Digoxin did not reduce overall mortality, but it reduced the rate of hospitalization both overall and for worsening heart failure. These findings define more precisely the role of digoxin in the management of chronic heart failure.

No abstract

Listeria monocytogenes, an uncommon foodborne pathogen, is increasingly recognized as a cause of life-threatening disease. A marked increase in reported cases of listeriosis during 1998 motivated a retrospective nationwide survey of the infection in Israel. From 1995 to 1999, 161 cases were identified; 70 (43%) were perinatal infections, with a fetal mortality rate of 45%. Most (74%) of the 91 nonperinatal infections involved immunocompromised patients with malignancies, chronic liver disease, chronic renal failure, or diabetes mellitus. The common clinical syndromes in these patients were primary bacteremia (47%) and meningitis (28%). The crude case-fatality rate in this group was 38%, with a higher death rate in immunocompromised patients.

West Nile (WN) virus is endemic in Israel. The last reported outbreak had occurred in 1981. From August to October 2000, a large-scale epidemic of WN fever occurred in Israel; 417 cases were confirmed, with 326 hospitalizations. The main clinical presentations were encephalitis (57.9%), febrile disease (24.4%), and meningitis (15.9%). Within the study group, 33 (14.1%) hospitalized patients died. Mortality was higher among patients >70 years (29.3%). On multivariate regressional analysis, independent predictors of death were age >70 years (odds ratio [OR] 7.7), change in level of consciousness (OR 9.0), and anemia (OR 2.7). In contrast to prior reports, WN fever appears to be a severe illness with high rate of central nervous system involvement and a particularly grim outcome in the elderly.

417 cases of West Nile (WN) fever were serologically confirmed throughout Israel; 326 (78%) were hospitalized patients. Cases were distributed throughout the country; the highest incidence was in central Israel, the most populated part. Men and women were equally affected, and their mean age was 54±23.8 years (range 6 months to 95 years). Incidence per 1,000 population increased from 0.01 in the 1st decade of life to 0.87 in the 9th decade. There were 35 deaths (case-fatality rate 8.4%), all in patients >50 years of age. Age-specific case-fatality rate increased with age. Central nervous system involvement occurred in 170 (73%) of 233 hospitalized patients. The countrywide spread, number of hospitalizations, severity of the disease, and high death rate contrast with previously reported outbreaks in Israel.

Intermediately penicillin-resistant S. pneumoniae is associated with an impaired bacteriologic and clinical response of acute otitis media to cefaclor and cefuroxime axetil. This effect was more pronounced with cefaclor than with cefuroxime axetil.

Fungal endocarditis has become an important infection associated with medical progress and a modern lifestyle. The most common organisms isolated from patients with fungal endocarditis are: Aspergillus spp.; Candida spp. and Torulopsis glabrata. Men are more frequently affected than women and predisposing factors include: previous cardiac surgery, antibiotic use and hyperalimentation, long-term i.v. catheters. Common clinical findings in patients with endocarditis include: fever, changing murmurs, peripheral emboli which are characteristically large and chorioretinitis. Characteristic laboratory findings are absent and positive blood cultures are obtained only in a relatively small number of patients. Characteristically, Aspergillus spp. almost never grow in blood cultures and must be isolated from removed emboli, from the diseased valve or from infected foreign bodies. Overall survival in patients with fungal endocarditis is rather poor, and hardly exceeds 50%. In general, a combined surgical-medical approach would yield the best results. New therapeutic modalities are needed in order to improve the prognosis of fungal endocarditis.

The in vitro susceptibilities of 86 recent clinical isolates of Brucella melitensis to minocycline, streptomycin, co-trimoxazole, rifampin, and six fluoroquinolones were determined. Minocycline exhibited the lowest MIC and was followed by rifampin and streptomycin. Among the quinolones, WIN 57273 and ciprofloxacin were the most active agents. No antibiotic combination of these agents exhibited synergy against 15 selected isolates. In killing rate experiments, streptomycin exhibited the most rapid kill (<12 h), while a complete kill with minocycline, rifampin, and ciprofloxacin was delayed up to 48 h. The combinations of streptomycin with each of minocycline, rifampin, or ciprofloxacin exhibited the fastest kills (within 2 h), while with the other combinations, a complete kill was delayed up to 96 h. These results demonstrate the discrepancy between the results of various in vitro methods in evaluating the antibiotic susceptibility of B. melitensis.Human brucellosis is an important ongoing medical problem. The Mediterranean basin is one of the most heavily afflicted regions (7). Despite the availability of many antibacterial agents, the complete cure of the infection with prevention of the frequent relapses is still an unattainable goal (7). The new fluoroquinolone antibacterial agents, because of their broad spectrum of bactericidal activity against a variety of gram-negative bacteria and because of their favorable intracellular penetration, could potentially be candidates for the therapy of brucellosis (13, 19). We therefore tested the in vitro activities of several fluoroquinolones (pefloxacin, ofloxacin, ciprofloxacin, fleroxacin, sparfloxacin, and WIN 57273) and compared them with the activities of the conventional anti-Brucella antibiotics: tetracycline, streptomycin, rifampin, and sulfamethoxazole-trimethoprim (co-trimoxazole), recommended for the therapy of brucellosis. In addition, we also studied the possible synergistic effects of several combinations of these antibiotics.Bacteria. Eighty-six Brucella melitensis strains isolated from patients at three different geographical districts in Israel were used. The identities of all B. melitensis strains were confirmed (by Menachem Banai) in the National Brucella Reference Laboratory by the Stamp stain appropriate biochemical reactions and by phage typing (2). Stock strains were kept frozen in small aliquots at -80°C and were kept between experiments on agar slants.Antibiotics. Antibiotics were obtained from their manufacturers as laboratory powders and were reconstituted in their recommended diluents to yield stock solutions of 1,000 ,u.g/ml that were kept at -70°C. Minocycline (Lederle, Pearl River, N.Y.) was used as a representative of the tetracycline family. Streptomycin sulfate (Teva, Jerusalem, Israel), sulfamethoxazole-trimethoprim (Wellcome, Beckenham, United Kingdom), rifampin (Ciba-Geigy, Basel, Switzerland), ciprofloxacin (Bayer AG, Leverkusen, Germany), ofloxacin (Hoechst AG, Frankfurt, Germany), pefloxacin and sparfloxacin (Rhone-Poulenc-Rorer, ...