Expanded Geographic Distribution and Clinical Characteristics of Ehrlichia ewingii Infections, United States

This bacterium should be considered as an etiologic agent of tickborne illness that might be missed by serologic testing.

Ehrlichiosis is a bacterial zoonosis, spread through the bites of infected ticks, that is most commonly caused in the United States by infection with the bacterium Ehrlichia chaffeensis. We retrospectively reviewed samples from an 18-month study of ehrlichiosis in the United States and found that E. ewingii was present in 10 (9.2%) of 109 case-patients with ehrlichiosis, a higher rate of infection with this species than had previously been reported. Two patients resided in New Jersey and Indiana, where cases have not been reported. All patients with available case histories recovered. Our study suggests a higher prevalence and wider geographic distribution of E. ewingii in the United States than previous reports have indicated.

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection.

Eclampsia in dogs: 31 cases (1995-1998)

OBJECTIVE

To compare clinical characteristics and laboratory findings of dogs with eclampsia with those of dogs without eclampsia.

DESIGN

Retrospective study.

ANIMALS

31 dogs with eclampsia (affected) and 31 with dystocia (controls).

PROCEDURE

Information on signalment, type of diet, reproductive history, litter size, time from whelping to eclampsia, body weight, clinical signs, results of physical examination and hematologic and biochemical analyses, response to calcium supplementation, and recurrence was obtained from the medical records of all dogs with eclampsia evaluated between 1995 and 1998 and compared with information from medical records of 31 of 102 dogs with dystocia evaluated during the same period.

RESULTS

Dogs with eclampsia weighed less, had a smaller body weight-to-litter size ratio, higher rectal temperature and heart and respiratory rates, and lower plasma total solids concentration than control dogs. Ionized calcium concentration was < or = 0.8 mmol/L for all but 1 of the affected dogs; median concentration for the affected dogs was significantly less than that for control dogs. Six (19%) dogs did not manifest typical clinical signs associated with eclampsia. Twelve (39%) dogs with eclampsia had previous litters; none had a history of eclampsia. Affected dogs were discharged from the hospital within hours after admission, but 3 dogs returned 1 to 3 weeks later because of recurrence of eclampsia.

CONCLUSIONS AND CLINICAL RELEVANCE

Eclampsia develops primarily in small-breed dogs with large litters. Plasma ionized calcium concentrations > 0.8 mmol/L in dogs with clinical signs typical of hypocalcemia may indicate that other causes of clinical signs should be considered. In addition, some dogs with eclampsia may have low ionized calcium concentrations and not manifest typical clinical signs.

Near-fatal status asthmaticus induced by nasal insufflation of cocaine

Asthma and cocaine abuse are both common. While cocaine has been associated with numerous pulmonary complications, only smoking cocaine has been clearly linked to the precipitation of life-threatening exacerbations of asthma. We report a case in which nasal insufflation of cocaine ("snorting") triggered a near-fatal asthmatic attack.

Treatment of skin and soft tissue infections: a comparative study of cefmetazole and cefoxitin

In this comparative study, both cefmetazole and cefoxitin were found to be safe and effective in the treatment of skin and soft tissue infections. Greater activity of cefmetazole against some strains of Staphylococcus aureus, Streptococcus pneumoniae, beta-haemolytic streptococci and aerobic Gram-negative bacilli was confirmed. A 90% or better cure rate was achieved with both drugs. At late follow up, three patients treated initially with cefmetazole had recurrent signs and symptoms. However, these three patients had vascular insufficiency which predisposed them to infection. Since cefmetazole has a longer half-life than cefoxitin, it may prove to be more convenient, or more cost effective, or both, in these and other infections.