Mycotic aneurysm of the inferior gluteal artery caused by non-typhi Salmonella in a man infected with HIV: a case report

<p>Abstract</p> <p>Introduction</p> <p>Non-typhi <it>Salmonellae </it>infections represent major opportunistic pathogens affecting human immunodeficiency virus-infected individuals residing in sub-Saharan Africa. To the best of our knowledge, we report the first documented case in the medical literature of a <it>Salmonella</it>-induced mycotic aneurysm involving an artery supplying the gluteal region.</p> <p>Case presentation</p> <p>A 37-year-old black, Kenyan man, infected with human immunodeficiency virus with a CD4 count of 132 cells per microliter presented with a pulsatile gluteal mass and debilitating pain progressing over one week. He was receiving prophylaxis with trimethoprim-sulfamethoxazole. Aspiration of the mass yielded gross blood. An ultrasound examination revealed a 37 ml vascular structure with an intra-luminal clot. Upon exploration, a true aneurysm of the inferior gluteal artery was identified and successfully resected. A culture of the aspirate grew a non-typhi <it>Salmonellae </it>species. Following resection, he was treated with oral ciprofloxacin for 10 weeks. He later began anti-retroviral therapy. Forty-two months after the initial diagnosis, he remained alive and well.</p> <p>Conclusions</p> <p>Clinicians caring for patients infected with human immunodeficiency virus in Africa and other resource-limited settings should be aware of the invasive nature of <it>Salmonella </it>infections and the potential for aneurysm formation in unlikely anatomical locations. Rapid initiation of appropriate anti-microbial chemotherapy and surgical referral is needed. Use of trimethoprim-sulfamethoxazole prophylaxis does not routinely prevent invasive <it>Salmonella </it>infections.</p

Retinopathy of prematurity in the UK II: Audit of national guidelines for screening and treatment

Aims To ascertain how closely in 1995, neonatologists and ophthalmologists were adhering to the national guidelines for the screening of retinopathy of prematurity (ROP, 1990) and those for screening and treatment (1995). Methods Questionnaires about the local arrangements for the screening and treatment of retinopathy of prematurity were sent to the entire consultant membership (n = 648) of the Royal College of Ophthalmologists (RCOphth) and to the clinical directors (n = 259) of neonatal units in the UK in 1995. Results One hundered and eighty-three ophthalmologists in the UK were identified as undertaking ROP screening and/or treatment, and ROP screening took place in 207 neonatal units. Seventy-seven per cent of the ophthalmologists either complied with or exceeded recommendations for determining which babies required screening, while 7% used criteria that would have resulted in substantially fewer babies being screened. Only 17% units and 12% ophthalmologists provided written information for parents, although 66% ophthalmologists talked to the parents of babies they screened. There was a lack of clarity about responsibilities for ensuring the continuation of screening on transfer to another hospital or on discharge to home. There was a wide range of views on the ophthalmic criteria that determined when screening examinations could cease and on the indications for treatment. Conclusions While ROP screening is almost universally adopted in the UK, there is a need for the process to be more efficient and effective. Despite the delay in reporting this survey several issues remain extant and future guidelines should clarify and refine the criteria for screening and treatment. There is a need for improved communication with parents, and particularly for written information