Polyarticular Arthritis Due to Sporothrix schenckii /PolyartikulÄre Arthritis durch Sporothrix schenkii

Sporothrix schenckii infection usually presents as cutaneous or lymphocutaneous disease. Rarely, this dimorphic fungus causes isolated osteoarticular infection. The patient described herein had polyarticular sporotrichosis with contiguous osteomyelitis presenting as carpal tunnel syndrome 5 years previously. He relapsed after 2 g of amphotericin B but responded to itraconazole, a new oral antifungal agent. However, he was left with severe limitation of motion in the affected joints due to the long interval from onset of symptoms to diagnosis. Zusammenfassung :  Die Sporothrix schenckii -Infektion ist gewÖhnlich an der Haut oder im Bereich der Haut-Lymphknoten lokalisiert. Selten verursacht dieser dimorphe Pilz eine isolierte osteoartikulÄre Infektion. Der hier vorgestellte Patient hatte eine polyartikulÄre Sporotrichose mit benachbarter Osteomyelitis, was sich 5 Jahre zuvor als Karpaltunnel-Syndrom dargestellt hatte. Der Patient erlitt nach Verabreichung von insgesamt 2 g Amphotericin B einen RÜckfall, sprach jedoch auf Itraconazol an. Es verblieben aber schwere BewegungseinschrÄnkungen der befallenen Gelenke wegen des langen Zeitraums vom Einsetzen der Symptome bis zur Diagnose.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71904/1/j.1439-0507.1988.tb04413.x.pd

“Growing your own herbs” and “cooking from scratch”: Contemporary discourses around good mothering, food, and class‐related identities

In a cultural climate of “intensive parenting” and concerns about the “obesity epidemic,” parents are expected to take responsibility for their children's health, particularly through the provision of a “healthy” diet. This study involved intergenerational dyad interviews with both middle‐class and working‐class mothers and daughters from the United Kingdom. Analysing the data using discourse analysis informed by feminist poststructuralist theory, we found that mothers were positioned as having prime responsibility for the nurturing of family members, including the provision of a healthy diet. However, providing a healthy diet alone was insufficient; mothers needed to demonstrate that time and effort had been taken in the preparation of meals using fresh ingredients. Those who failed to do so were positioned as “lazy,” thus inviting the blaming of mothers for any current or future health problems encountered by family members (especially children). However, talk from some of the working‐class mothers pointed to the unattainable and “classed” ideals that are set by such cultural expectations

Thermal and Sedimentation Stress Are Unlikely Causes of Brown Spot Syndrome in the Coral Reef Sponge, Ianthella basta

Background: Marine diseases are being increasingly linked to anthropogenic factors including global and local stressors. On the Great Barrier Reef, up to 66% of the Ianthella basta population was recently found to be afflicted by a syndrome characterized by brown spot lesions and necrotic tissue.\ud \ud Methodology/Principal Findings: Manipulative experiments were undertaken to ascertain the role of environmental stressors in this syndrome. Specifically, the effects of elevated temperature and sedimentation on sponge health and symbiont stability in I. basta were examined. Neither elevated temperature nor increased sedimentation were responsible for the brown spot lesions, but sponges exposed to 32°C developed substantial discoloration and deterioration of their tissues, resulting in death after eight days and a higher microbial diversity in those samples. No shifts in the microbial community of I. basta were observed across a latitudinal gradient or with increased sedimentation, with three previously described symbionts dominating the community of all sponges (Alphaproteobacteria, Gammaproteobacteria and Thaumarchaea).\ud \ud Conclusions/Significance: Results from this study highlight the stable microbial community of I. basta and indicate that thermal and sedimentation stress are not responsible for the brown spot lesions currently affecting this abundant and ecologically important sponge species

Imipenem resistance of Pseudomonas in pneumonia: a systematic literature review

<p>Abstract</p> <p>Background</p> <p>Pneumonia, and particularly nosocomial (NP) and ventilator-associated pneumonias (VAP), results in high morbidity and costs. NPs in particular are likely to be caused by <it>Pseudomonas aeruginosa </it>(PA), ~20% of which in observational studies are resistant to imipenem. We sought to identify the burden of PA imipenem resistance in pneumonia.</p> <p>Methods</p> <p>We conducted a systematic literature review of randomized controlled trials (RCT) of imipenem treatment for pneumonia published in English between 1993 and 2008. We extracted study, population and treatment characteristics, and proportions caused by PA. Endpoints of interest were: PA resistance to initial antimicrobial treatment, clinical success, microbiologic eradication and on-treatment emergence of resistance of PA.</p> <p>Results</p> <p>Of the 46 studies identified, 20 (N = 4,310) included patients with pneumonia (imipenem 1,667, PA 251; comparator 1,661, PA 270). Seven were double blind, and 7 included US data. Comparator arms included a β-lactam (17, [penicillin 6, carbapenem 4, cephalosporin 7, monobactam 1]), aminoglycoside 2, vancomycin 1, and a fluoroquinolone 5; 5 employed double coverage. Thirteen focused exclusively on pneumonia and 7 included pneumonia and other diagnoses. Initial resistance was present in 14.6% (range 4.2-24.0%) of PA isolates in imipenem and 2.5% (range 0.0-7.4%) in comparator groups. Pooled clinical success rates for PA were 45.2% (range 0.0-72.0%) for imipenem and 74.9% (range 0.0-100.0%) for comparator regimens. Microbiologic eradication was achieved in 47.6% (range 0.0%-100.0%) of isolates in the imipenem and 52.8% (range 0.0%-100.0%) in the comparator groups. Resistance emerged in 38.7% (range 5.6-77.8%) PA isolates in imipenem and 21.9% (range 4.8-56.5%) in comparator groups.</p> <p>Conclusions</p> <p>In the 15 years of RCTs of imipenem for pneumonia, PA imipenem resistance rates are high, and PA clinical success and microbiologic eradication rates are directionally lower for imipenem than for comparators. Conversely, initial and treatment-emergent resistance is more likely with the imipenem than the comparator regimens.</p