AbstractIn rare instances, Listeria monocytogenes bacteremia and central nervous system infection appear to have followed either infectious or mechanical disturbances of the gastrointestinal tract. We report a patient who developed postoperative colitis due to Clostridium difficile that in turn was complicated by bacteremia due to L. monocytogenes. To our knowledge, this is the first report of this association. In addition, we summarize other published instances in which invasive listeriosis closely followed gastrointestinal tract disturbances by other infectious agents or endoscopic instrumentation.

ABSTRACT The relationship between dogs and humans is ancient and mutually beneficial. Dogs have served people well as companions, workmates, guides, and protectors. However, on occasion, dogs may injure humans through biting or may transmit pathogens resulting in a large number of problems ranging from a trivial rash to life-threatening bacteremia. Given that there are more than 80 million pet dogs in the United States, it is worth knowing the potential problems that can result from canine exposure. Annually, almost 5 million people in the United States suffer a dog bite. Dog bite wounds become infected up to 15% of the time. In those who have had a splenectomy, a dog bite may transmit the bacterium Capnocytophaga canimorsus , leading to life-threatening bacteremia. Other illnesses that humans can acquire from dog contact include ringworm, diarrheal disease (salmonellosis, campylobacteriosis, and intestinal parasites), leptospirosis, brucellosis, Q fever, visceral larva migrans, and echinococcosis. Evidence exists that the family dog may serve as a reservoir for uropathogenic Escherichia coli that can lead to urinary tract infections among human household contacts. In this article we discuss dog-related infectious diseases as well as measures to minimize dog-associated illness (e.g., do not disturb sleeping dogs; HIV-infected persons who wish to acquire a puppy should have the dog’s stool checked for Cryptosporidium ).

Osler advised physicians to "learn to see." Visual intelligence, an ability to look carefully, to be attentive to the visible information in one's environment, and to articulate that information to others, is a skill that can be learned. Being a skilled observer, seeing the world the way an artist might see it, can make one into a more skilled physician.

Updates7 May 2013Update in Infectious Diseases: Evidence Published in 2012Bennett Lorber, MDBennett Lorber, MDFrom Temple University School of Medicine, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-9-201305070-00102 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Is there any more dynamic medical specialty than infectious diseases? I don't think so, and I believe the medical literature published in 2012 supports my assertion. Revelations include a paradigm shift in our understanding of the role of asymptomatic bacteriuria, the description of an ehrlichiosis-like illness due to a newly discovered virus, and a sinusitis study based in primary care, office-based practices showing that antibiotic treatment does not improve disease-specific quality of life. This Update reviews clinically based papers that would be interesting and useful to general internists.SinusitisThe Usual Patient With Sinusitis Does Not Benefit From Antibiotic Treatment ...References1. Centers for Disease Control and Prevention (CDC). Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy—United States, July–November 2002. MMWR Morb Mortal Wkly Rep. 2002;51:1109-12. [PMID: 12530707] MedlineGoogle Scholar2. Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157:865-77. [PMID: 23362516] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Temple University School of Medicine, Philadelphia, Pennsylvania.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3133.Corresponding Author: Bennett Lorber, MD, Temple University Hospital, Broad and Ontario Streets, Philadelphia, PA, 19140; e-mail: bennett.[email protected]edu.Author Contributions: Conception and design: B. Lorber.Analysis and interpretation of the data: B. Lorber.Drafting of the article: B. Lorber.Critical revision of the article for important intellectual content: B. Lorber.Final approval of the article: B. Lorber.Provision of study materials or patients: B. Lorber.Administrative, technical, or logistic support: B. Lorber.Collection and assembly of data: B. Lorber.This article was published at www.annals.org on 11 April 2013. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 7 May 2013Volume 158, Issue 9Page: 686-690KeywordsAntibioticsEndocarditisErythemaHIV preventionLyme diseaseMeningitisSurgeryTicks ePublished: 7 May 2013 Issue Published: 7 May 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...

The vast microbiota in the human body is dominated by anaerobic gram-negative rods. The five recent publications reviewed here demonstrate important roles for Bacteroides species and other anaerobic bacteria both in the production of illness and the maintenance of health.

Cutaneous infections due to Listeria monocytogenes are rare. Typically, infections manifest as nonpainful, nonpruritic, self-limited, localized, papulopustular or vesiculopustular eruptions in healthy persons. Most cases follow direct inoculation of the skin in veterinarians or farmers who have exposure to animal products of conception. Less commonly, skin lesions may arise from hematogenous dissemination in compromised hosts with invasive disease. Here, we report the first case in a gardener that occurred following exposure to soil and vegetation.

Imagine if debilitating arthritis were due to an anaerobic bacterium that lives in our mouths. What if heart attacks were due to a transmissible bacterium or autism to a virus? What if vaccines could prevent these and other chronic illnesses?

The bacterium Listeria monocytogenes infrequently causes illness in the general population. In some groups, however, including pregnant women, newborns, elderly persons, and those with impaired cell-mediated immunity, including many cancer patients, it is an important cause of invasive disease, particularly bacteremia, meningitis, encephalitis, and brain abscess. Nocardia species are aerobic, Gram-positive, branching, filamentous, bacterial rods, which are most often found in the environment in soil, water, and vegetable matter. The key host defense against developing nocardiosis is cell-mediated immunity; the humoral immune response offers little protection. These organisms are considered opportunistic pathogens, causing infection in patients with impaired cell-mediated immune response, including patients with lymphoreticular neoplasia, organ transplantation, HIV/AIDS, diabetes mellitus, and alcoholism. In particular, there is a well-documented association between nocardiosis and chronic granulomatous disease (CGD). In this chapter, we present a detailed review of epidemiology, clinical presentation, and management of these opportunistic infections in immunosuppressed patients with cancer.

Cure of Listeria monocytogenes Meningitis after EarlyTransition to Oral Therapy ᰔ Due to its lethality, Listeria monocytogenes infection of the central nervous system (CNS) typically is treated parenterally.We describe a case of L. monocytogenes meningitis cured with trimethoprim-sulfamethoxazole (TMP-SMX) utilizing early oral therapy on an outpatient basis.A 64-year-old woman was hospitalized with an acute onset of fever and personality change.She had a history of hypertension and rheumatoid arthritis controlled with weekly methotrexate without recent exposure to corticosteroids or tumor necrosis factor-alpha antagonists.Ten days before the current illness, she experienced a 3-day, self-limited episode of fever, vomiting, and diarrhea.The day of admission, her family noted the abrupt onset of bizarre behavior.She began attempting to rearrange furniture and shouting obscenities, which progressed into incoherent speech.After witnessing a fall without head strike, her family brought her to the hospital.At the time of admission, she was confused.Her temperature was 39.3°C.She had nuchal rigidity and photophobia without focal neurological findings.The peripheral leukocyte count was 15,600 cells/mm 3 (79% neutrophils, 5% bands, and 14% lymphocytes).A noncontrast computed tomography (CT) examination of the head was unremarkable.Cerebrospinal fluid (CSF) contained 545 leukocytes/mm 3 (77% neutrophils), a protein level of 209 mg/dl, and a glucose level of 62 mg/dl (serum glucose, 128 mg/dl).Gram stain showed few leukocytes but no organisms.After obtaining a history of oro-labial swelling following penicillin, the patient was given intravenous vancomycin, moxifloxacin, and TMP-SMX (15 mg/kg of body weight TMP daily in four divided doses).Dexamethasone and acyclovir were also

Sir, Within our institution, we have recently seen an increase in bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) having decreased responsiveness to glycopeptides. Testing has revealed that these isolates are neither vancomycin intermediate nor heterogeneous vancomycin intermediate. Patients continue to be bacteraemic despite therapeutic levels of vancomycin. In September 2009, the FDA approved telavancin for the treatment of complicated skin and soft-tissue infections. To date, there have been no reports of the use of telavancin in bacteraemic patients. Here we report the successful use of telavancin for MRSA bacteraemia and right-sided endocarditis. A patient with a history of hepatitis C and intravenous drug use presented with fevers and chills. Blood cultures grew MRSA (vancomycin MIC≤0.5 mg/L, daptomycin MIC≤1 mg/L) and he was begun on 15 mg/kg vancomycin every 12 h. He was found to have septic pulmonary emboli and a pleural effusion. A transoesophageal echocardiogram showed severe tricuspid valve regurgitation with a large tricuspid valve vegetation. Blood cultures remained positive through 8 days of vancomycin treatment with documented trough levels of 15–20 mg/L. Treatment was changed to 10 mg/kg telavancin intravenously every 24 h. Blood cultures became negative within 1 day of the start of telavancin. The patient’s creatinine was monitored and remained stable from admission. The patient underwent a tricuspid valve repair for severe tricuspid regurgitation 1 month after his initial positive culture. He completed 4 weeks of telavancin and was discharged home in a stable condition 6 weeks after his admission. At follow-up 6 weeks after completing treatment, the patient was afebrile with documented negative blood cultures. To our knowledge, this is the first case of persistent MRSA bacteraemia treated successfully with telavancin. Telavancin is a lipoglycopeptide with a mechanism of action similar to that of the glycopeptides but with an added mechanism that interferes with cell membrane function. It is reportedly rapidly bactericidal against S. aureus, thus having potential for use in bacteraemic patients. The study of telavancin in MRSA bacteraemia has been completed in murine models with the comparator being vancomycin. In this model, telavancin demonstrated greater killing activity than vancomycin, and a statistically significant difference in survival was found between the two groups with 0% survival for vancomycin and 93% for telavancin. These results have been attributed to the dual mechanism of action of telavancin as well as a longer post-antibiotic effect. With the increasing frequency of persistent MRSA bacteraemia with decreased responsiveness to vancomycin and failures reported with daptomycin after vancomycin use, new therapeutic options are desirable. Clinical studies will be necessary to determine whether telavancin offers advantages over other currently available antibiotics.