Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile.

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

Evaluation of oral rabies vaccination programs for control of rabies epizootics in coyotes and gray foxes: 1995-2003.

OBJECTIVE: To evaluate the effectiveness of intervention efforts to halt 2 wildlife rabies epizootics from 1995 through 2003, including 9 oral rabies vaccination campaigns for coyotes and 8 oral rabies vaccination campaigns for gray foxes. DESIGN: Retrospective study. ANIMALS: 98 coyotes during prevaccination surveillance and 963 coyotes and 104 nontarget animals during postvaccination surveillance in south Texas, and 699 gray foxes and 561 nontarget animals during postvaccination surveillance in west-central Texas. PROCEDURES: A recombinant-virus oral rabies vaccine in edible baits was distributed by aircraft for consumption by coyotes and gray foxes. Bait acceptance was monitored by use of microscopic analysis of tetracycline biomarker in upper canine teeth and associated bone structures in animals collected for surveillance. Serologic responses were monitered by testing sera for rabies virus-neutralizing antibodies by use of the rapid fluorescent focus inhibition test. The incidence of rabies in the distribution area was recorded via active and passive surveillance activities; tracking of rabies virus variants in confirmed rabid animals was used to determine the number and type of rabies cases before and after distributions of the vaccine. RESULTS: The expansion of both epizootics was halted as a result of the vaccine bait program. The number of laboratory-confirmed rabid animals attributable to the domestic dog-coyote rabies virus variant in south Texas declined to 0, whereas the number of laboratory-confirmed rabid animals attributable to the Texas fox rabies virus variant in west-central Texas decreased. CONCLUSIONS AND CLINICAL RELEVANCE: Data indicated that oral rabies vaccination resulted in protective immunity in a sufficient percentage of the target wildlife population to preclude propagation of the disease and provided an effective means of controlling rabies in these species.