A Case of Disseminated Histoplasmosis From California, in the Setting of Secondary Hemophagocytic Lymphohistiocytosis: A Diagnostic Challenge.

Histoplasma capsulatum is a geographically specific dimorphic fungus that can cause a spectrum of diseases. While most cases are asymptomatic pulmonary infections, in severe cases, particularly in immunocompromised patients, disseminated disease can occur. Histoplasmosis in California is limited to only a few case reports. In this article, we describe a rare case of disseminated histoplasmosis in a non-endemic region presenting with diagnostically challenging symptomatology, including altered mental status, status epilepticus, septic shock, and bilateral adrenal masses.

Methicillin resistant Staphylococcus aureus infective endocarditis presenting as neutrophilic meningoencephalitis.

Infective endocarditis (IE) with Staphylococcus aureus is associated with intravenous drug abuse or infected cardiac devices and commonly presents with non-specific constitutional symptoms. A 53-year-old female presented to the hospital with back pain, altered mental status, fever, and tachycardia. Due to patient's lethargy and decline in respiratory effort, she was intubated and lumbar puncture was performed that revealed neutrophil-predominant leukocytosis of the cerebrospinal fluid. The patient was empirically started on ceftriaxone and vancomycin, and blood cultures were positive for methicillin resistant Staphylococcus aureus (MRSA). A chest X-ray demonstrated pulmonary congestion and an implanted pacemaker; furthermore, a transesophageal echocardiogram (TEE) revealed a vegetation on the atrial lead of the pacemaker. As the patient's condition improved after a few days, she was extubated and was able to provide a clear history. The source of her infection was a pus pocket around her pacemaker which was placed two months prior to her admission. As expected, the infection resolved with proper source control and antibiotic therapy.

Hormonal Signaling Cascade during an Early-Adult Critical Period Required for Courtship Memory Retention in Drosophila.

Formation and expression of memories are critical for context-dependent decision making. In Drosophila, a courting male rejected by a mated female subsequently courts less avidly when paired with a virgin female, a behavioral modification attributed to "courtship memory." Here we show the critical role of hormonal state for maintenance of courtship memory. Ecdysis-triggering hormone (ETH) is essential for courtship memory through regulation of juvenile hormone (JH) levels in adult males. Reduction of JH levels via silencing of ETH signaling genes impairs short-term courtship memory, a phenotype rescuable by the JH analog methoprene. JH-deficit-induced memory impairment involves rapid decay rather than failure of memory acquisition. A critical period governs memory performance during the first 3 days of adulthood. Using sex-peptide-expressing "pseudo-mated" trainers, we find that robust courtship memory elicited in the absence of aversive chemical mating cues also is dependent on ETH-JH signaling. Finally, we find that JH acts through dopaminergic neurons and conclude that an ETH-JH-dopamine signaling cascade is required during a critical period for promotion of social-context-dependent memory.