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The free-living amoebae are thermophilic organisms that may play an increasing role among diseases of a warming world. They are uncommon, accidental, yet high consequence pathogens, with differing pathologic syndromes. New prospects for diagnosis and life-saving treatment make early disease recognition imperative. We review the three most commonly diagnosed species that infect humans: Naegleria fowleri, Acanthamoeba species, and Balamuthia mandrillaris.

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Listeria monocytogenes is an increasingly recognized cause of human diseases, especially in the immunocompromised host. Vascular infections involving Listeria remain relatively rare. In addition, Listeria vascular infections and Listeria endocarditis appear to be slightly different entities. We report the case of a 50-year-old man with steroid-dependent systemic lupus erythematosis who presented with Listeria bacteremia occurring with acute axillobifemoral graft thrombosis and an aortic root pseudoaneurysm. Following thrombectomy and graft revision, the patient was successfully treated with a 6-week course of intravenous antibiotics.The authors review Listeria vascular infections published to date and compare them with L. monocytogenes endocarditis cases published in the literature. Only 18 Listeria vascular infections have been previously reported. Major risk factors include age over 50 years, arteriosclerosis, hypertension, and diabetes. Most cases can be managed with surgical resection and/or graft revision followed by extended antibiotic therapy. Ampicillin or trimethoprim-sulfamethoxazole are the drugs of choice in treating these infections. (Infect Dis Clin Pract 2004;12:345-349) CASE PRESENTATIONA 50-year-old African-American male presented to the Emergency Department with the acute onset of fever, nausea, vomiting, diarrhea, right lower extremity tenderness, and numbness. He was experiencing pain in his right lateral upper leg with parasthesias below the knee. That morning, he had awakened and noticed local discomfort and swelling at his right lateral tibial area.The patient's past medical history was significant for systemic lupus erythematosis with associated renal and cerebrovascular involvement. He was chronically steroid-dependent. The patient also had sickle cell trait and anemia with a history of congestive heart failure with an ejection fraction of 25-30%. He denied tobacco and ethanol use. He had received an abdominal aortic aneurysm repair in 1993 and a right axillobifemoral bypass and thrombectomy in 2000. He was married and was a nonsmoker and nondrinker.The man did not recall any specific environmental or dietary exposures in the prior month. He frequently patronized a specific Mexican-style fast food restaurant and recalls ordering a burrito there on the previous day. He occasionally dined at another fastfood chicken restaurant but mostly had hot meals prepared at home by his spouse and mother. He avoided most cold foods and dairy products.Physical examination revealed a cachectic 50-year-old black male lying in an emergency room bed. Vital signs on admission were significant for a fever of 101.38F. Blood pressure was 91/52 mm Hg and pulse was 107 beats per minute. Respirations were 18 breaths per minute. No nuchal rigidity was apparent. His lungs were clear bilaterally. He was tachycardic but had no cardiac murmurs. The abdominal examination was benign. He had a left above the knee amputation. The right lower extremity examination showed mottling of the right foot and coolness of the foot t...

Hantaviruses are a diverse group of RNA arboviruses in the Bunyaviridae family. Although their role as the causative agents of HFRS has been well established, the recent outbreak of a new disease in the Southwest clearly demonstrates the protein clinical manifestations that this pathogen can produce. Furthermore, whereas hantaviruses have been characterized largely as focal agents in the production of geographically delimited diseases, recent trends indicate that endemic areas for the virus are expanding. Outbreaks often occur in clusters as a result of the epizoology of rodent hosts, but isolated cases of hantavirus-related disease also may be observed. Although hantaviruses have proven their pathogenic capability in other areas of the world, it was perceived widely that they were of little consequence to public health in the United States. However, as more is learned about the nature of this truly global infectious agent, its potential danger to mankind becomes increasingly apparent. It is hoped that continued research will elucidate all the facets of hantavirus-induced disease.