Hawaii medical journal
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Hawaii medical journal · Apr 2011
Review Case ReportsArtesunate: investigational drug for the treatment of severe falciparum malaria in Hawai'i.
There are hundreds of millions of cases of malaria each year worldwide resulting in a million deaths. These deaths are mostly due to Plasmodium falciparum. The only Federal Drug Administration approved treatment for severe malaria is intravenous quinidine gluconate. Intravenous quinidine is increasingly unavailable in the United States. In 2007, the Center for Disease Control and Prevention implemented an investigational new drug protocol to allow the use of intravenous artesunate for cases of severe malaria in the United States. The authors present such a case treated under this protocol at Tripler Army Medical Center, Hawai'i. ⋯ Our patient met the criteria for severe Plasmodium falciparum malaria. He was immediately treated with intravenous artesunate and manifested a quick and durable response to therapy. At present, intravenous artesunate is awaiting Federal Drug Administration approval but available via a strategic network controlled by the Centers for Disease Control and Prevention. This case highlights a common delay in diagnosis, importance of optimal prophylaxis, and attention to travel history as they relate to the development of severe malaria.
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Hawaii medical journal · Jun 2009
Review Case ReportsFirst reported United States case of Legionella pneumophila serogroup 1 pneumonia in a patient receiving anti-tumor necrosis factor-alpha therapy.
Legionellosis has been reported to be an extremely rare disease in Hawai'i. The authors report a case of a 67-year-old woman with a history of rheumatoid arthritis treated with long-term adalimumab who developed severe right-sided community-acquired pneumonia and a parapneumonic effusion. Legionella pneumophila serogroup 1 was confirmed as the microbiologic cause based on a positive urine Legionella antigen as well as direct fluorescent antibody and Legionella culture of bronchoalveolar lavage. ⋯ With the increasing use of TNF-alpha antagonists, Legionella pneumophila should be recognized as a potential re-emerging pathogen. Clinicians should particularly consider the diagnosis of legionellosis in patients who are immunocompromised, including those who receive anti-TNF-alpha therapy, or who have severe pneumonia. In such cases, there should be a low threshold for including empiric Legionella antimicrobial coverage until the diagnosis can be confirmed or reasonably excluded.
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Hawaii medical journal · May 2007
Review Case ReportsCentipede bites in Hawai'i: a brief case report and review of the literature.
In this article, a local case of a centipede bite, with fairly typical symptoms and an uncomplicated course, is presented. The literature is reviewed, indicating that serious complications, while rare, are possible. The author recommends that clinicians structure assessments of centipede bites around knowledge of serious potential complications and provide counseling on prevention of future attacks.
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Hawaii medical journal · Oct 2006
ReviewOral antibiotic treatment for methicillin-resistant Staphylococcus aureus skin and soft tissue infections: review of the literature.
The emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a cause of hospital- and community-associated infection has been reported worldwide and has become an increasing health care problem. Treatment options for MRSA infection are limited, complicated and expensive. Oral antibiotics have been used in the outpatient setting for less severe MRSA infections such as skin and soft tissue infections (SSTIs), but their efficacy has not been well studied. ⋯ The antibiotics available for MRSA SSTI vary widely in chances of resistance, activity, adverse effects, and cost. More clinical studies of clinical efficacy are needed, especially with comparative trials. Selection of the most appropriate antibiotic will depend upon local antibiotic resistance, type of infection, potential adverse effects, and cost for the individual.