An Adult Case of Adenovirus-Associated Acute Disseminated Encephalomyelitis.

Acute disseminated encephalomyelitis (ADEM) is an autoimmune neurological disease that predominately affects pediatric population. Only a single fatal adult case of adenovirus-associated ADEM has previously been published by Qamar et al. in 2021. Here, we present an adult case of adenovirus-associated ADEM, which was diagnosed early in her clinical course. The patient was treated with the prompt initiation of steroids, intravenous immune globulin (IVIG), and plasmapheresis (PLEX), and the patient recovered fully. This case highlights the importance of early accurate diagnosis for other clinicians to treat adenovirus-associated ADEM in a timely fashion to prevent a potentially fatal outcome.

A delayed diagnosis of ocular toxocariasis presenting as total monocular retinal detachment in an immunocompetent 57-year-old male.

A healthy 57-year-old man present to outpatient ophthalmological services in southwestern Connecticut with a 16-month history of unilateral periorbital pain, photophobia, and progressively decreasing visual acuity in his left eye. Prior extensive work-up for uveitis in his home state of Mississippi had yielded no etiology for his symptoms, and empiric therapy with glucocorticoid eye drops had not halted their decline. Fundoscopic examination demonstrated total combined retinal detachment of the left eye. Extensive repeat serological and immunological screening was positive for Toxocara immunoglobulin-G, consistent with a diagnosis of ocular toxocariasis, and the patient completed a course of albendazole with stabilization of symptoms. Despite toxocara being endemic to the United States, diagnoses of ocular toxocariasis are extremely uncommon, with the majority of cases occurring in young children. This unusual case of ocular toxocariasis in a healthy adult serves to illustrate that significant, irreversible morbidity can result from lack of both clinician and public awareness of this parasitic infection.

Human Borrelia miyamotoi infection: A cause of persistent fever and severe hyperthermia in New England.

An adult male presented to a hospital in southwestern Connecticut with tachypnea, generalized weakness, altered mental status, and relapsing fever with maximum recorded temperature of 106 °F. He required active cooling, antipyretic therapy, broad spectrum antibiotics, and intubation for airway protection after an episode of emesis. Initial laboratory and imaging workup were remarkable for elevated inflammatory markers, acute kidney injury, and bilateral lower lobe infiltrates. Further workup with lumbar puncture and electroencephalography were unrevealing. Extensive testing for causes of relapsing fever including tickborne diseases revealed that the patient was seropositive for Borrelia miyamotoi. Notably, he had no rash, and workup found no evidence of coinfection by other Borrelia, Ehrlichia or Anaplasma species. This case illustrates the need for clinicians to test for tick-borne diseases when evaluating for cases of relapsing fever in New England and is among the first case reports to demonstrate Borrelia miyamotoi as a cause of severe pyrexia.

Haemophilus Parainfluenzae mural endocarditis with large atrial septal defect and peripheral embolization.

Mural endocarditis is a rare subclass of infective endocarditis (IE) associated with intra-cardiac tumors, prosthesis, valvular vegetation's, or structural abnormalities such as ventricular septal defects. Bacteria classified as HACEK (Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) are rare causes of IE found in only 1.3% to 10% of cases. We describe the second reported case of mural endocarditis involving the left ventricle (LV) caused by a Haemophilus species. A young male with no prior intravenous drug use, valvular heart disease, or recent dental work presented with splenic infarcts. H. para-influenza was identified on blood cultures. Cardiac imaging revealed a 1.5 cm LV mass underneath the posterior leaflet of the mitral valve and a large Atrial Septal Defect (ASD). Awaiting surgery, the patient sustained embolic and hemorrhagic cerebral events. The patient underwent debulking of LV mass, ASD closure, and mitral valve repair complicated by post-pericardiotomy syndrome, and he completed six weeks of ceftriaxone therapy. The patient met modified Duke Criteria, but the diagnosis was challenging due to absence of risk factors, sub-acute symptom onset, delayed blood culture growth, and ambiguous characterization of the mass on imaging. .

Persistent Elizabethkingia meningoseptica bacteremia in a patient with multiple myeloma.

Elizabethkingia meningoseptica is a non-motile, gram-negative organism, previously classified as part of the Flavobacterium then Chryseobacterium genus. It has been isolated in hospital settings and has been known to cause infection, particularly in immunocompromised patients. Treatment has remained a challenge as this organism is resistant to many traditional antimicrobials used to treat gram-negative infections. We present a case of persistent E. meningoseptica bacteremia in a patient despite tailored antimicrobial therapy.

Impact of an Adherence Program on the Health and Outlook of HIV-Infected Patients Failing Antiretroviral Therapy.

BACKGROUND: We prospectively studied the impact of an adherence counselor on the outcome of patients failing antiretroviral therapy because of nonadherence. METHODS: Forty-six patients, identified as chronically nonadherent were enrolled. Individual attention was provided using the information, motivation and behavioral methodology. HIV RNA (viral load, in copies/mL), CD4 count (in cells/mm(3)), and body weight before and after the adherence counselor were measured. Qualitative outcome and patient satisfaction were assessed by deidentified third-party interviews. RESULTS: Over half completed at least 1 year; only 8 patients were lost to follow-up. Mean CD4 counts increased significantly (P < .05) for completers at 6 and 12 months. Viral loads decreased between baseline and 6 months. Most clients reported subjective benefit from working with the adherence counselor. CONCLUSION: Although few clients showed complete virologic suppression, the value of an adherence counselor was validated. Longer term adherence programs should be evaluated.

State mandated prenatal human immunodeficiency virus screening at a large community hospital.

PURPOSE: To describe the initial experience of state mandated prenatal HIV screening at a large community hospital. METHODS: HIV screening was provided to all pregnant women as of October 1, 1999. All HIV-positive women identified received aggressive antiretroviral therapy to reduce the likelihood for vertical transmission. Neonates were screened for HIV at zero, six, and 12 months of age. RESULTS: Seven pregnant women (0.3%) and two additional family members tested positive for HIV. All seven infants born to the identified HIV-positive women have tested negative for infection. We estimated that six of nine cases of HIV infection identified would have been missed under a policy of voluntary HIV screening. CONCLUSIONS: Universal screening for HIV in pregnancy is achievable and desirable and provides the best opportunity to minimize the number of new neonatal HIV infections.