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Successful maintenance therapy with weekly interferon-alpha for HIV-associated multicentric Castleman's disease is described.

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The relative incidence and rate of lung cancer in HIV-infected patients compared with the general US population has been a source of controversy. We sought to establish these parameters in a cohort of 2616 HIV-infected patients. Tumour type, stage of disease, patient demographics and immune parameters including viral loads were ascertained. An annual rate of 191 cases/100,000 population was found, which is 3.01 times greater (95% confidence interval [CI]=1.3-7.0) when compared with the general US population and 7.4 times the rate in US males between ages 35 and 54 (95% CI=3.1-17.8). Three patients had CD4 counts greater than 200 cells/mm3 at diagnosis and 2 had undetectable viral loads. The mean age was 44 years and all had advanced disease and short survival. In conclusion, the incidence of primary lung cancer was increased in this cohort of HIV-infected patients and occurred over a wide range of immunosuppression and viral replication.

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OBJECTIVES: To determine the pattern of penicillin use in the treatment of pneumococcal pneumonia, and factors contributing to the use of alternative antibiotics. METHODS: This study included all adult inpatients of St. Vincent's Hospital and Medical Center who had documented pneumococcal pneumonia between December 1998 and October 1999. St. Vincent's is a 600 bed tertiary teaching hospital in New York City. Patients who had Streptococcus pneumoniae isolated from a respiratory tract specimen were identified through microbiology laboratory records. A retrospective chart review of these patients was conducted, and those identified with clinical pneumonia were included in this study. Antibiotic use, patient demographics, resistance data, and clinician awareness of the antibiotic susceptibility results were noted. RESULTS: Sixty adult patients hospitalized with documented pneumococcal pneumonia were identified. Thirteen (21.6%) of the 60 patients received penicillin or ampicillin. Susceptibility results were not noted in the medical record in 21 (35.0%) of the 60 patients, and none received penicillin. High rates of reported penicillin allergy in 8 (13.3%) of the 60 patients, and reluctance to use penicillin when isolates demonstrated intermediate susceptibility in 8 (13.3%) of the 60 patients were observed. CONCLUSIONS: Several remediable obstacles to penicillin use were identified in this study. An increased awareness of susceptibility results by physicians and education of practitioners could have increased the use of penicillin as therapy to two-thirds of these patients.

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OBJECTIVE: To validate the non-radiometric, broth-based ESP system for determining Mycobacterium avium complex (MAC) susceptibilities. METHODS: MAC isolates from sterile body sites of 20 adult HIV-infected patients who were failing their present MAC regimen were identified. Susceptibilities were determined and comparisons made between the agar proportion method and the ESP system for clarithromycin, ethambutol, sparfloxacin and cycloserine. RESULTS: Ninety-nine percent of the MICS generated by the ESP system user identical to or lower than the MICs determined by the agar proportion METHOD: In vitro resistance was documented by the ESP system for 86% of the drugs that patients were taking at the time of breakthrough, and no resistance was seen to cycloserine, a drug that no patient was taking. CONCLUSIONS: The ESP system, a fast and reliable method for determining MAC susceptibilities, could be used to optimize MAC regimens in a timely fashion, avoid the use of ineffective drugs, minimize emerging resistance and ultimately improve outcome.

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A prospective study was undertaken to determine colonization rates, susceptibility profiles, and outcomes in patients with clinical isolates of Acinetobacter baumannii. Fifty percent of patients became colonized with A. baumannii, and 29% of these patients had clinical and colonizing isolates with discordant susceptibility profiles, without apparent relation to antibiotic use. Barrier infection control measures are necessary to prevent nosocomial transmission.

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This report describes two patients with multidrug resistant tuberculosis who were successfully treated with the addition of amoxicillin-clavulanic acid to second-line drugs. Mycobacterium tuberculosis possesses a beta-lactamase contributing to its resistance to beta-lactam antibiotics. The combination of clavulanic acid, a beta-lactamase inhibitor, and amoxicillin has been shown bactericidal for M tuberculosis in vitro. These data suggest that resistant tuberculosis may warrant a trial of treatment including amoxicillin-clavulanic acid.

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Four experiments assessed the effects of stimulating chick embryos with colored light at 2 intensity levels. Both posthatch color pecking preferences (Experiments 1 and 2) and color discrimination learning (Experiments 3 and 4) were unaffected. These results affirm and extend a prior finding of no pre- and posthatch colored light stimulation effect on posthatch color preferences in ducklings. The color pecking preferences found replicated prior findings with chicks. However, they differed from the approach color preferences observed in color discrimination learning.

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