Legionnaires' disease is an acute bacterial infection, generally sustained by Legionella pneumophila, which involves primarily the lower respiratory tract, although it is often associated with multi-systemic extrapulmonary manifestations. Afflicted patients may sometimes have gastrointestinal symptoms, liver function abnormalities, renal failure or central nervous system complications, while cutaneous manifestations are very uncommon and may include erythematous, maculopapular or petechial skin lesions. Pathogenesis of skin involvement in the setting of Legionnaires' disease is still uncertain, but may involve toxic or immunological mechanisms. Two exceptional cases of Legionella pneumonia complicated by diffuse, macular rash in two adult women are described, in association with severe peripheral polyneuropathy and flaccid quadriplegia in one case.

The iatrogenic form of Kaposi's sarcoma (KS) is typically observed among transplant recipients, and the most appropriate therapeutic approach (usually including reduction of immunosuppression, specific chemotherapy, and/or administration of antiviral agents against human herpes virus-8) is still controversial. Available experiences on the effect of the anti-herpes viruses drug cidofovir provide conflicting results. Herein, we report the clinical, histological, and virological features of a liver transplant recipient successfully treated with a combined therapy of cidofovir and liposomal daunorubicin, associated with a reduction of the immunosuppressive regimen, for an advanced cutaneous and visceral KS.

The fourth case report of a brain abscess due to the fastidious Gram-negative organism Capnocytophaga spp. is described and discussed on the grounds of clinical, microbiological, and therapeutic evidence. A probable origin from a cat bite and/or an underlying severe mandibulary granuloma is suspected. Due to lack of clinical and neuroradiological response to neurosurgery and a combination of imipenem-amikacin-clindamycin-fluconazole, second-line empiric llnezolid treatment proved rapidly successful, in the absence of further microbial isolations. In vitro antimicrobial susceptibility testing is often unpredictable for Capnocytophaga spp., and agents usually active on Gram-positive organisms may also be effective, both in vitro and in vivo. Due to its favorable brain penetration and its dual mode of administration, linezolid may be an alternative option for patients with multiple risk factors, brain abscess of suspected polymicrobial origin, and lack of response to empiric or culture-driven therapeutic attempts.

Background: Actinomycosis is a rare, insidious, infectious disease. Cervicofacial, thoracic and abdominopelvic districts are most commonly involved. Its tendency to involve surrounding structures may mimic a tumor on imaging studies. Early diagnosis, obtained with mini-invasive methods or surgical biopsy, is fundamental to optimize therapeutic approach and to reduce morbidity due to aggressive surgery. Antibiotic therapy is the cornerstone of the treatment of actinomycosis, but the combination with a surgical resection can be necessary in patients who do not respond to medical treatment. Methods: A 66-years old female presented at our attention with an abdominal, retroperitoneal mass found during clinical tests for a vertiginous syndrome. Patient presented with asthenia, anorexia, weight loss, and sacral pain. A retroperitoneal mass, studied with Computed tomography (CT) and Positron emission tomography (PET), was found. No inflammatory signs were found in laboratory tests. Previous core biopsies did not provide the expected results. Cause of that, the patient was prepared for a surgical laparoscopic biopsy and ureteral stenting. After frozen biopsies, histological findings have identified filaments of Actinomyces. No apparent cause of this infection has been identified at first exploration. Results: The patient was treated with antibiotic therapy for three months (Amoxicillin: 1g three times daily). At three months first follow-up, the CT shows the reduction of the retroperitoneal mass and the presence of diverticulosis of the sigma near the mass, in absence of signs of fistulisation. Conclusion: Abdominopelvic actinomycosis should be considered in patients with unusual abdominal mass on abdominal CT or PET. Early diagnosis is necessary to avoid aggressive surgery and its morbidities. Open/laparoscopic surgical biopsy is often necessary to identify the infection. Antibiotic therapy is the standard treatment but surgery can help to optimize medical approach removing necrotic tissue and persistent sinuses.

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Letters to the Editor CD4 lymphocyte count which was 277/mm3 at the time of diagnosis. He was evaluated by two ophthalmologists, both of whom confirmed CMV retinitis with a retinal detachment. In addition he had a vitreal biopsy which was positive by PCR for CMV and negative for herpes simplex, herpes zoster and Toxoplasma gondii. His retinitis failed to respond to intravenous genciclovir, but subsequently responded to induction with 3 weeks of intravenous foscamet therapy and remains quiescent on IV foscamet maintenance therapy. Following diagnosis of CMV infection his CD4 count fell to 90/mm3 within 6 months, although it improved with combination antiretroviral therapy (zidovudine and zalcitabine HIV itself alone, in the absence of other infecting agents, also has been implicated as a cause of prostatic abnormalities.2In the current literature we rarely find reports of prostatitis caused by cytomegalovirus (CMV) in HIV-positive persons. ' We here report a rare case of prostatitis due to CMV infection in a patient with AIDS in whom the diagnosis was established after death and who received antiviral chemotherapy with ganciclovir.A 34 year old intravenous drug abuser with AIDS was hospitalised complaining of lower abdominal pain, urinary frequency without dysuria, and fever. Six months before he had came to our attention because of CMV retinitis that had been treated with ganciclovir with a successful response, but the patient had not continued with a maintenance therapy. At the moment of the admission he appeared severely ill. The laboratory studies revealed a CD4 + lymphocyte cells count below 50/pl, a white blood cells count (WBC) of 3400/mm3 with 60% neutrophils, and 18% lymphocytes, an erythrocyte sedimentation (ESR) rate of 78 mm/hour, and a lactate dehydrogenase (LDH) value of 650 U/l. Urinanalysis revealed one to five WBC per high power field without casts and trace amounts of protein. Repeated urine culture grew CMV. Microscopic and cultural examinations of blood, sputum and stool specimens were unremarkable. An ultrasound evaluation of the lower abdomen was normal. The examination of the prostate was normal. An active CMV retinitis in the right ocular fundus was detected. Reinduction therapy with ganciclovir was started in association with cotrimoxazole. The patient's clinical condition continued to deteriorate, and he died after two weeks of hospitalisation. Post mortem examination reported a disseminated CMV infection, with prominent localisation in the prostatic gland, the lungs and the adrenal glands. Macroscopic evaluation revealed a normal sized prostate, while microscopically there was evidence of a large inflamed prostatic epythelium with multiple areas of tissue necrosis containing CMV intranuclear and intracytoplasmatic inclusions.Although infection with CMV is commonly benign in the immunocompetent person, the virus remains a major cause of morbidity and 447 on 1 May 2019 by guest. Protected by copyright.

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