A Review of Extrapulmonary Tuberculosis.

Mycobacterium tuberculosis is an aerobic, non-spore-forming, non-motile bacillus that causes tuberculosis of both pulmonary and extrapulmonary sites. Though nationwide 66 percent of reported tuberculosis cases occur in foreign-born individuals, these individuals only contributed to 29 percent of the cases in South Dakota in 2015, whereas most of our cases were found in citizens born in the U.S.1 The South Dakota Department of Health also reported 317 cases of latent tuberculosis in South Dakota in 20151, making reactivation tuberculosis a major concern for U.S.-born residents. During the five years spanning 2011-2015, we have seen varying presentations of tuberculosis in South Dakota, many of which included extrapulmonary sites. We report a recent case involving of a 62-year-old Native American female with extrapulmonary tuberculosis cystitis.

Atypical Presentations of Tularemia.

Francisella tularensis is a gram-negative coccobacillus that causes a condition commonly referred to as tularemia. There has been a dramatic increase in tularemia cases reported in South Dakota, many of which were challenging to diagnose due to atypical clinical manifestations. We describe an interesting case of pneumonic tularemia and summarize six similar cases, several of which presented with lung nodules suggestive of malignancy. According to the literature, this is only the third outbreak of pneumonic tularemia reported in the U.S. We believe it is important for clinicians to be aware of the increased incidence of tularemia in the area and to be vigilant in the diagnosis and management of these atypically presenting cases.

Vaccination and the health care worker.

Historically, health care worker vaccination has been a strategy to protect the health care worker from infectious work related risk. This article will discuss the transition to health care worker vaccination as a key patient safety initiative for hospitals and health care systems. As the case is evolving toward mandatory influenza vaccination of health care workers, we have outlined key success factors for a voluntary program in a rural frontier referral hospital. Additionally, pertussis vaccination for health care workers is discussed as to the patient safety aspects of a progressive approach further making the case for value creation on behalf of our patients we have the privilege of providing care.

Development of a strategy for decreasing multi-drug resistant bacteria with implementation of a program emphasizing appropriate antibiotic utilization and strict infection control measures in western South Dakota.

In this follow-up of an article written in the South Dakota Journal of Medicine, February 2001, Antimicrobial Resistance: Steps to Reduce the Problem with Emphasis on Antibiotic Utilization--The Rapid City Experience, subsequent local analysis based on evolving literature, local measures undertaken, and results of these measures will be presented. With national numbers of Methicillin resistant Staphylococcus aureus (MRSA) and Vancomycin resistant enterococcus (VRE) rising, steps taken in the Rapid City Region have shown reduction in these two pathogens. The two key components of these programs have been appropriate antibiotic utilization and strict adherence to aggressive infection control measures.