Capnocytophaga canimorsus meningitis in a 38-year-old immunocompetent woman from household pet exposure.

A 38-year-old otherwise healthy woman with no history of immunocompromise, recent travel, or concerning exposures presented to the ED with several days of nonspecific cold-like symptoms with associated generalized headache. After the patient was symptomatically treated and discharged, she returned several hours later with worsening of symptoms and new vomiting, confusion, and sensorineural hearing loss. Blood and cerebrospinal fluid cultures eventually returned positive for a Capnocytophaga canimorsus infection, a bacterial pathogen found in the saliva of dogs and cats. Only after that, the patient recalled being scratched and licked by her pets, two dogs and a cat. She was treated with a course of systemic steroids, antibiotics and discharged home.

A Severe Case of Odontogenic Infection and Necrotizing Fasciitis of the Anterior Chest Wall and Neck.

Necrotizing fasciitis is a life-threatening infection that can be rapidly fatal. Early identification and emergent surgical management are essential to minimize morbidity and mortality. This case report describes a 25-year-old male who presented to the emergency department with a three-day history of worsening left lower dental infection and new-onset neck pain and swelling. He received broad-spectrum antibiotics and intravenous fluid resuscitation and underwent computed tomography of the neck and chest. Following intensive care unit admission, he underwent tooth extraction where intraoperative evaluation revealed subcutaneous crepitus. Immediate debridement was performed, revealing copious foul-smelling purulent discharge and necrotic tissue extending over the anterior chest wall and neck. During his hospital course, he underwent multiple debridements to manage the expanding infection. The final tissue defect was substantial, with deep dissection to muscle extending over the entire anterior surface of the rib cage to just inferior to the clavicles. This significant tissue defect was managed with skin grafts, and he was discharged home in stable condition. The patient is doing well almost a year after discharge. The key to our patient's survival was the early identification and debridement of the affected tissue. Our study reinforces the tenants of wound care and aggressive management required to bolster patient odds of survival in the setting of necrotizing fasciitis and underscores the importance of maintaining vigilance in patients presenting with dental infections. This study is unique in that our patient was young, with a past medical history significant for polydrug use, and the area of debridement was substantial.

Test-retest reliability and responsiveness of gaze stability and dynamic visual acuity in high school and college football players.

OBJECTIVES: The purpose of this study was to establish reliability and responsiveness of the dynamic visual acuity test (DVAT) at head speeds of 150-200 degrees per second (deg/s) and the gaze stabilization test (GST) in high school and college football players. DESIGN: Reliability design. PARTICIPANTS: Fifty high school and college football athletes completed the DVAT and GST in both the yaw (horizontal) and pitch (vertical) planes twice within two weeks. RESULTS: Test-retest reliability for the DVAT was good in yaw, Intraclass Correlation Coefficient (ICC) = 0.770, and moderate/good in pitch, ICC = 0.725. Minimal detectable change (MDC) was 0.16 logMAR for yaw and 0.21 logMAR for pitch. GST reliability was moderate in yaw, ICC = 0.634, and poor in pitch, ICC = 0.411. MDCs were 73.4 deg/s (yaw) and 81.2 deg/s (pitch). CONCLUSIONS: The DVAT is reliable at high head speeds in high school and college football athletes in both yaw and pitch. GST head speeds were higher than previously reported in the literature, but reliability of this tool for this population was poor to moderate. From a clinical perspective, DVAT may be reliably used in the assessment of high school and college football athletes; however, GST requires further evaluation.