 thin films.

Vibrio vulnificus infection and liver cirrhosis: a potentially lethal combination.

We present a case of a 40-year-old man with decompensated alcoholic liver cirrhosis presenting with atraumatic cellulitis of one extremity and severe sepsis that rapidly progressed to compartment syndrome despite broad-spectrum antibiotics. Local cultures following debridement revealed Vibrio vulnificus, and subsequent history revealed consumption of raw oysters 48 h before presentation. Our case points out the unique susceptibility of those with cirrhosis and elevated iron saturation to Vibrio septicaemia, as well as the rapidity and severity of the disease progression.

Factors Supporting and Inhibiting Adherence to HIV Medication Regimen in Women: A Qualitative Analysis of Patient Interviews.

Adherence to antiretroviral therapy reduces morbidity and mortality; however rates of non-adherence are variable among women for unclear reasons. This study was a single-center qualitative analysis of interviews with 18 female HIV-positive non-adherent patients (defined by virologic failure) to explore psychosocial factors impacting adherence. Factors identified were categorized as promoting, inhibiting or having no effect on adherence. Three themes, characterized as social factors, illness factors and other societal pressures, were identified. Medical systems support, family support and compliance for children were most commonly identified as promoting adherence, while psychiatric comorbidities, lack of medical systems support and side effects were identified most often as inhibitors of adherence. While stigma was frequently identified, it was not seen as a barrier to adherence. Enhancing relationships between patients and their providers as well as their community support systems are critical avenues to pursue in improving compliance. Interventions to promote compliance are important avenues of future research.

Characteristics of fibrillatory activities during spontaneous termination of paroxysmal atrial fibrillation: new insight from high-density right atrium frequency mapping.

BACKGROUND: Sinus node (SN) activity is difficult to assess during atrial fibrillation (AF). The aim of the present study was to investigate SN activity by frequency analysis during AF. METHODS: Thirteen patients with paroxysmal AF and atrial flutter in the right atrium (RA) underwent 3-dimensional noncontact mapping. The fibrillatory activity was recorded from a multielectrode array in the RA. A frequency analysis with 2- and 6-second time-segment lengths was performed. Spectral characteristics (dominant frequency and harmonic index) and isopotential activation maps were used to investigate the spatiotemporal activity of the SN region and the rest of the RA (crista terminalis, septum, and free wall) during the initiation, while ongoing, and before the termination of AF. RESULTS: With duration of 6 seconds, the whole RA had similar trends of frequency distribution. With duration of 2 seconds prior to termination, the SN region exhibited a trend of low-frequency pattern and high-organization distribution, compared with the segments for the 2 to 4 and 4 to 6 seconds before termination. The isopotential activation maps showed the spontaneous earliest activities had wave front propagation patterns similar to those during sinus rhythm (after termination). CONCLUSIONS: The fibrillatory activity of the SN region was organized, and slow activation was detected, by frequency analysis and isopotential mapping, within 2 seconds just prior to AF termination.

Cavotricuspid isthmus: anatomy, electrophysiology, and long-term outcome of radiofrequency ablation.

The cavotricuspid isthmus (CTI) had a complex architecture with an anisotropic conduction property. An incremental pacing from the low right atrial isthmus produced a conduction delay and block, and initiated atrial flutter. Radiofrequency catheter ablation of the CTI was very effective in eliminating the typical atrial flutter. However, atrial fibrillation often occurred after ablation of the isthmus and needs further treatment.

Conduction barriers of atrial flutter: relation to the anatomy.

Atrial flutter (AFL) is a common arrhythmia in clinical practice. Several experimental models such as tricuspid ring model, tricuspid regurgitation model, and atrial crush injury model have provided important information about the role of conduction barriers in the reentrant circuit. Human typical AFL uses the tricuspid annulus as the anterior barrier, and uses the crista terminalis, Eustachian ridge, and sometimes sinus venosa as the posterior boundary. Rate-dependent conduction block was found in the crista terminalis and sinus venosa. Some barriers such as the crista terminalis and Eustachian ridge are not intact. The conduction gap in the barrier can produce another kind of arrhythmia. Understanding the barriers of AFL is necessary for successful radiofrequency ablation.

Electrophysiological mechanisms of atrial flutter.

Atrial flutter (AFL) is a common arrhythmia in clinical practice. Several experimental models such as tricuspid regurgitation model, tricuspid ring model, sterile pericarditis model and atrial crush injury model have provided important information about reentrant circuit and can test the effect of antiarrhythmic drugs. Human atrial flutter has typical and atypical forms. Typical atrial flutter rotates around tricuspid annulus and uses the crista terminalis and sometimes sinus venosa as the boundary. The IVC-tricuspid isthmus is a slow conduction zone and the target of radiofrequency ablation. Atypical atrial flutter may arise from the right or left atrium. Right atrial flutter includes upper loop reentry, free wall reentry and figure of eight reentry. Left atrial flutter includes mitral annular atrial flutter, pulmonary vein-related atrial flutter and left septal atrial flutter. Radiofrequency ablation of the isthmus between the boundaries can eliminate these arrhythmias.

Prevalence of viral and mycobacterial co-infections in perinatally HIV-infected children.

The progression of HIV disease may be affected by co-infection with other viruses. This study investigates the prevalence of Epstein-Barr virus (EBV); cytomegalovirus (CMV); herpes simplex virus (HSV) types 1 and 2; hepatitis A, B, and C (HA, HB, HC); and tuberculosis in perinatally HIV-infected children. Electrochemiluminescence Immunoassay (EIA) against EBV, CMV, HSV 1 and 2, HAV HBV HCV, and skin testing with purified protein derivative was performed on 45 perinatally HIV-infected children. CMVwas positive in 51%, EBVin 93.3%, HSV-1 in 62.2%, HSV-2 in 48.9%, HAV in 15.6%, HBVand HCV in 6.7% and PPD in 0%. HSV-2 prevalence was higher in females and Hispanics. The prevalence of CMV, EBV HSV-1, and tuberculosis was equivalent to rates reported in the general population. Prevalence of HSV-2 was significantly higher than in the general population (p < 0.001). Higher rates of HSV-2 infection and hepatitis may be secondary to high maternal co-infection rate and subsequent vertical transmission.