Relative bradycardia and lymphopenia in patients with babesiosis.

The medical records of 17 patients with babesiosis were reviewed. Nine of 17 patients (52.9%) presented with fever (temperature, > 101 degrees F), and 8 of the 9 patients (88.9%) had relative bradycardia. Four of the nine patients (44.4%) had morning temperature spikes during initial hospitalization. As revealed by laboratory analysis, 13 of 17 patients (76.5%) with babesiosis had lymphopenia, and 5 of 17 patients (29.4%) had rouleaux formation in their peripheral blood smears. These newly described clinical and laboratory findings represent additional clinical and laboratory features that may be used as diagnostic clues in the differential diagnosis of babesiosis.

Atovaquone in the treatment of Babesia microti infections in hamsters.

The traditional therapy for the treatment of human Babesia microti infections has been the combination of clindamycin and quinine. However, in recent years, it has become apparent that some patients have not responded to this regimen. We became involved in the treatment of several cases of babesiosis in which atovaquone was used to treat this infection. Therefore, using the hamster model, we determined the efficacy of atovaquone alone as well as atovaquone plus azithromycin for the treatment of experimental babesiosis. Atovaquone (100 mg/kg/day) and atovaquone (100 mg/kg/day) with azithromycin (150 mg/kg/day) were effective agents for the treatment of experimental babesiosis in hamsters. When atovaquone was used as monotherapy recrudescences occurred. Organisms obtained from recrudescent animals, when inoculated into uninfected animals, proved to be unresponsive to atovaquone therapy, suggesting the emergence of drug resistance. Resistant organisms did not emerge in hamsters treated with the combination of atovaquone and azithromycin. Atovaquone should be considered in the therapeutic regimen of patients with babesiosis who have either failed standard therapy or have become intolerant to such therapy.

Pneumonia syndromes: a clinical approach in the elderly.

Important in the pathogenesis of pneumonia in the elderly patient are chronic diseases, including diabetes mellitus, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and cerebrovascular disease. Also vital are the changes that take place in the immune system and mucociliary clearance mechanisms of the lung. The clinician should be aware of these risk factors, especially since the mortality rate of lower respiratory infections approaches 40% in these elderly patients. Treatment guidelines are included.

Poststernotomy mediastinitis.

The clinician should suspect mediastinitis in patients after sternotomy who have unexplained fever or leukocytosis, sternal wound tenderness, or atypical chest or neck discomfort 2 to 3 weeks following surgery. Mediastinitis should be considered if any of these features are present. The diagnosis should be aggressively pursued by mediastinal aspiration via the suprasternal notch. Early empiric treatment with an antibiotic(s) with antistaphylococcal and gram-negative coverage is critical to survival.

Haemophilus parainfluenzae bacteremia associated with a pacemaker wire localized by gallium scan.

A young woman with a history of sick sinus syndrome and placement of a permanent pacemaker 6 months before admission had fever and Haemophilus parainfluenzae bacteremia. A gallium scan localized the infection to the site of the pacemaker wire. Echocardiograms were negative for any vegetations. The patient responded to cefotaxime and trimethoprim-sulfamethoxazole therapy. We believe that this is the first case of H. parainfluenzae bacteremia associated with a pacemaker wire and localized by gallium scan.

Early seizures in patients with acquired immunodeficiency syndrome without mass lesions.

Generalized tonic-clonic seizures in persons infected with the human immunodeficiency virus have usually occurred in the setting of space-occupying lesions in the brain. Seizures have also been known to occur in patients with acquired immunodeficiency syndrome-related dementia. Two patients, each with prior history of human immunodeficiency virus infection, had seizures early in the course of their illness. Neither patient had evidence of space-occupying lesions or dementia at the time of admission for the seizures. Patients with human immunodeficiency virus infection may present with seizures and may not have a clinically detectable focus for their seizures.

Cytomegalovirus and legionella species as the cause of liver enzyme elevations in haemodialysis patients.

We conclude that reinfection or recurrent infection with CMV or legionella may be responsible for serum glutamic-pyruvic transaminase (SGPT) elevations in up to one fourth of haemodialysis patients. Since NANB infection or asymptomatic coinfection with these agents cannot be discounted with certainty, it seems prudent to maintain haemodialysis patients with abnormal liver-function tests on Body Fluid Precautions, even if they remain asymptomatic.