Despite an increasing incidence of severe neurological disease due to West Nile virus, supportive care remains the mainstay of treatment. We present the first report of WNV induced acute flaccid paralysis successfully treated with high-dose corticosteroid therapy.

Bacterial endocarditis secondary to Panton-Valentine leukocidin producing community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections is rare. We report 5 previously healthy patients who presented with endocarditis after developing furunculosis due to CA-MRSA. A retrospective chart review of all patients with MRSA positive blood cultures was conducted over a 12-month period. Patients with multiple positive blood cultures within 72 h of admission and who had no risk factors for MRSA acquisition were included. Modified Duke's criteria were used to define bacterial endocarditis. PCR detection of Panton-Valentine leukocidin (PVL) genes as well as SCCmec typing was performed. In addition, strain typing of MRSA isolates was performed utilizing pulsed-field gel electrophoresis. Five out of a total of 193 patients had features consistent with CA-MRSA infections and met modified Duke's criteria for bacterial endocarditis. Blood culture isolates were found to be PVL gene positive and carried the type IV SCCmec element. PFGE confirmed that skin isolate was identical to the isolate cultured from his blood. Bacterial endocarditis in patients with CA-MRSA furunculosis is an emerging entity. In areas where CA-MRSA skin infections are prevalent, inappropriate initial antibiotics remain a major problem and may result in significant morbidity.

Despite increasing awareness of central line-associated bloodstream infections (CLABSIs) in general wards, published strategies come from intensive care units (ICUs) of large tertiary care centers. After implementing a central line insertion checklist, two community hospitals experienced an 86% reduction in CLABSI rates in ICUs and a 57% reduction in non-ICU settings over 36 months.

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