Erysipelothrix rhusiopathiae cellulitis with associated bacteraemia following seafood preparation.

Erysipelothrix rhusiopathiae is a pleomorphic Gram-positive bacillus, zoonotic pathogen of mammals, birds and fish. Human disease caused by this organism most commonly occurs following occupational or recreational exposure to infected animals and typically presents as a localised cutaneous disease. Invasive infection resulting in bacteraemia, endocarditis or other distant sequelae is infrequently seen. Most commonly, invasive infection is seen in patients with predisposing risk factors including diabetes, immunocompromising conditions, alcohol use disorder or chronic kidney disease. The organism is highly susceptible to penicillin-class drugs which serve as first-line antimicrobial therapy with prolonged courses typically prescribed for invasive disease, given the predilection of this organism to cause endocarditis. In this report, we present an interesting case of a polymicrobial finger abscess with E. rhusiopathiae bacteraemia following laceration with a fish spine in an immunocompetent patient in Southern US state. This bacteraemic episode was successfully treated with a fluoroquinolone course owing to patient's penicillin allergy.

Histoplasma tympanomastoiditis: Case report and literature review.

Histoplasma is a dimorphic fungus capable of producing a diverse array of clinical pathology in humans dependent upon the host immune status. Acute symptomatic infection typically presents as an isolated pulmonary or nodal disease in immunocompetent patients with extra-thoracic manifestations rarely seen in this population. In this report, we describe a novel case of Histoplasma capsulatum tympanomastoiditis in an immunocompetent patient who presented with progressively worsening purulent otorrhea, vertigo, and facial nerve palsy. He was successfully managed with surgical debridement and a prolonged antifungal course.

Understanding flow patterns from the field - Controlled laboratory experiments on the transport behavior of veterinary antibiotics in the presence of liquid manure.

The main entry path of veterinary antibiotics to the environment is the application of liquid manure on agricultural land. Along with the manure, they can infiltrate into soils and leach into groundwater. As the environmental behavior of veterinary antibiotics is strongly affected by the process of sorption, the comprehensive knowledge regarding their sorption behavior is key to a reliable risk assessment. However, the flow patterns in field experiments are influenced by several factors that can hardly be distinguished, while most of the sorption studies on veterinary antibiotics were designed without manure or as batch experiments, which means that the effects of manure on the transport behavior of the antibiotic substances remained unaccounted for. In order to understand the results from a previous field experiment and concurrently fill the identified knowledge gap, a column experiment was performed to investigate the effects of manure on the transport of sulfamethazine, sulfadiazine, tetracycline, and lincomycin in soil. Results show that sulfamethazine and sulfadiazine were highly mobile in both the presence and absence of manure, while tetracycline did not appear at the outlet of any column. Despite their high mobility, in the presence of manure the sulfonamides were slightly delayed compared to the conservative tracer as was also seen during the previous field experiment. Lincomycin transport was already delayed in the absence of manure. Furthermore, in the presence of manure, lincomycin was delayed by 4.5 times relative to the tracer, which clearly underlined the influence of manure on the transport of lincomycin and offers an explanation why lincomycin has barely been detected in the long-term field experiment. However, in contrast to the results obtained in the field experiment, the recovery rates were the same in presence and absence of manure for both sulfonamides and lincomycin, probably due to reduced degradation at the applied concentration level.

Escherichia coli prosthetic valve endocarditis from a non-genitourinary source.

Escherichia coli (E. coli) is a rare cause of infective endocarditis due to its lack of traditional virulence factors that promote endocardial adherence. Previous case reports of E. coli infective endocarditis demonstrate specific risk factors to include advanced age over 70, female sex, diabetes, immunosuppression, and intravascular or cardiac devices. Antecedent genitourinary infection is the most common source. We present a case of a 55-year-old Honduran man with a recent bioprosthetic mitral valve replacement and tricuspid valve repair who presented with one month of subjective fevers, night sweats, anorexia, and significant weight loss. After extensive work-up, the patient was diagnosed with E. coli infective endocarditis secondary to E. coli growth in blood cultures and a transesophageal echocardiogram (TEE) revealing a vegetation on his prosthetic mitral valve. An indolent gastrointestinal source was suspected to be the source of infection with imaging only notable for mild periappendiceal stranding concerning for a possible site of antecedent inflammation. He was treated with a 6-week course of ceftriaxone and gentamicin inpatient and then discharged on trimethoprim-sulfamethoxazole suppressive therapy with serial echocardiographic follow-up given the persistent small vegetation on repeat echocardiogram. Our case report and review of ten recent cases of prosthetic valve endocarditis described in the literature illustrates several common features of the epidemiology, presentation, and management of E. coli prosthetic valve endocarditis including more commonly reported non-genitourinary sources of bacteremia, a trend towards more frequent surgical interventions, and a declining mortality rate.

Occurrence, effects and behaviour of the antibiotic lincomycin in the agricultural and aquatic environment - A review.

Lincomycin, an antibiotic commonly used in veterinary medicine, is frequently detected within the agricultural environment. The active compound enters the aquatic environment after manure application via infiltration or surface run-off, where it may negatively affect non-target organisms and contribute to the development and spread of resistant genes. However, a review on the fate of lincomycin within the agricultural and aquatic environment is lacking. Hence, to provide an overview, the main part of this paper summarizes the current literature on the occurrence, effects and behaviour of lincomycin in all relevant environmental compartments, including manure, soil, surface water and groundwater. Lincomycin was regularly detected in all environmental compartments and even in the food chain, appeared to sorb temporarily and mainly in its cationic microspecies, and dissipated after time periods that could cover days, months, or years, depending on the compartment and conditions. As noticed during the literature research conducted, information on the attenuation of lincomycin in terms of biological degradation in the aquatic environment is widely lacking, although it seems that biodegradation is the major removal mechanism. Therefore, a laboratory study, implemented by means of batch experiments, was carried out in order to evaluate the biological degradation of lincomycin in the aquatic environment. First order degradation started after a start-up phase of 10-14 days with a degradation rate constant of 0.55 d-1 and a half-life time of 30 h. Further, the degradation rate constant was found to be independent of initial concentrations as long as concentrations did not exceed a concentration level at which the bacteria were inhibited, as it was the case in this study at a concentration of 10 mg L-1. Biodegradation was confirmed as an important degradation pathway for LIN in the aquatic environment.

Mobility of contaminants of emerging concern in soil column experiments.

In this study, laboratory column experiments under water saturated conditions were conducted for over 35 days to investigate the transport of nine pharmaceuticals (nadolol, sulfamethizole, sulfamethoxazole, sulfamethoxypyridazine, carbamazepine, ibuprofen, diclofenac, hydrochlorothiazide, and gemfibrozil) and four artificial sweeteners (acesulfame, saccharin, cyclamate, and sucralose) in two soils (S and C) with similar organic carbon content (between 0.8 and 1.1%) and pH (7.90 and 7.25) but different texture (58.3 and 85.5% of silt+clay, respectively). Ibuprofen and artificial sweeteners reached maximum concentrations at the outlet of the columns and showed a homogenous vertical profile in the aqueous phase, with the same concentration in all sampling ports under flow percolation conditions. Regarding carbamazepine and hydrochlorothiazide, apparent retardation was observed for both and was attributed to sorption. Nadolol, a positively charged beta-blocker, did not show any apparent breakthrough. After 35 days, the columns were washed using tap water for over one week. Soils were then analyzed at different depths and vertical concentration profiles were plotted. Overall, highest concentrations were measured in the top most layers for contaminants in the soil column with higher clay content (C), whereas vertical profiles were more uniform in that with lower clay content (S).

Tracing veterinary antibiotics in the subsurface - A long-term field experiment with spiked manure.

The purpose of this long-term experiment was on gaining more insights into the environmental behaviour of veterinary antibiotics in the subsurface after application with manure. Therefore, manure spiked with a bromide tracer and eight antibiotics (enrofloxacin, lincomycin, sulfadiazine, sulfamethazine, tetracycline, tiamulin, tilmicosin and tylosin) in concentrations of milligrams per litre were applied at an experimental field site. Their pathway was tracked by continuous extraction of soil pore water at different depths and systematic sampling of groundwater for a period of two years. Seven target compounds were detected in soil pore water of which four leached into groundwater. Concentrations of the detected target compounds were, with few exceptions, in the range of nanograms per litre. It was concluded that a large fraction of the investigated antibiotics sorbed or degraded already within the first meter of the soil. Further, it was inferred from the data that long and warm dry periods cause attenuation of the target compounds through increased degradation or sorption occurring in the soil. In addition, the comprehensive data-set allowed to estimate a retardation factor between 1.1 and 2.0 for sulfamethazine in a Plaggic Anthrosol soil, and to classify the individual compounds by environmental relevance based on transport behaviour and persistence. According to the distribution of resistant genes in the environment, sulfamethazine was found to be the most mobile and persistent substance.

A model-based analysis of the reactive transport behaviour of 37 trace organic compounds during field-scale bank filtration.

Though bank filtration diminishes the loads of many trace organic compounds (TOrCs) present in the source water, still there is a wide uncertainty on the influence of local environmental conditions on biodegradation processes. This research addresses the fate and transport behaviour of 37 trace organic compounds at a bank filtration site in Germany over a relatively long-time span of six years. Using two-dimensional heat and reactive transport modelling in FEFLOW, TOrCs are classified according to their occurrence in bank filtration wells with a residence time of up to 4 months. We identify 12 persistent compounds, 20 reactive compounds and 5 transformation products formed during aquifer passage. Estimates of first-order biodegradation rate constants are given for six reactive compounds. Minimum biodegradation rate constants (i.e. maximum half-lives) are approximated for eight compounds only present in the surface water. For some compounds, a simple first-order degradation model did not yield satisfactory results and the behaviour appears to be more complex. Processes like sorption, redox- and/or temperature-dependent biodegradation and temperature-dependent desorption are suspected but incorporating these into the model was beyond the scope of this paper that provides an overview for many compounds. Results highlight the ability of the sub-surface to improve the water quality during bank filtration, yet at the same time show the persistence of several compounds in the aquifer.

The uncertainty of biodegradation rate constants of emerging organic compounds in soil and groundwater - A compilation of literature values for 82 substances.

The present study reports on biodegradation rate constants of emerging organic compounds (EOCs) in soil and groundwater available in the literature. The major aim of this compilation was to provide an assessment of the uncertainty of hydrological models with respect to the fate of EOCs. The literature search identified a total number of 82 EOCs for which 1st-order rate constants could be derived. It was found that for the majority of compounds degradation rate constants vary over more than three orders of magnitude. Correlation to factors that are well known to affect the degradation rate, such as temperature or redox condition was weak. No correlation at all was found with results from available quantitative structure-activity relationship models. This suggests that many unknown site specific or experimentally specific factors influence the degradation behavior of EOCs in the environment. Thus, local and catchment scale predictive models to estimate EOC concentration at receptors, e.g., receiving waters or drinking water wells, need to consider the large uncertainty in 1st-order rate constants. As a consequence, applying rate constants that were derived from one experiment or field site investigation to other experiments or field sites should be done with extreme caution.

Approach to skin and soft tissue infections in non-HIV immunocompromised hosts.

PURPOSE OF REVIEW: Skin and soft tissue infections are frequent contributors to morbidity and mortality in the immunocompromised host. This article reviews the changing epidemiology and clinical manifestations of the most common cutaneous pathogens in non-HIV immunocompromised hosts, including patients with solid organ transplants, stem cell transplants, solid tumors, hematologic malignancies, and receiving chronic immunosuppressive therapy for inflammatory disorders. RECENT FINDINGS: Defects in the innate or adaptive immune response can predispose the immunocompromised host to certain cutaneous infections in a predictive fashion. Cutaneous lesions in patients with neutrophil defects are commonly due to bacteria, Candida, or invasive molds. Skin lesions in patients with cellular or humoral immunodeficiencies can be due to encapsulated bacteria, Nocardia, mycobacteria, endemic fungal infections, herpesviruses, or parasites. Skin lesions may reflect primary inoculation or, more commonly, disseminated infection. Tissue samples for microscopy, culture, and histopathology are critical to making an accurate diagnosis given the nonspecific and heterogeneous appearance of these skin lesions due to a blunted immune response. SUMMARY: As the population of non-HIV immunosuppressed hosts expands with advances in medical therapies, the frequency and variety of cutaneous diseases in these hosts will increase.

Redox and Temperature Dependent Attenuation of Twenty Organic Micropollutants - A Systematic Column Study.

Owing to advanced analytical procedures an increasing number of organic micropollutants have been identified within the aquatic environment. Results from field investigations evidenced the attenuation of various organic micropollutants to be impacted by the predominant hydrochemical conditions. In the course of this study, column experiments were performed to examine the influence of redox conditions and temperature on the attenuation of 20 wastewater derived organic micropollutants. For this purpose, the degradation behavior of these compounds were investigated under oxic, nitrate reducing, iron/manganese reducing and sulfidic conditions at 21 °C in sandy aquifer sediments. Redox dependent degradation was observed for the pharmaceutically active compounds atenolol, metoprolol, sotalol, iopromide, phenazone, propyphenazone, acesulfame and trimethoprim as well as for two phenazone type metabolites. In order to identify temperature dependencies, oxic columns were in addition operated at 6 °C, indicating the removal of several compounds to be influenced by the prevalent temperature.

Occurrence of Antibiotics in Surface and Groundwater of a Drinking Water Catchment Area in Germany.

The contamination of the aquatic environment with organic micropollutants, such as veterinary pharmaceuticals, has become an increasingly serious problem and has aroused attention in the course of the last decades. This study presents a screening for a series of veterinary antibiotics, potentially introduced by the application of liquid manure, in ground- and surface water of a drinking water catchment in Lower Saxony, Germany. Of the 26 compounds analyzed, eight, including sulfadiazine, sulfapyridine, sulfamethoxazole, trimethoprim, dehydrato-erythromycin, sulfadimidine, tylosin, and tetracycline were detected in surface water samples. Trimethoprim was detected in 11 out of 15 shallow groundwater samples, indicating its high environmental relevance. Column sorption experiments conducted on trimethoprim show a comparatively moderate sorption affinity to sandy aquifer material with a retardation coefficient of 5.7.

Central Nervous System Infections.

This chapter provides an overview of infectious syndromes, pathogens, and diagnostic testing modalities for central nervous system infections in the immunocompromised host.

Temperature dependent redox zonation and attenuation of wastewater-derived organic micropollutants in the hyporheic zone.

The hyporheic zone - a spatially fluctuating ecotone connecting surface water and groundwater - is considered to be highly reactive with regard to the attenuation of organic micropollutants. In the course of the presented study an undisturbed sediment core was taken from the infiltration zone of a bank filtration site in Berlin and operated under controlled laboratory conditions with wastewater-influenced surface water at two different temperatures, simulating winter and summer conditions. The aim was to evaluate the fate of site-relevant micropollutants, namely metoprolol, iopromide, diclofenac, carbamazepine, acesulfame, tolyltriazole, benzotriazole, phenazone and two phenazone type metabolites, within the first meter of infiltration dependent on the prevailing temperature. A change in temperature resulted in a development of significantly distinct redox conditions. Both temperature dependencies and related redox dependencies were identified for all micropollutants except for benzotriazole and carbamazepine, which behaved persistent under all conditions. For the remaining compounds degradation rate constants generally decreased from warm and oxic/penoxic/suboxic over cold and oxic/penoxic to warm and manganese reducing (transition zone). Individual degradation rate constants ranged from 0 (e.g. diclofenac, acesulfame and tolyltriazole in the transition zone) to 1.4×10(-4)s(-1) for metoprolol under warm conditions within the oxic to suboxic zone.

Sorption behavior of 20 wastewater originated micropollutants in groundwater--column experiments with pharmaceutical residues and industrial agents.

Since sorption is an essential process with regard to attenuation of organic pollutants during subsurface flow, information on the sorption properties of each pollutant are essential for assessing their environmental fate and transport behavior. In the present study, the sorption behavior of 20 wastewater originated organic micropollutants was assessed by means of sediment column experiments, since experimentally determined data for these compounds are not or sparsely represented in the literature. Compounds investigated include various psychoactive drugs, phenazone-type pharmaceuticals and ß-blockers, as well as phenacetine, N-methylphenacetine, tolyltriazole and para-toluenesulfonamide. While for most of the compounds no or only a low sorption affinity was observed, an elevated tendency to sorb onto aquifer sand was obtained for the ß-blockers atenolol, propranolol and metoprolol. A comparison between experimental data and data estimated based on the octanol/water partition coefficient following the QSAR approach demonstrated the limitations of the latter to predict the adsorption behavior in natural systems for the studied compounds.

Oral antimycobacterial therapy in chronic cutaneous sarcoidosis: a randomized, single-masked, placebo-controlled study.

IMPORTANCE: Sarcoidosis is a chronic granulomatous disease for which there are limited therapeutic options. This is the first randomized, placebo-controlled study to demonstrate that antimycobacterial therapy reduces lesion diameter and disease severity among patients with chronic cutaneous sarcoidosis. OBJECTIVE: To evaluate the safety and efficacy of once-daily antimycobacterial therapy on the resolution of chronic cutaneous sarcoidosis lesions. DESIGN AND PARTICIPANTS: A randomized, placebo-controlled, single-masked trial on 30 patients with symptomatic chronic cutaneous sarcoidosis lesions deemed to require therapeutic intervention. SETTING: A tertiary referral dermatology center in Nashville, Tennessee. INTERVENTIONS: Participants were randomized to receive either the oral concomitant levofloxacin, ethambutol, azithromycin, and rifampin (CLEAR) regimen or a comparative placebo regimen for 8 weeks with a 180-day follow-up. MAIN OUTCOMES AND MEASURES: Participants were monitored for absolute change in lesion diameter and decrease in granuloma burden, if present, on completion of therapy. OBSERVATIONS: In the intention-to-treat analysis, the CLEAR-treated group had a mean (SD) decrease in lesion diameter of -8.4 (14.0) mm compared with an increase of 0.07 (3.2) mm in the placebo-treated group (P = .05). The CLEAR group had a significant reduction in granuloma burden and experienced a mean (SD) decline of -2.9 (2.5) mm in lesion severity compared with a decline of -0.6 (2.1) mm in the placebo group (P = .02). CONCLUSIONS AND RELEVANCE: Antimycobacterial therapy may result in significant reductions in chronic cutaneous sarcoidosis lesion diameter compared with placebo. These observed reductions, associated with a clinically significant improvement in symptoms, were present at the 180-day follow-up period. Transcriptome analysis of sarcoidosis CD4+ T cells revealed reversal of pathways associated with disease severity and enhanced T-cell function following T-cell receptor stimulation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01074554.

The effect of aeration on the removal of wastewater-derived pharmaceutical residues from groundwater - a laboratory study.

Several studies on waste- or drinking water treatment processes as well as on groundwater have recently shown that some pharmaceutical residues (PRs) are redox-sensitive. Hence, their (bio)degradation depends on the redox conditions prevalent in the aquifer. Groundwater, providing raw water for drinking water production, is often anoxic and aeration is a widespread treatment method applied mainly to eliminate unwanted iron and manganese from the water. As a side-effect, aeration may trigger the elimination of PRs. Within the present study the influence of aeration on the fate of a number of wastewater derived analgesics and their residues as well as several antimicrobial compounds was investigated. For this purpose, anoxic groundwater was transferred into stainless steel tanks, some of which were aerated while others were continuously kept anoxic. Results prove that the degradation of six phenazone type compounds is dependent on oxygen availability and compounds are efficiently removed under oxic conditions only. Concerning the antimicrobials, doxycycline and trimethoprim were better removed during aeration, whereas a slightly improved removal under anoxic conditions was observed for clindamycin, roxithromycin and clarithromycin. The study provides first laboratory proof of the redox-sensitivity of several organic trace pollutants. In addition, results demonstrate that aeration is an effective treatment for the elimination of a number of wastewater derived PRs.

Marriage amendment ballots of 2004: could state residents read them?

Close to 43% of adults have difficulties reading and understanding printed materials. Given the fact that so many American adults have difficulty reading basic text, we were interested in looking at the readability levels of the marriage amendment ballots of the 2004 election. Results indicated, with the exception of two states, a mismatch between the educational levels and the readability levels of the proposed amendments. Legal recognition of same-sex civil marriages can be considered a mental health public policy issue and therefore public health professionals should advocate for easier to read and understand ballots.