Outbreak of Locally Acquired Mosquito-Transmitted (Autochthonous) Malaria - Florida and Texas, May-July 2023.

Eight cases of locally acquired, mosquito-transmitted (i.e., autochthonous) Plasmodium vivax malaria, which has not been reported in the United States since 2003, were reported to CDC from state health departments in Florida and Texas during May 18-July 17, 2023. As of August 4, 2023, case surveillance, mosquito surveillance and control activities, and public outreach and education activities continue in both states. U.S. clinicians need to consider a malaria diagnosis in patients with unexplained fever, especially in areas where autochthonous malaria has been recently reported, although the risk for autochthonous malaria in the United States remains very low. Prompt diagnosis and treatment of malaria can prevent severe disease or death and limit ongoing transmission to local Anopheles mosquitoes and other persons. Preventing mosquito bites and controlling mosquitoes at home can prevent mosquitoborne diseases, including malaria. Before traveling internationally to areas with endemic malaria, travelers should consult with a health care provider regarding recommended malaria prevention measures, including potentially taking malaria prophylaxis. Malaria is a nationally notifiable disease; continued reporting of malaria cases to jurisdictional health departments and CDC will also help ensure robust surveillance to detect and prevent autochthonous malaria in the United States.

Needling Policy Makers and Sharpening the Debate: Do Syringe Exchange Programs Improve Health at the Population Level?

CONTEXT: In the midst of the current opioid epidemic, states have selected differing legislative routes implementing pathways to ensure access to clean needles and syringes. OBJECTIVE: To determine whether states that implemented laws supporting syringe exchange programs (SEPs) had reductions in transmission rates of hepatitis B, hepatitis C, and HIV infection compared with states without such laws. DESIGN AND SETTING: Utilizing a longitudinal panel design, we determined the legal status of SEPs in each state for years 1983-2016. Disease transmission rates for this period were estimated via a simple Poisson regression, with transmitted cases as the dependent variable, law categories as the predictor variables, and the log of state population as the exposure. The mean number of incident cases per state-year was also calculated. PARTICIPANTS: US states were utilized as the unit of analysis. RESULTS: Hepatitis B and hepatitis C mean transmission rate per 100 000 population declined in states with local ordinances/decriminalized statutes and legalized SEPs (hepatitis B: 71% and 81%, respectively, differences P < .001; hepatitis C: 8% and 38%, respectively, differences P < .001). Reductions in mean incident cases per state-year mirrored these findings. HIV infection among injection drug users yielded inconsistent results. CONCLUSIONS: Hepatitis B and hepatitis C transmission were reduced at the population level in states with SEP laws in a pattern reflecting the degree of legal intervention. HIV infection, based upon a smaller data set, showed a mixed impact. POLICY IMPLICATIONS: The results show promise that SEPs have population-level effects on disease transmission. States lacking SEPs should reconsider current policies.

Recurrent Erythema Multiforme Major Following COVID-19 Infection.

Erythema multiforme (EM) is a rare and potentially serious skin condition that can present as a myriad of mucocutaneous lesions. EM can be commonly confused with other cutaneous etiologies, leading to misdiagnosis and delay in proper treatment. This paper describes a case of recurrent erythema multiforme following COVID-19 infection in a 34-year-old male with no prior medical history. The patient had an extensive rash of the oral and genital mucosal areas, diffuse cutaneous involvement, and an extended length of recovery. This unexpected association of EM and COVID-19 provides additional insight into the limited research available regarding the correlation between these two pathologies.

Leishmania (Viannia) guyanensis Causing Localized Cutaneous Leishmaniasis in a Traveler.

We report on a 66-year-old male who presented for evaluation of rapidly expanding lesions on his lower extremities. He first noticed these lesions following a trip to Costa Rica, in which he was bitten by several unidentified bugs. He was initially treated empirically with antibiotics in the outpatient setting with no improvement of his symptoms. His lesions continued to expand and spread locally which prompted further workup with a biopsy of one of his lesions. He was ultimately found to have Leishmaniasis (Viannis) guyanensis confirmed by microscopy and polymerase chain reaction. He was treated with aggressive wound care and amphotericin B due to the risk of progressing to involve his mucosa.

Not Your Usual Case of Culture-Negative Endocarditis: A Case Report of Bartonella Endocarditis.

Advancements in transcatheter interventions have revolutionized the treatment of adult congenital heart disease. We present a case of a 32-year-old male with a history of tetralogy of Fallot with pulmonary atresia diagnosed with Bartonella spp. culture-negative infective endocarditis (IE) of his Melody valve, necessitating Melody valve replacement.

A Case of a Thoracic Arteriovenous Fistula Between an Intercostal Artery and a Pulmonary Vein.

Arteriovenous (AV) fistulas are irregular connections between arteries and veins, and thoracic AV fistulas are rarely identified in clinical practice. We report a case of a 56-year-old female with a history of esophageal adenocarcinoma treated with radiation and resection who presented to the hospital due to hemoptysis. She underwent bronchoscopy revealing a tracheobronchial fistula, and esophagogastroduodenoscopy revealing active arterial bleed. Subsequent angiography uncovered an AV fistula between her right T8 intercostal artery and pulmonary vein with a pseudoaneurysm. She underwent coiling of her T8 and T9 intercostal arteries with resolution of her symptoms.

Acinetobacter radioresistens and Enterococcus casseliflavus co-infection with endocarditis, bacteremia, and pneumonia.

Acinetobacter species are Gram-negative coccobacilli found to cause a multitude of infections. However, they are a rare cause of bacteremia with Acinetobacter radioresistens accounting for less than 10 % of Acinetobacter infections. In this report, we describe a patient presenting with acute encephalopathy, fever, and hypoxia who was initially found to have bilateral perihilar and lower lobar peribronchial thickening on chest x-ray. Two sets of blood cultures obtained on admission were positive for Acinetobacter radioresistens and Enterococcus casseliflavus and one set of blood cultures returned positive for Leclercia adecarboxylata although believed to be a skin contaminant. Susceptibilities confirmed all bacteria were pan-sensitive. The patient was also found to have an aortic valve vegetation which was not amenable to surgical intervention. He was treated with 42 days of daptomycin and cefepime. At present, co-infection with Acinetobacter radioresistens and Enterococcus casseliflavus with manifestations of polymicrobial endocarditis has never been reported. Though this co-infection was pan-sensitive, there is an increasing rate of resistance to commonly used, broad-spectrum antibiotics such as ß-lactams, which will continue to pose a challenge between balancing treatment and antibiotic stewardship.