Multiorgan dysfunction caused by travel-associated African trypanosomiasis.

We describe a case of multiorgan dysfunction secondary to Trypanosoma brucei rhodesiense infection acquired on safari in Zambia. This case was one of several recently reported to ProMED-mail in persons who had traveled to this region. Trypanosomiasis remains rare in travelers but should be considered in febrile patients who have returned from trypanosomiasis-endemic areas of Africa.

Recognition of risk for clinically significant drug interactions among HIV-infected patients receiving antiretroviral therapy.

We assessed the risk of clinically significant drug interactions in patients receiving antiretrovirals, and their recognition by physicians. Clinically significant drug interactions were recorded in 27% of 159 patients, with 15% of interactions potentially lowering antiretroviral concentrations. Risk of clinically significant drug interactions was significantly related to receipt of protease inhibitors. Only 36% of clinically significant drug interactions were correctly identified by physicians.

Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran--a prospective multicenter point prevalence study.

OBJECTIVE: We aimed to compare the features of intensive care units (ICUs), their antimicrobial resistance patterns, infection control policies, and distribution of infectious diseases from central Europe to Mid-West Asia. METHODS: A cross-sectional point prevalence study was performed in 88 ICUs from 12 countries. Characteristics of ICUs, patient and antibiotic therapy data were collected with a standard form by infectious diseases specialists. RESULTS: Out of 749, 305 patients at least with one infectious disease were assessed and 254 patients were reported to have coexistent medical problems. When primary infectious diseases diagnoses of the patients were evaluated, 69 had community-acquired, 61 had healthcare-associated, and 176 had hospital-acquired infections. Pneumonia was the most frequent ICU infection seen in half of the patients. Distribution of frequent pathogens was as follows: Enteric Gram-negatives (n = 62, 28.8%), Acinetobacter spp. (n = 47, 21.9%), Pseudomonas aeruginosa (n = 29, 13.5%). Multidrug resistance profiles of the infecting microorganisms seem to have a uniform pattern throughout Southern Europe and Turkey. On the other hand, active and device-associated infection surveillance was performed in Turkey more than Iran and Southeastern Europe (p < 0.05). However, designing antibiotic treatment according to culture results was highest in Southeastern Europe (p < 0.05). The most frequently used antibiotics were carbapenems (n = 92, 30.2%), followed by anti-gram positive agents (vancomycin, teicoplanin, linezolid, daptomycin, and tigecycline; n = 79, 25.9%), beta-lactam/beta lactamase inhibitors (n = 78, 25.6%), and extended-spectrum cephalosporins (n = 73, 23.9%). CONCLUSION: ICU features appears to have similar characteristics from the infectious diseases perspective, although variability seems to exist in this large geographical area.

A multinational outbreak of histoplasmosis following a biology field trip in the Ugandan rainforest.

BACKGROUND: Outbreaks of histoplasmosis have been increasingly reported in association with travel to endemic areas. Multiple outbreaks have been reported following travel to the Americas, but reports of pulmonary histoplasmosis in short-term immunocompetent travelers to Africa are rare. METHODS: A biology student was referred to our unit with suspected pulmonary histoplasmosis following her return from a field trip in the Ugandan rainforest. The patient informed us that several of her multinational student colleagues on the same expedition had developed a similar illness. Using an alert in ProMED-mail and a questionnaire forwarded to each of the symptomatic students, we accumulated data on the other cases involved in this apparent outbreak of pulmonary histoplasmosis. RESULTS: Thirteen of 24 students developed respiratory symptoms following the expedition. Chest X-ray appearances were often suggestive of miliary tuberculosis but in most cases a final diagnosis of histoplasmosis was made (confirmed with serology in five cases, clinically diagnosed in six, and retrospectively suspected in two). Detailed questioning indicated that the likely source was a large hollow bat-infested tree within the rainforest. CONCLUSIONS: This is an unusual outbreak of histoplasmosis following short-term travel to Africa. Pulmonary histoplasmosis should always be considered in the differential diagnosis of an acute febrile respiratory illness in travelers returning from endemic areas or reporting activities suggesting exposure.

Infectious spondylodiscitis.

OBJECTIVES: To review the available literature on infectious spondylodiscitis and provide recommendations on management, particularly identification of the causative agent and antimicrobial therapy. METHODS AND RESULTS: The medical literature was searched using PubMed, employing the key words discitis, disc space infection, infectious spondylodiscitis, pyogenic discitis, septic discitis and post-operative discitis. Infectious spondylodiscitis is rising in incidence and diagnosis has been facilitated by the availability of sensitive imaging techniques such as MRI. No randomized controlled studies of antimicrobial therapy were identified in this literature search and there appear to be no UK consensus guidelines on investigation and management. Comprehensive French guidelines have been published and were scrutinized for this review. CONCLUSIONS: Unless the patient is severely unwell antimicrobial therapy should be delayed until a microbiological diagnosis is established. If initial blood cultures are negative then a CT-guided biopsy should be conducted. Tentative recommendations for antimicrobial therapy can be made based on theoretical considerations and limited data from uncontrolled studies.