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Frederick William Twort and Felix d'Hérelle independently discovered bacteriophages in 1915 and 1917, respectively. This led to the early trials of using bacteriophages to treat infectious diseases worldwide. The earliest reported use of bacteriophages therapeutically in the United States was in 1922. With the subsequent discovery of antibiotics in the 1940s, and because of disappointing results of phage therapy in the next decade, use of bacteriophages as therapeutic agents declined in western countries. This paper addresses two questions in the field: what is the historical record of the successes and failures of phage therapy in the United States and, what led to abandoning phage therapy in the United States? We examined the literature from 1915 to 1965, and we present a numerical analysis of the papers published during that period. We report key historical factors leading to a decline in the use of phage therapy in the United States by the 1950s. Since bacteriophages were first used therapeutically, several changes have occurred: increased antimicrobial drug resistance and a better knowledge of the biology of bacteriophages are important examples. Early assessments leading to the rejection of phage therapy in the United States were perhaps appropriate. However, it is time to reconsider the role of bacteriophages in treatment of bacterial infections.

Multiple sclerosis is the commonest non-traumatic disabling disease that affects young adults. The presenting signs and symptoms include several common symptoms seen in primary care. It therefore behooves primary care practitioners to recognize the disease’s presentation, mimicking diagnoses and initial workup. Management of many of the symptoms of disease exacerbations are within the purview of the primary care provider. Co-management of the patient with multiple sclerosis with a neurologist improves patient care and provides a context for management of co-morbidities. The patient-centered medical home provides many services and resources that can be of use to a multiple sclerosis patient. Vaccinations and other preventative care are important in the care of the multiple sclerosis patient, particularly those on immunosuppression therapy for their disease.

OBJECTIVES: Both chronic and acute malnutrition in children under 5 remain a persistent problem in low and low-middle income countries. Haiti faces the highest burden of childhood malnutrition in the Western Hemisphere. We attempted to describe the prevalence of malnutrition in children in a farming community in Haiti and record characteristics of the those experiencing the disease. METHODS: A household survey was conducted within the town of Fontaine in the Nord department of Haiti on all children under the age of 5. A total of 535 children were assessed. Anthropometric data was taken on the children and household information was assessed via a population-based survey. RESULTS: Of the children assessed, 28% (149/535) were either chronically or acutely malnourished. Of the children who were malnourished: 36.4% (43/118) had 3 or more bouts of diarrhea in the past 3 months and only 5.3% (7/132) had stopped breastfeeding before 1 year of age. On average, the mothers of these children had completed 6.2 years of formal schooling. A slight majority of mothers, 54.7% (81/148), either “never” or “rarely” were concerned their child was malnourished. Of the households with malnourished children 88.4% (130/147) had reported running out of food in the last month. When asked what caused children in Fontaine to be malnourished, mothers of malnourished children cited a lack of food, 56.2% (82/146), and a lack of access to employment, 25.3% (37/146), most frequently. CONCLUSIONS: Malnutrition commonly affects children in Fontaine. Efficacious prevention interventions could possibly include decreasing food insecurity, or increasing girls’ education level. FUNDING SOURCES: None.

A pencil core with an intact pencil tip was excised from the thigh of a 60-year-old male 53 years after a puncture wound. Histologic examination of the excised pencil core and the surrounding tissue revealed a foreign body reaction with abundant entrapped dark black pigment and chronic reparative changes, including dense sclerosis and focal granulation tissue formation.

Cystic fibrosis is a recessive autosomal disease caused by mutations in the cystic fibrosis transmembrane conductance regulator gene. Cystic fibrosis-related diabetes (CFRD) is a common comorbidity of cystic fibrosis. Diabetic myonecrosis is a rare self-limited complication of poorly controlled diabetes mellitus that commonly presents with acute, intense pain and swelling of lower extremities and responds well to conservative management. We report the first case of diabetic myonecrosis in a patient with CFRD.

Objective: This case study describes the burden of psychiatric disease and mental health services available on the Caribbean island of Nevis. Methods: Hospital and clinic records and government reports were retrospectively collated and analyzed. Previously unpublished information pertaining to psychiatric cases on the island from 2003 to 2005 was collated and analyzed. The personal experience of the authors as primary care providers participating in mental health care is integrated into the analysis. Results: Mental health services on the island of Nevis are provided free of cost as part of community health services. A psychiatrist visits the island twice a week from the adjoining island of Saint Kitts and is aided by two resident psychiatric nurses. Local primary care providers at the island's only hospital are providers of emergency, urgent, and hospital psychiatric care. The most common psychiatric diagnoses are depression, schizophrenia, and drug-induced psychosis. Conclusions: Psychiatric disease and...

* Abbreviations: ETU — : Ebola treatment unit EVD — : Ebola virus disease PPE — : personal protective equipment I had the privilege of serving as a short-term Ebola clinician in Sierra Leone. I went as part of a team with the nongovernmental organization Partners in Health1 in January and February 2015. Sierra Leone is a country of 5.9 million people, with 41.7%

Background: Nearly 30% of people in the United States are colonized with Staphylococcus aureus and 1% to 2% with methicillin-resistant Staphylococcus aureus (MRSA) in the anterior nares. However, it is not known if lytic bacteriophages against S. aureus are present in the anterior nares, and if they are, what the prevalence rate is, or if they interfere with S. aureus colonization. The aim of this study was to determine the prevalence of nasal carriage of S. aureus and MRSA and to screen for S. aureus lytic bacteriophages in healthcare environment workers and ambulatory patients. Methods: We enrolled 202 individuals into this study. The anterior nares were swabbed to isolate S. aureus, MRSA, and any lytic S. aureus bacteriophages that may be present. Putative S. aureus colonies on blood agar plates were identified using gram stain, catalase and coagulase tests, and confirmed by S. aureus-specific PCR. Presence of staphylococcal lytic bacteriophages were screened by a plaque assay technique using a methicillin-sensitive reference S. aureus strain ATCC 29213. Results: Of the 49 (24%) individuals who screened positive for S. aureus, two (1%) were positive for MRSA. None of the samples were positive for lytic bacteriophages against S. aureus. Subgroup analysis found no significant difference in the prevalence of S. aureus in the house staff compared to other healthcare environment workers or ambulatory patients of the clinic. Similarly, no significant difference in colonization was noted across the population with respect to age, sex, body mass index, or presence of diabetes mellitus. Conclusion: The prevalence of nasal carriage of S. aureus and MRSA in the studied population was 24% and 1%, respectively, similar to the rate of prevalence in the United States. The study also showed that the anterior nares do not seem to harbor lytic bacteriophages against S. aureus.

It is not known whether farming families have more cases of uncommon fungal infections than the general population because of their interdependence on farming environments, including farm animals and other pets. The authors describe here two cases of fungal infections with interesting epidemiology that suggest associations that have been insufficiently described and explored in the literature. The first is a case of otomycosis in a 17-year-old female and is suspected to be linked to hay baling. The second is a case of tinea capitis in a 25-month-old female toddler living on a farm and illustrates that rural farming families with closer association with animals are infected with different species of fungi than are seen in urban areas.