Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Histoplasmosis has become an important mycosis in regions of endemicity in North and Central America. Traditionally, treatment has been reserved for patients with disseminated or chronic pulmonary histoplasmosis. The availability of safe and effective oral regimens, however, has offered alternatives to amphotericin B. ⋯ The determination of fluconazole's role in therapy for histoplasmosis awaits completion of ongoing trials. Continued research is needed to develop better-tolerated fungicidal alternatives to amphotericin B and oral agents with better absorption and drug interaction profiles than those of itraconazole and ketoconazole. Preventive strategies should be explored to reduce the frequency of histoplasmosis among individuals from regions of endemicity who are at high risk for more severe manifestations of histoplasmosis.
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Case Reports
Group B streptococcal endocarditis involving the tricuspid valve in a 7-month-old infant.
To our knowledge, we report the first case of group B streptococcal endocarditis that occurred in an infant after the neonatal period. A large, friable vegetation had destroyed the tricuspid valve and resulted in pulmonary emboli. ⋯ A review of the English-language literature on older patients with group B streptococcal endocarditis revealed a mortality rate of 60% among patients treated with antimicrobial drugs alone and a mortality rate of 29% among those whose treatment included both surgery and therapy with antimicrobial drugs. Surgical debridement of the valve may be necessary for children with large vegetations, which tend to embolize and thus contribute to the morbidity and mortality associated with group B streptococcal endocarditis.
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Letter Case Reports
Staphylococcus aureus meningitis after short-term epidural analgesia.
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Multicenter Study
Epidemiology and cost of infection with human parainfluenza virus types 1 and 2 in young children.
To determine the morbidity, costs, and epidemiological features of lower respiratory tract infections (LRIs) due to human parainfluenza virus types 1 and 2 (HPIV-1 and HPIV-2), we evaluated 1,213 children < 6 years of age who were seen for LRIs in the emergency room of the Children's Hospital of Wisconsin and/or were admitted to the hospital for LRIs during the fall quarter of 1991. The age, sex, race, and respiratory syndrome were recorded for each child; 158 patients (13%) had respiratory samples cultured for viruses and were followed clinically for the duration of their illness. Caucasian children had croup diagnosed more often than did African-American children (relative risk [RR] = 3.12; 95% confidence interval [CI], 2.43-4.00; P < .001), while African-American children more often had pneumonia (RR = 1.85; 95% CI, 1.36-2.5; P < .001). ⋯ Together these two viruses were recovered from 49% of children presenting with croup, 10% of those presenting with bronchiolitis, and 12% of those presenting with pneumonia. Gender- and race-associated differences were documented in the group of children infected with HPIV-2: specifically, this group included more girls than boys (RR = 1.99; 95% CI, 1.02-3.88; P < .04) and more Caucasian than African-American children (RR = 2.64; 95% CI, 1.05-6.63; P = .027). These data extrapolate nationally to approximately 250,000 emergency-room visits and approximately 70,000 hospitalizations due to HPIV-1 and HPIV-2, with a cost of $50 million for the former and $140 million for the latter.