Cryptococcus neoformans is a major, global cause of meningoencephalitis in immunocompromised patients. Despite advances in the molecular epidemiology of C. neoformans, its population structure and mode of reproduction are not well understood. In the environment, it is associated with avian guano or vegetation. We collected nearly 800 environmental isolates from three locations in the United States (viz., North Carolina, California, and Texas) and compared them with one another and with clinical isolates from North Carolina. As expected, they consisted of the most prevalent serotypes, serotypes A and D, as well as serotype AD hybrids. The majority of environmental isolates were obtained from pigeon excreta. All environmental and clinical isolates of serotype A or D had the MAT␣ mating-type allele. However, the AD hybrids included MATa alleles typical of serotypes A and D. Using an amplified fragment length polymorphism fingerprinting technique with two primer pairs, we identified 12 genotypes among the isolates of serotype A. Six of these genotypes were present in both the clinical and the environmental populations. However, one of the most prevalent environmental genotypes was absent from the clinical samples, and two other genotypes were isolated only from patients. The combined molecular data suggest that this environmental population of C. neoformans is predominantly clonal, although there was evidence for recent or past recombination.

Despite the recent focus on alcohol education and prevention at the college level, college students have not been taught how to define standard drinks accurately. They tend to overstate the appropriate volumes, leading them to overpour drinks and underreport levels of consumption. Self-reported consumption levels are altered by feedback regarding the accuracy of students' definitions of standard drinks. The findings raise important questions about the validity of students' responses on alcohol surveys and the definitions of risky drinking that are based them.

In the 20th century, the introduction of multiple vaccines significantly reduced childhood morbidity, mortality, and disease outbreaks. Despite, and perhaps because of, their public health impact, an increasing number of parents and patients are choosing to delay or refuse vaccines. These individuals are described as vaccine hesitant. This phenomenon has developed due to the confluence of multiple social, cultural, political and personal factors. As immunization programs continue to expand, understanding and addressing vaccine hesitancy will be crucial to their successful implementation. This review explores the history of vaccine hesitancy, its causes, and suggested approaches for reducing hesitancy and strengthening vaccine acceptance.

Background-Cerebrospinal fluid (CSF) white blood cell (WBC) counts for neonates and young infants are usually interpreted based on values reported in reference texts or handbooks. However, current reference texts either present normal CSF parameters without citation or cite studies with significant limitations.

BACKGROUND: Cerebrospinal fluid (CSF) protein values decline over the first few months of life as the infant's blood‐CSF barrier matures. However, published studies differ in the reported rate, timing, and magnitude of this decline. OBJECTIVE: To quantify the age‐related changes in CSF protein concentration and to determine accurate, age‐specific reference values for neonates and young infants. DESIGN, SETTING AND PATIENTS: This cross‐sectional study included infants age 56 days or younger who had a lumbar puncture performed in the emergency department of an urban tertiary care children's hospital between January 1, 2005 and June 30, 2007. Infants with conditions associated with elevated CSF protein concentrations, including traumatic lumbar puncture and bacterial or viral meningitis, were excluded. RESULTS: Of 1064 infants undergoing lumbar puncture, 375 (35%) met inclusion criteria. The median CSF protein value was 58 mg/dL (interquartile range: 48–72 mg/dL). In linear regression, the CSF protein concentration decreased 6.8% (95% confidence interval [CI], 5.4%‐8.1%; P < 0.001) with each 1 week increase in age. The 95th percentile values were 115 mg/dL for infants ≤28 days and 89 mg/dL for infants 29–56 days. The 95th percentile values by age category were as follows: ages 0–14 days, 132 mg/dL; ages 15–28 days, 100 mg/dL; ages 29–42 days, 89 mg/dL; and ages 43–56 days, 83 mg/dL. CONCLUSIONS: We quantify the age‐related decline in CSF protein concentration among infants 56 days of age and younger and provide age‐specific reference values. The values reported here represent the largest series to‐date for this age group. Journal of Hospital Medicine 2011. © 2010 Society of Hospital Medicine.

Achromobacter xylosoxidans is a rare, opportunistic infection most commonly encountered among immunocompromised patients during hospitalization. Primary uncomplicated bacteremia, catheter-associated infections, and pneumonia have been reported as the most common clinical presentations, but skin and soft tissue infections from A. xylosoxidans are rare. We describe a case of A. xylosoxidans presenting as cellulitis and bacteremia in an immunocompromised patient.

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