Gonococcal endocarditis with aortic root abscess and severe aortic insufficiency.

Gonorrhea caused by Neisseria gonorrhoeae is a very common sexually transmitted infection in the United States and World-wide (Kirkcaldy et al., 2019) [1]. The population with highest prevalence is young sexually active adults aged 15-24 years. In a majority of cases, the presentation is asymptomatic however can range from vaginitis to pelvic inflammatory disease in women. Symptoms in men can include urethritis, epididymitis and proctitis. Disseminated disease is characterized by arthritis and tenosynovitis. Gonococcal endocarditis is a rare but life-threatening complication of disseminated gonococcal infection (DGI) occurring in 1-2% of patients with DGI (Shetty et al., 2004) [3]. Gonococcal endocarditis has a predisposition for aortic valve involvement with formation of large vegetation and valvular ring abscess. Only a handful of cases have been reported in the literature since the advent of penicillin. This case highlights the importance of timely diagnosis and appropriate surgical evaluation to prevent mortality in young patients that may present with this rare complication.

Asymmetric type F botulism with cranial nerve demyelination.

We report a case of type F botulism in a patient with bilateral but asymmetric neurologic deficits. Cranial nerve demyelination was found during autopsy. Bilateral, asymmetric clinical signs, although rare, do not rule out botulism. Demyelination of cranial nerves might be underrecognized during autopsy of botulism patients.

Prevalence of GB virus type C in urban Americans infected with human immunodeficiency virus type 1.

GBV-C virus infection has been linked to improved clinical outcome in HIV-1 co-infected individuals. The epidemiology of GBV-C has, thus far, been limited to the gay male, HIV+ population. Here we describe the prevalence of antibodies against GBV-C envelope glycoprotein E2 and GBV-C viremia in an HIV+ inner city population. This study group is predominantly African-American; 41% of the participants are women. The major risk factor for HIV infection is intravenous drug use. Overall, 56% of the study population had evidence of current or past infection with GBV-C. GBV-C exposure was not associated with hepatitis C virus infection. The group of participants, who had GBV-C viremia and anti-E2 antibodies, had high percentage of patients with an undetectable HIV-1 viral load. These data provide increased insight into the prevalence of GBV-C co-infection in the HIV epidemic in this understudied population.