Meningitis and splenic infarction due to disseminated Mycobacterium genavense infection in an HIV patient. Case report and review of the literature.

We report a case of disseminated infection with Mycobacterium genavense in a 58 year old HIV positive woman presenting with fever, diarrhea, abdominal pain and weight loss. She had a striking hepatosplenomegaly, abdominal lymphadenopathy, anaemia and thrombopenia. Direct smears and cultures of blood, stool, sputum, urine and bone marrow were negative for common and opportunistic microorganisms. Splenectomy revealed numerous acid fast bacill. Lumbar puncture also showed acid fast bacilli at direct examination. Specific PCR and 16s rRNA gene sequencing identified M. genavense. The outcome was fatal despite antimycobacterial therapy. M. genavense must be included in the differential diagnosis of fever, weight loss, lymphadenopathy and splenomegaly in immunocompromised patients. Prompt diagnosis is based on molecular biology methods. Empirical therapy, using at least three antimycobacterial agents, including clarithromycin should be introduced in case of high clinical suspicion.

Chronic intestinal pseudo-obstruction caused by an intestinal inflammatory myopathy: case report and review of the literature.

Chronic intestinal pseudo-obstruction (CIP) is an uncommon disorder that may be of primary or secondary origin. We report a case of a 37-year-old woman with CIP due to inflammatory disorder of unknown origin involving the skin (eosinophilic fasciitis), the lungs (decreased diffusion capacity) and the gastrointestinal tract. History, clinical examination, plain abdominal film, barium X-ray and colonoscopy established a diagnosis of recurrent pseudo-obstruction. A full-thickness biopsy was performed during explorative laparotomy, and histological examination revealed findings compatible with an inflammatory myopathy due to a dense lymphoid infiltrate and extensive loss of the muscularis propria layers. Immunosuppressive therapy with cyclosporin was initiated, with significant clinical improvement. This case illustrates another form of CIP, characterized by an inflammatory myopathy, which is histologically distinct from other known visceral myopathies and neuropathies.

Medicaid nursing facility reimbursement methods: 1979-1997.

This article describes state Medicaid nursing facility reimbursement methods and rates in 1979-1997, using data derived from telephone surveys of state Medicaid reimbursement. The 1980s saw shifts toward prospective methodology. The late 1980s and early 1990s were characterized by adoption of casemix methods. The early 1990s also saw fewer changes in methodology with a hiatus in the mid-1990s followed recently by renewed changes to methodology. Medicaid per diem rates have increased faster than inflation but less rapidly than general health costs. The repeal of the Boren Amendment may now allow states to institute greater cost controls or moratoria on rate increases. Despite states' tendencies to follow one another's examples, Medicaid reimbursement remains diverse nationally, with wide differences in policies and rates.

Pharmacokinetic profile of ABELCET (amphotericin B lipid complex injection): combined experience from phase I and phase II studies.

Amphotericin B (AmB) has been the most effective systemic antifungal agent, but its use is limited by the dose-limiting toxicity of the conventional micellar dispersion formulation (Fungizone). New formulations with better and improved safety profiles are being developed and include ABELCET (formerly ABLC), but their dispositions have not been well characterized; hence, the reason for their improved profiles remains unclear. This report details the pharmacokinetics of ABELCET examined in various pharmacokinetic and efficacy studies by using whole-blood measurements of AmB concentration performed by high-pressure liquid chromatography. The data indicated that the disposition of AmB after administration of ABELCET is different from that after administration of Fungizone, with a faster clearance and a larger volume of distribution. It exhibits complex and nonlinear pharmacokinetics with wide interindividual variability, extensive distribution, and low clearance. The pharmacokinetics were unusual. Clearance and volume of distribution were increased with dose, peak and trough concentrations after multiple dosings increased less than proportionately with dose, steady state appeared to have been attained in 2 to 3 days, despite an estimated half-life of up to 5 days, and there was no evidence of significant accumulation in the blood. The data are internally consistent, even though they were gathered under different conditions and circumstances. The pharmacokinetics of ABELCET suggest that lower concentrations in blood due to higher clearance and greater distribution may be responsible for its improved toxicity profile compared to those of conventional formulations.

Cholestasis in patients with the acquired immune deficiency syndrome: comparison between ultrasonographic and cholangiographic findings.

Cholestasis in patients with acquired immune deficiency syndrome was systematically investigated by ultrasonography and endoscopic retrograde cholangiopancreatography. The two procedures were found to be complementary, and showed similar results in 56.2% of the cases. Ultrasonography was superior in detecting common bile duct wall thickening, whereas endoscopic retrograde cholangiography was superior in demonstrating intrahepatic narrowing of the biliary tract.

Perirenal urinoma secondary to prostatic obstruction.

We report a case of perirenal urinoma secondary to benign prostatic hypertrophy. This rare complication of bladder outlet obstruction was due to subsequent hydronephrosis and increased pressure in the renal cavities, leading to rupture of caliceal fornix and allowing perirenal extravasation of urine. Complete resolution of the urinoma was obtained with bladder decompression and conservative management.

Antimicrobial susceptibilities of rough, smooth, and mucoid colony types of Pseudomonas isolated from cystic fibrosis patients.

Minimal inhibitory concentrations of carbenicillin, chloramphenicol, tetracycline, gentamicin, tobramycin, and trimethoprim-sulfamethoxazole were determined for rough, smooth, and mucoid Pseudomonas sp. isolates from sputa collected from 40 cystic fibrosis patients. Ninety-four percent of the minimal inhibitory concentrations obtained by using mixed inocula of colonies of different morphological types fell within one serial dilution of the most resistant minimal inhibitory concentration obtained when each colony type was tested separately.