Outcomes of persons with blastomycosis involving the central nervous system.

Blastomyces dermatitidis is a dimorphic fungus which is potentially life-threatening if central nervous system (CNS) dissemination occurs. Sixteen patients with proven or probable CNS blastomycosis are presented. Median duration of symptoms was 90 days; headache and focal neurologic deficit were the most common presenting symptoms. Magnetic resonance imaging (MRI) consistently demonstrated an abnormality, compared to 58% of computed tomography scans. Tissue culture yielded the pathogen in 71% of histology-confirmed cases. All patients who completed treatment of an amphotericin B formulation and extended azole-based therapy did not relapse. Initial nonspecific symptoms lead to delayed diagnosis of CNS blastomycosis. A high index of suspicion is necessary if there is history of contact with an area where B. dermatitidis is endemic. Diagnostic tests should include MRI followed by biopsy for tissue culture and pathology. Optimal treatment utilizes a lipid-based amphotericin B preparation with an extended course of voriconazole.

Potential consequences of essential drug shortages in Canada: Brain abscess due to Nocardia farcinica associated with dapsone prophylaxis for Pneumocystis jirovecii pneumonia.

In 2012, Canadian pharmacies experienced a shortage of trimethoprim-sulfamethoxazole tablets. Drug shortages may result in unintended clinical consequences such as infection with pathogens against which the alternative medication is ineffective. This is highlighted in the present article, which describes a case of brain abscess due to Nocardia species that developed while receiving dapsone as an alternative for prophylaxis against Pneumocystis jirovecii pneumonia in a highly immune-suppressed patient. Clinicians should be cognizant of these issues when prescribing alternative agents.

En 2012, les pharmacies canadiennes ont subi une pénurie de comprimés de triméthoprim-sulfaméthoxazole. Les pénuries de médicaments peuvent avoir des conséquences non intentionnelles, telles qu'une infection par des pathogènes contre lesquels le médicament de remplacement n'a pas d'effets. C'est ce qu'on souligne dans le présent article, qui décrit un cas d'abcès cérébral attribuable à une espèce de Nocardia qui s'est manifesté pendant l'administration de dapsone en prophylaxie de remplacement contre une pneumonie à Pneumocystis jirovecii chez un patient très immunodéprimé. Les cliniciens devraient connaître ces enjeux lorsqu'ils prescrivent des médicaments de remplacement.

Legionella pneumophila serotype 1 pneumonia in patient receiving adalimumab.

We describe a case of severe pneumonia caused by Legionella pneumophila serotype 1 in a woman receiving the tumor necrosis factor-α antagonist to treat rheumatoid arthritis. As use of tumor necrosis factor-α inhibitors increase, clinicians should consider their possible association with legionellosis.

A review of amoebic liver abscess for clinicians in a nonendemic setting.

Amoebic liver abscess (ALA) is an uncommon but potentially life-threatening complication of infection with the protozoan parasite Entamoeba histolytica. E histolytica is widely distributed throughout the tropics and subtropics, causing up to 40 million infections annually. The parasite is transmitted via the fecal-oral route, and once it establishes itself in the colon, it has the propensity to invade the mucosa, leading to ulceration and colitis, and to disseminate to distant extraintestinal sites, the most common of which is the liver. The authors provide a topical review of ALA and summarize clinical data from a series of 29 patients with ALA presenting to seven hospitals in Toronto, Ontario, a nonendemic setting, over 30 years.