ABSTRACT
Even though prompt diagnosis and treatment of purpura fulminans (PF) is essential to reduce mortality, early administration of antibiotics may preclude identification of the causative agent by standard bacterial cultures and thus render definitive diagnosis impossible. Here we present a case of an infant with PF and negative bacterial cultures for whom polymerase chain reaction (PCR) analysis of a cutaneous biopsy specimen obtained 4 days after initiation of antibiotics identified the genomic sequence of Neisseria meningitidis genogroup C. When bacterial cultures fail to provide useful information, PCR of skin biopsy specimens can be a valuable diagnostic tool in PF.
Subject(s)
Meningococcal Infections/diagnosis , Meningococcal Infections/genetics , Neisseria meningitidis, Serogroup C/genetics , Polymerase Chain Reaction/methods , Purpura Fulminans/diagnosis , Purpura Fulminans/microbiology , Anti-Bacterial Agents/therapeutic use , Biopsy , Female , Humans , Infant , Meningococcal Infections/drug therapy , Neisseria meningitidis, Serogroup C/isolation & purification , Skin/microbiology , Skin/pathologySubject(s)
Collagen/therapeutic use , Skin Ulcer/therapy , Skin, Artificial , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Female , Humans , Mastectomy , Methicillin-Resistant Staphylococcus aureus , Middle Aged , Staphylococcal Infections/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Wound Healing/radiation effectsABSTRACT
HIV infection remains a major world health problem more than 20 years after discovery of the virus. Mental disorders make individuals more vulnerable to behaviors that transmit HIV and interfere with HIV treatment adherence. The evidence supporting the need for optimal provision of mental health care in HIV clinics is mounting, along with evidence that these disorders can be treated successfully. Disorders of mental life include brain diseases (eg, depression, bipolar disorder, schizophrenia, and dementia), personality disorders, addictions, and psychologic disruptions, which contribute to the spread of the virus through their influence on behavior. However, although evidence exists that successful treatment of co-occurring mental disorders leads to improved HIV outcomes, integrated mental health care in HIV clinics remains grossly suboptimal.