Outbreak of tungiasis following a trip to Ethiopia.

Tungiasis is a skin disease caused by the ectoparasite sand flea Tunga penetrans. Although tungiasis is an important health problem in endemic areas, mainly South America and sub-Saharan Africa, it is reported uncommonly in travelers. We describe an outbreak of tungiasis in a group of travelers to Ethiopia. Following the diagnosis of tungiasis in a member of a group of 17 Israeli travelers to Ethiopia, other affected members were identified by photograph assisted self diagnosis. The characteristics, including relevant demographic and epidemiologic data were recorded using a telephone interview and computerized questionnaire, and analyzed subsequently. The attack rate of tungiasis in the travel group was 53% (9 patients). Most of the patients (89%) wore open sandals during prolonged periods of their journey, but the pattern of shoeware use was similar in unaffected group members. An insect bite was not felt by any patient. The median number of skin lesions was one, and most lesions were located on the foot (7 of 9 travelers), but the hands were also affected in 2 travelers. All skin lesions healed without a need for a major intervention and without major sequela within 5 weeks of their appearance. Tungiasis may be underdiagnosed in travelers. Medical personnel should include tungiasis in pre-travel recommendations, and post-travel assessment.

A retrospective six-year national survey of P. multocida infections in Israel.

Pasteurella multocida is the commonest organism infecting pet bites. Anecdotal reports tend to overemphasize dramatic outcomes. We aimed to study a large database of P. multocida infections. This retrospective survey of P. multocida infections in Israeli hospitals refers to the y 2000-2005. Clinical microbiologists were contacted by email and asked to perform a back-search of their hospital's records for isolates of P. multocida. The charts of patients growing P. multocida were abstracted into a structured questionnaire. 77 cases were identified in 12 hospitals, yielding an annual incidence of 0.19/100,000. The mean age was 49.2+/-26.5 y and the mortality rate was 2.6%. Those who died were >65 y of age, had diabetes mellitus or cirrhosis and were bacteraemic. One-third of the cases occurred in people aged > or =65 y. Cats caused most of these infections (54%). Surgery for debridement was common (53.7%), but no-one required amputation; a second- and third-look operation was necessary for these patients. Bacteraemia was found in 32.5% of patients and was significantly more common among those aged >60 y (p =0.044). Hospitalized patients with P. multocida have a favourable prognosis, apart from elderly and bacteraemic patients with comorbidities. Surgery and reoperations may be required in about half of the patients.

Enterococcal-associated lower respiratory tract infections: a case report and literature review.

We report a rare case of bacteremic enterococcal pneumonia in an 81-year-old man, with an indolent disease course. We reviewed the literature concerning lower respiratory tract infections associated with enterococci for the burden, the pathogenesis and the clinical characteristics of these unusual infections.

Formal adult infectious disease outpatient consultations: a retrospective 6-year survey.

BACKGROUND: The field of outpatient infectious disease (ID) consultations is expanding. Surprisingly, limited data are available regarding the scope of formal, adult, outpatient ID consultations. METHODS: The computerized records of all adult outpatient ID consultations conducted by a single ID expert over the years 2001-2007 were retrospectively analyzed. Demographic, clinical and management characteristics were studied. RESULTS: We identified 619 eligible cases, mostly women (61.4%). The mean age (+/- SD) was 39 +/- 15.5 years, and each patient had 1.3 +/- 0.7 visits on average. In 12% of the cases, symptoms have been fluctuating for > or = 1 year. Most of the cases (54.3%) have been referred for the purpose of management rather than diagnostics. Largest areas leading to ID consultation were post-travel medical conditions (15.5%) and pregnancy-related infections (11%); specific leading categories were viral infections (17.3%), skin and soft tissue syndromes (15.2%) and gastrointestinal syndromes (7.6%). Recurrent, well-characterized infections plus ill-defined syndromes constituted a substantial part of all referrals. Newly discovered findings were elicited in the medical history and physical examination in 3.7% and 2.7% of cases, respectively. CONCLUSIONS: Formal outpatient ID consultations have unique aspects, which differ from "traditional" inpatient consultations. The field offers exciting medical research possibilities and new themes for healthcare executives.

Hand infections following penetrating fish fins or bones injuries (FFBI): a large, hospital based, retrospective study.

BACKGROUND: The incidence of hand infections caused by penetrating fish fins or bones injuries (FFBI) is likely to increase following worldwide constant growth of fishery production and consumption. Because data on these infections are scarce, the purposes of this study were to describe their clinical characteristics and disease course, and to analyze risk factors for a complicated disease course. METHODS: We studied retrospectively all cases of hospitalized patients with hand infections following FFBI over the years 1999-2006 in a single medical center. Demographic data, underlying diseases, clinical characteristics and disease course were analyzed for each case. Univariate and multivariate analysis were used for analyzing risk factors for a complicated hospitalization course. RESULTS: There were 122 separate episodes of hand infections following FFBI among 116 patients, with a mean age (+/- SD) of 52 +/- 19.7. The majority of cases were women (51.6%), and they arrived significantly later to the hospital after injury. Predisposing conditions (diabetes mellitus, liver disease, rheumatologic disorder, malignancy or chronic steroid treatment) were present in 25% of cases. Most of the cases presented with cellulitis. Cultures of either blood or wound were obtained in approximately 1/3 of cases, and 40% of them yielded an isolate. Ceftazidime and doxycycline were administered to 68.8% and 96.7% of cases, respectively. Surgical debridement was performed in 34.4% of cases, but there was no case of death or limb amputation. The presence of fever (p = 0.0005) and a predisposing condition (p = 0.035) were independently correlated with a complicated hospitalization course. CONCLUSIONS: The overall prognosis in this largest cohort of hand infections following FFBI was favorable, but immune dysfunction carried a complicated course.

Fluoroquinolones in community-acquired pneumonia when tuberculosis is around: an instructive case.

Fluoroquinolones are increasingly used for the treatment of community-acquired pneumonia. However, their use has been associated with a delay in the diagnosis and treatment of pulmonary tuberculosis. We describe the clinical and insightful bacteriological course of a 39-year-old patient with pulmonary tuberculosis who had presented as having community-acquired pneumonia and was treated empirically with levofloxacin. The case highlights a major problem associated with the indiscriminate use of fluoroquinolones.

[New technologies for obesity treatment: on-line supported self-treatment program]. / Obésité. Nouvelles technologies pour la prise en charge: autotraitement par Internet.

Obesity treatment effects are difficult to maintain on a long course, especially when patients also suffer from an eating disorder. Confronted with this statement, authors were interested in the use of new technologies to enhance the treatment palette at disposal. A self-treatment for bulimia nervosa on the Internet as well as a system of relapse prevention using Telephone-Linked Care (TLC) technology for obese patients after a weightloss have already been evaluated with success. A new self-treatment program for people suffering from compulsive eating disorders was developed and implemented on the Internet. It contains eleven steps based on cognitive and behavioural therapy and has to be done under a psychologist's supervision.