Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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All New York City patients whose cultures yielded Mycobacterium tuberculosis with isolated resistance to rifampin in 1993 and 1994 were included in this study. Of the 96 patients, 48 (50%) had primary resistance, 32 (33%) had acquired resistance, and 16 (17%) had unclassified resistance; 66% had histories of illicit drug use, and 79% were infected with human immunodeficiency virus (HIV). ⋯ Each of the HIV-infected patients with acquired resistance (cases, n = 29) was matched to two HIV-infected patients who had disease due to fully susceptible M. tuberculosis (controls, n = 58). In multivariate analysis, factors associated with the emergence of rifampin resistance were as follows: a sputum smear positive for acid-fast bacilli, advanced immunosuppression, and nonadherence to therapy.
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Practice Guideline Guideline
Prevention of bacterial endocarditis: recommendations by the American Heart Association.
To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. ⋯ Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate-, and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered; and (6) for gastrointestinal or genitourinary procedures, the prophylactic regimens have been simplified. These changes were instituted to more clearly define when prophylaxis is or is not recommended, improve practitioner and patient compliance, reduce cost and potential gastrointestinal adverse effects, and approach more uniform worldwide recommendations.
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Comment Letter Review
Ganciclovir therapy for severe cytomegalovirus infection in immunocompetent patients.
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We conducted a study to assess the incidence and outcome of hemophagocytic histiocytosis (HH) in thrombocytopenic patients with sepsis syndrome or septic shock and to define the possible associations between HH, disseminated intravascular coagulation (DIC), and platelet-associated IgG (PAIgG) in promoting thrombocytopenia. Twenty immunocompetent thrombocytopenic patients were included. Bone marrow aspirates were obtained from each patient to identify hemophagocytic histiocytes. ⋯ Eight of the 12 patients with HH and four of the eight patients without HH died (P = NS). The results of this study suggest that HH could be involved in the development of thrombocytopenia in immunocompetent patients with sepsis syndrome or septic shock. HH does not seem to be associated with increased mortality.
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Review Case Reports
Streptococcus bovis infection of the central nervous system: report of two cases and review.
Streptococcus bovis is an uncommon cause of meningitis and subdural empyema. We report one case each of meningitis and subdural empyema in which S. bovis biotype II was isolated from both the spinal fluid and blood. In one case, the organisms were seen on a gram-stained preparation of cerebrospinal fluid. ⋯ The second patient presented with syncope, developed a subdural empyema, and died; at autopsy, a colonic adenoma was found. A review of the English-language literature revealed only 14 previously reported cases of meningitis due to S. bovis and no cases of subdural empyema due to S. bovis. These cases indicate the importance of complete laboratory identification of specific organisms and confirm the need for a thorough neurological examination and search for underlying gastrointestinal disease in cases of S. bovis infection.