scholarly journals Cryptococcal Meningitis in an Apparent Immunocompetent Patient

2019 ◽  
Vol 7 ◽  
pp. 232470961983457 ◽  
Author(s):  
Marian Poley ◽  
Richard Koubek ◽  
Leonard Walsh ◽  
Brian McGillen
Keyword(s):  
United States ◽  
Cryptococcus Neoformans ◽  
Cryptococcal Meningitis ◽  
Delayed Diagnosis ◽  
Severe Infection ◽  
Altered Mental Status ◽  
The United States ◽  
Immunocompetent Patient ◽  
Recent Estimate ◽  
Low Incidence

Cryptococcal meningitis is an uncommon and severe infection that tends to affect immunocompromised hosts worldwide and in the United States. Annually it is estimated that there are 200 000 cases of cryptococcal meningitis, with the most recent estimate of 3400 cases per year in the United States alone. However, despite the low incidence, 1-year mortality is estimated at 20% to 30% even with long-term consolidation antifungal therapy. A 37-year-old man presented to the emergency department with headaches, dysarthria, hallucinations, and acute worsening of altered mental status, and he was found to have increased intracranial pressure, cerebrospinal fluid leukocytosis, and few encapsulated yeasts consistent with Cryptococcus neoformans meningitis in addition to radiologic evidence consistent with a cryptococcoma of the lungs. This report highlights the occurrence of Cryptococcus neoformans meningitis in a presumed immunocompetent host. The clinician should be aware of sources of minor immunosuppression, as they may contribute to development of Cryptococcus neoformans meningitis. Mortality in this condition remains high due to subacute presentations and delayed diagnosis in non-immunocompromised patients.

scholarly journals 1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S720-S720
Author(s):  
Amy M Beeson ◽  
Grace E Marx ◽  
Amy M Schwartz ◽  
Alison F Hinckley
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Standard Treatment ◽  
Age Distribution ◽  
Public Health Problem ◽  
The United States ◽  
Adverse Outcomes ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Low Incidence

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD. Methods We performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD. Results A total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p< 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p< 0.0001) and during non-summer months (OR 2.2, p< 0.0001) was more likely to be non-standard. Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription Seasonality of standard versus non-standard treatment of Lyme disease Conclusion In this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes. Disclosures All Authors: No reported disclosures

Uromyces appendiculatus. [Descriptions of Fungi and Bacteria].

1965 ◽  
Author(s):  
G. F. Laundon
Keyword(s):  
United States ◽  
Sierra Leone ◽  
Geographical Distribution ◽  
World Wide ◽  
Indirect Evidence ◽  
Severe Infection ◽  
The United States ◽  
Total Loss ◽  
Uromyces Appendiculatus

Abstract A description is provided for Uromyces appendiculatus. Information is included on the disease caused by the organism, its transmission, geographical distribution, and hosts. HOSTS: On Dolichos, Phaseolus and Vigna species. DISEASE: Rust on leaves of French, Lima, and Scarlet Runner beans, and other Phaseolus spp., and cowpeas. The reddish-brown, circular sori may be surrounded by a yellow halo in some varieties. Complete defoliation and total loss of crop results in seasons favouring severe infection. GEOGRAPHICAL DISTRIBUTION: World-wide wherever beans are grown (CMI Map 290, Ed. 2, 1964). TRANSMISSION: By urediospores disseminated by wind, and through contact with animals including man and his implements. Indirect evidence of the possibility of introduction into Sierra Leone on seed imported from Ghana and S. Africa has been given by Deighton (25: 253). Some 40% of urediospores stored for 2 yr. at -60°C, and 16% stored more than 600 days at -18°C, have survived with virulence unimpaired, and it is thought that the rust is thus able to overwinter on bean trash and trellis poles in the United States (42: 167; 43, 299).

scholarly journals A Fatal Case of Primary Amoebic Meningoencephalitis from Recreational Waters

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Edward Hamaty ◽  
Saif Faiek ◽  
Minesh Nandi ◽  
David Stidd ◽  
Manish Trivedi ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Bacterial Meningitis ◽  
Fatal Case ◽  
Altered Mental Status ◽  
The United States ◽  
Recreational Waters ◽  
Primary Amoebic Meningoencephalitis ◽  
Presenting Symptoms ◽  
Amoebic Meningoencephalitis

Background. Naegleria Fowleri is a single-cell, thermophilic amphizoid amoeba, and a rare known causative agent for primary amoebic meningoencephalitis with >97% mortality rate. The amoeba resides in freshwater lakes and ponds but can also survive in inadequately chlorinated pools and recreational waters. The mode of infection includes activities such as diving or jumping into freshwater or submerging the head under the water. Although most commonly seen in the southern United States, it is essential to keep this clinical suspicion in mind regardless of geography, as presenting symptoms can be very similar to classic bacterial meningitis. Case Summary. We report the first-ever case in the state of New Jersey of a 29-year-old male presented after a visit to a recreational water park in Texas five days before his presentation with altered mental status. In ICU, his ICP remained refractory to multiple therapies, including antibiotics and antivirals, external ventriculostomy drain, hypertonic saline, pentobarbital-induced coma, and bilateral hemicraniectomies. The CSF analysis revealed trophozoites indicating a protozoan infection, which we diagnosed in the neurocritical unit, and the patient was then immediately started with treatment that included amphotericin B, rifampin, azithromycin, and fluconazole. This suspicion was promptly confirmed by the Center for Disease Control (CDC). Unfortunately, despite all the aggressive intervention by the multidisciplinary team, the patient did not survive. Conclusion. As per the CDC, only four people out of 143 known infected individuals in the United States from 1962 to 2017 have survived. Symptoms start with a median of 5 days after exposure to contaminated water. Given the rarity of this case and its very high mortality rate, it is crucial to diagnose primary amoebic meningoencephalitis accurately as its presentation can mimic bacterial meningitis. It is vital to obtain a careful and thorough history, as it can aid in prompt diagnosis and treatment.

scholarly journals Influenza Circulation in United States Army Training Camps Before and During the 1918 Influenza Pandemic: Clues to Early Detection of Pandemic Viral Emergence

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
Daniel S. Chertow ◽  
Rongman Cai ◽  
Junfeng Sun ◽  
John Grantham ◽  
Jeffery K. Taubenberger ◽  
...  
Keyword(s):  
United States ◽  
World War I ◽  
United States Army ◽  
Respiratory Diseases ◽  
National Guard ◽  
Influenza Pandemic ◽  
Case Fatality ◽  
The United States ◽  
Low Incidence ◽  
1918 Influenza

Abstract Background.  Surveillance for respiratory diseases in domestic National Army and National Guard training camps began after the United States’ entry into World War I, 17 months before the “Spanish influenza” pandemic appeared. Methods.  Morbidity, mortality, and case-fatality data from 605 625 admissions and 18 258 deaths recorded for 7 diagnostic categories of respiratory diseases, including influenza and pneumonia, were examined over prepandemic and pandemic periods. Results.  High pandemic influenza mortality was primarily due to increased incidence of, but not increased severity of, secondary bacterial pneumonias. Conclusions.  Two prepandemic incidence peaks of probable influenza, in December 1917–January 1918 and in March–April 1918, differed markedly from the September–October 1918 pandemic onset peak in their clinical-epidemiologic features, and they may have been caused by seasonal or endemic viruses. Nevertheless, rising proportions of very low incidence postinfluenza bronchopneumonia (diagnosed at the time as influenza and bronchopneumonia) in early 1918 could have reflected circulation of the pandemic virus 5 months before it emerged in pandemic form. In this study, we discuss the possibility of detecting pandemic viruses before they emerge, by surveillance of special populations.

Ethics Committees at Work

1994 ◽  
Vol 3 (1) ◽  
pp. 135-142
Author(s):  
Patricia A. Marshall ◽  
Jay Hartz ◽  
S.Y. Tan
Keyword(s):  
United States ◽  
Emergency Department ◽  
Severe Infection ◽  
Ethics Committees ◽  
The United States ◽  
High Fever ◽  
Insulin Dependent Diabetes ◽  
Her Family ◽  
Insulin Dependent

Mrs. A. is a 50-year-old woman, originally from Greece, who came to the United States with her family in 1973. A widow, with three grown children, she has been living near two of her sons and their families. For many years, Mrs. A. has suffered from, non-insulin-dependent diabetes, emphysema, and hypertension. On the day of a family picnic, she developed a high fever and vomiting. She was taken by her oldest son, Thomas, to the emergency department, where evidence was discovered of a severe infection of her kidneys that had spread to her blood.

scholarly journals Low Incidence of Citrullinemia Carriers Among Dairy Cattle of the United States

1993 ◽  
Vol 76 (3) ◽  
pp. 853-858 ◽  
Author(s):  
J.L. Robinson ◽  
J.L. Burns ◽  
C.E. Magura ◽  
R.D. Shanks
Keyword(s):  
United States ◽  
Dairy Cattle ◽  
The United States ◽  
Low Incidence

scholarly journals Mainstreamed English language instruction in a low-incidence rural school district : a case study

2010 ◽  
Author(s):  
◽  
Margaret René Watring Yoesel
Keyword(s):  
United States ◽  
English Language Learners ◽  
Public Schools ◽  
Teacher Perceptions ◽  
Language Learners ◽  
English Language ◽  
First Language ◽  
The United States ◽  
Language Instruction ◽  
Low Incidence

Classrooms in the United States are changing as the population of the United States becomes more diverse with growing numbers of English language learners (Banks, 2005; Capps, Fix, Murray, Ost, Passel and Herwantoro, 2005; Cartledge, Gardner, and Ford, 2009; DeVillar, Faltis, and Cummins, 1994; Diaz, 2001; Dilg, 2003; Hernandez, 2001; Ovando and McLaren, 2000; Sadowski, 2004; Sleeter and Grant, 1994). Immigrants and their families have traditionally settled in larger urban communities, but recent trends indicate a growing number of English language learners are enrolling in rural mid-west public schools. Many rural districts have very little experience or resources to meet the needs of this new diverse group of students. As a result teachers, especially in rural and low-incidence districts, are experiencing academic and cultural challenges of educating students whose first language is not English (Berube, 2000; Hill and Flynn, 2004). The purpose of this study was to examine elementary teacher perceptions regarding experience with instructing mainstreamed English language learners in a low-incidence district. This study also explores issues these teachers feel most influence their ability to successfully teach students from diverse cultures and who speak a first language other than English. Research examining teacher perceptions should provide important insight to teachers, administrators and policy makers regarding teacher needs and support in the education of English language learners.

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