5. HIV and Infectious Diseases page 1
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5. HIV and Infectious Diseases

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  • ESSENCES

    Deep dermatophytosis: rare infections or common, butunrecognised, complications of lymphatic spread?

    Hay RJ, Baran R. Curr Opin Infect Dis 2004; 17:77-79

    This review article discusses deep dermatophytosisand the possible link with lymphatic spread. The mech-anisms limiting spread of dermatophyte fungi, undernormal circumstances, to the epidermis remain elusive.The hypothesis linking a specific clinical form of der-matophyte nail infection with lymphatic spread needsverification. In particular, it is important to clarify whe-ther viable dermatophytes can be detected outside theepidermis or nail plate and whether they will then remainviable and provide a source of endogenous re-infection.There is still some doubt as to whether the mysteriousarrival of dermatophytes in the proximal nail fold, par-ticularly in immunosuppressed patients, is a sign oflymphatic dissemination or whether we should besearching for another portal of entry.

    Fatal cases of Rocky Mountain spotted fever in familyclustersThree states, 2003

    Levy C, Burnside J, Tso T, et al. MMWR 2004; 53:407-410

    Rocky Mountain spotted fever (RMSF) is a tickborneinfection caused by Rickettsia rickettsii and characterizedby a rash. It has a case-fatality rate as high as 30% incertain untreated patients. Even with treatment, hospi-talization rates of 72% and case-fatality rates of 4% havebeen reported. This article summarizes the clinicalcourse of 3 fatal cases of RMSF in children and relatedillness in family members during the summer of 2003.These cases underscore the importance of prompt diag-nosis and appropriate antimicrobial therapy in patientswith RMSF to prevent deaths. They also emphasizeconsideration of RMSF as a diagnosis in family membersand contacts who have febrile illness and share environ-mental exposures with the patient.

    The safety and efcacy of daptomycin for the treatment ofcomplicated skin and skin-structure infections

    Arbeit RD, Maki D, Tally FP, et al. Clin Infect Dis 2004;38:1673-1681

    Daptomycin, 4 mg/kg intravenously (IV) every 24 hfor 7-14 days, was compared with penicillinase-resistantpenicillins, 4-12 g IV per day or vancomycin (Vancocin),1 g IV every 12 h, in 2 randomized, international trialsthat included 1, 092 patients with complicated skin andskin-structure infections. Among 902 clinically evaluablepatients, clinical success rates were 83.4% and 84.2% forthe daptomycin- and comparator-treated groups,respectively. Among patients successfully treated with IVdaptomycin, 63% required only 4-7 days of therapy,compared with 33% of comparator-treated patients (p