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This retrospective, case-control study aimed to identify variables associated with the incidence of Clostridium difficile--associated diarrhea (CDAD) in acute care facilities and to specifically identify the relationship of fluoroquinolones and acid suppressive agents in the development of CDAD. Seventy-one symptomatic patients positive for C. difficile toxin A or B hospitalized for at least 72 hours were compared with 142 control patients hospitalized for at least 72 hours who were not positive for C. difficile toxin A or B. Two controls were matched to one case patient for age within 5 years, unit of admission, and date of admission. The mean ages for cases and controls were 63.5 and 62.7 years, respectively. After adjusting for two confounding variables--hospital stay within 3 months and Charlson Comorbidity Index-conditional multiple logistic regression identified six risk factors for development of CDAD: gastrointestinal procedures within 60 days (odds ratio [OR] 9.1, P < 0.013), levofloxacin exposure (OR 8.2, P < 0.033), moxifloxacin exposure (OR 4.1, P < 0.026), imipenem exposure (OR 14.9, P < 0.014), laxative use (OR 20.2, P < 0.0001), and immunosuppressive use (OR 20.7, P < 0.034). The risk of CDAD after exposure to levofloxacin or moxifloxacin was not significantly different. Acid suppressive therapy was not a risk factor for CDAD development. [ABSTRACT FROM AUTHOR]

The persistence of Plasmodium falciparum in the placenta after apparently adequate therapy with quinine has been described. We describe this phenomenon in the placenta of a 19-year-old woman with falciparum malaria, who was treated with a combination of quinidine and clindamycin. Although this therapy was effective and diminished her peripheral blood parasitemia from 3% at presentation to almost undetectable at the time of delivery, vast numbers of P. falciparum-infected erythrocytes were present in the maternal sinusoids of the placenta. This sequestration of infected erythrocytes produced a local parasitemia in the placenta of 70% to 80%. Additionally, rare Plasmodium-infected erythrocytes were also seen in the fetal blood of the placenta. We review malaria in pregnancy, parasitic involvement of the placenta and emphasize that Plasmodium-infected erythrocytes may persist in the placenta even after clearance of parasites from the peripheral blood.

Background: Paragonimiasis is a parasitic infection with a predilection for pulmonary involvement. Paragonimus species occur throughout the world and exist in nature in a snail-crustacean-mammalian life cycle. Human disease is most frequently encountered in cultures that ingest raw or undercooked crustaceans. North American paragonimiasis, caused by an endemic Paragonimus species, Paragonimus kellicotti, predominantly causes disease in carnivorous and omnivorous animals but may cause human disease if the intermediate host, the crayfish, is ingested raw or undercooked., Case: A previously healthy, 21-year-old male was infected with P kellicotti and developed parasitic hemoptysis. The disease was contracted through the ingestion of local, undercooked crayfish. Diagnosis was established through the morphologic examination of eggs in the cytologic preparation of bronchioalveolar lavage fluid. The patient was successfully treated with praziquantel and recovered without incident., Conclusion: Paragonimiasis is a cause of parasitic hemoptysis worldwide. Paragonimiasis is infrequently encountered in North America and is usually not considered in the differential diagnosis of hemoptysis unless specific risk factors are known. The cytologist or cytopathologist, therefore, may be the first to encounter the diagnostic eggs and should be familiar with this disease.

Central nervous system invasion by Treponema pallidum, the causative agent of syphilis, occurs in many, if not most, patients with syphilis. Laboratory findings from untreated asymptomatic syphilis patients with abnormalities of cerebrospinal fluid are termed asymptomatic neurosyphilis and represent a group that has an increased risk for developing clinical neurosyphilis syndromes. Clinical neurosyphilis syndromes, which occur in a minority of patients, may become apparent at any time in the natural history of untreated disease and often cause serious morbidity for individuals who develop them. Because there is no single sensitive and highly specific test for neurosyphilis diagnosis, clinicians must approach this important syndrome using a combination of clinical and laboratory data and a firm understanding of the disease.