Coccidioidomycosis in India: Report of a third imported case.

We describe the third fatal case of imported coccidioidomycosis in India in a 31-year-old mechanical engineer originally from Andhra Pradesh, India, who lived in Gwinner, North Dakota. He had traveled to Arizona in summer of 2006, where he drove tractors in a dusty environment at a tractor production facility near Phoenix, Arizona. He was human immunodeficiency virus (HIV) positive. Initially, he was treated in Fargo, North Dakota, in 2006, with liposomal amphotericin B followed by oral fluconazole. Antiretroviral treatment for HIV infection was started. He moved back to India and was admitted to the intensive care unit of St. John's Medical College and Hospital, Bangalore, India. His blood cultures yielded Coccidioides sp. The identity of the isolate was confirmed using the Gen Probe Accuprobe test at the Centers for Disease Control and Prevention, Atlanta, Georgia. In spite of initiation of treatment with antifungal agents (amphotericin B and fluconazole), his condition deteriorated and he expired three days following his admission to the hospital.

A dose-ranging study of gentamicin pharmacokinetics: implications for extended interval aminoglycoside therapy.

Prolonged distribution time has been noted for high-dose (7 mg/kg) gentamicin. Higher doses are used for extended-interval aminoglycoside therapy (EIA). The authors investigated whether the increase in distribution time was proportional to the dose of gentamicin. Twelve healthy volunteers were given low (LD, 2 mg/kg), medium (MD, 4.5 mg/kg), and high (HD, 7 mg/kg) doses of gentamicin in a randomized, crossover fashion. Gentamicin was infused over 30 minutes, with 15 concentrations obtained over 8 hours after each dose. Data were fit to a two-compartment pharmacokinetic model. Distribution half-life for HD (31.1 +/- 5.7 min) differed significantly (p < 0.05) from LD (22.4 +/- 6.1 min) and MD (23.8 +/- 5.1 min) with no significant difference being seen between LD and MD. This study verifies that when using EIA dosing with HD gentamicin, sampling within 90 minutes after the beginning of the infusion provides information that leads to overestimation of peak serum concentration/minimum inhibitory concentration and inaccurate calculation of pharmacokinetic parameters.