Rhodococcus equiis an unusual zoonotic pathogen that can cause life-threatening diseases in susceptible hosts. Twelve patients withR. equiinfection in Kentucky were compared to 137 cases reported in the literature. Although lungs were the primary sites of infection in immunocompromised patients, extrapulmonary involvement only was more common in immunocompetent patients (P<0.0001). Mortality inR. equi-infected HIV patients was lower in the HAART era (8%) than in pre-HAART era (56%) (P<0.0001), suggesting that HAART improves prognosis in these patients. Most (85–100%) of clinical isolates were susceptible to vancomycin, clarithromycin, rifampin, aminoglycosides, ciprofloxacin, and imipenem. Interestingly, there was a marked difference in susceptibility of the isolates to cotrimoxazole between Europe (35/76) and the US (15/15) (P<0.0001). Empiric treatment ofR. equiinfection should include a combination of two antibiotics, preferably selected from vancomycin, imipenem, clarithromycin/azithromycin, ciprofloxacin, rifampin, or cotrimoxazole. Local antibiograms should be checked prior to using cotrimoxazole due to developing resistance.
CMV Colitis in Immunocompetent Patients—A Case Series
