Zidovudine and other reverse transcriptase inhibitors in the management of human immunodeficiency virus-related disease.

Licensed in 1987, zidovudine remains the only medication with proved efficacy for the treatment of disease caused by the human immunodeficiency virus (HIV). New information on the pharmacology (adults and children), effects of kidney and liver dysfunction on the disposition of the drug, and drug-drug interactions have improved the way we use and monitor this agent. The serious toxicity associated with zidovudine has led researchers to develop safer dosage regimens. Also, recognition that zidovudine slows but does not halt progression of disease has increased the search for effective alternatives. The best-studied agents are didanosine (2',3'-dideoxyinosine, ddl), zalcitabine (2',3'-dideoxycytidine, ddC), and foscarnet.

Thermophilic sporeforming bacilli that mimic fastidious growth characteristics and colonial morphology of legionella.

Gram-negative bacilli resembling legionellae were isolated from contaminated culture media. These bacilli are distinguishable from legionellae by their thermophilic characteristic.

Two epidemics of pseudobacteremia due to Staphylococcus aureus and Aerococcus viridans.

Two epidemics of pseudobacteremia are reported. The first, due to Staphyloccus aureus, was caused by a physician who had active staphylococcal skin infection and nasal colonization. Because the blood culture system in use at the time was open, and used screw cap bottles, we assume that the physician contaminated the bottles at the time of inoculation. The second outbreak, caused by Aerococcus viridans, was traced to contamination of the blood culture bottle tops as they were received from the manufacturer. We assume that there was inadequate disinfection of the bottle tops by the physicians prior to their use.

Fever and pneumonia after flexible fiberoptic bronchoscopy.

The frequencies of fever, parenchymal infiltration, and bacteremia were studied prospectively after 100 flexible fiberoptic bronchoscopies performed transnasally under topical anesthesia. Fever occurred after 16 per cent, and parenchymal infiltration, after 6 per cent of the procedures. Most complications were mild and transient; however, one patient developed rapidly progressive pneumonia and died. No organisms were isolated from cultures of blood drawn at the time of the procedure or during complications. The organisms most commonly isolated from the sputum of the patients who developed pneumonia were the aerobic and anaerobic bacteria normally found in the mouth. Isolation of a significant pathogen before the procedure did not predispose to development of a complication. Advanced age (greater than 60 years) and the endoscopic findings of abnormalities were significant predisposing factors. Bronchial brushing, but not bronchial biopsy or bronchial washing, was associated with significantly higher complication rates in patients with bronchial carcinomas than in those without a neoplasm. The mechanism of the fever and parenchymal infiltration is thought to be related to obstructive atelectasis and infection produced by organisms present in the airways at the time of the procedures.