Background In late August 1999, an unusual cluster of cases of meningoencephalitis associated with muscle weakness was reported to the New York City Department of Health. The initial epidemiologic and environmental investigations suggested an arboviral cause. Methods Active surveillance was implemented to identify patients hospitalized with viral encephalitis and meningitis. Cerebrospinal fluid, serum, and tissue specimens from patients with suspected cases underwent serologic and viral testing for evidence of arboviral infection. Results Outbreak surveillance identified 59 patients who were hospitalized with West Nile virus infection in the New York City area during August and September of 1999. The median age of these patients was 71 years (range, 5 to 90). The overall attack rate of clinical West Nile virus infection was at least 6.5 cases per million population, and it increased sharply with age. Most of the patients (63 percent) had clinical signs of encephalitis; seven patients died (12 percent). Mu...

/pdf/the-outbreak-of-west-nile-virus-infection-in-the-new-york-1ptnncwn1l.pdf

The Outbreak of West Nile Virus Infection in the New York City Area in 1999

Amphotericin B, the first commercially significant antifungal drug, has been available for more than 30 years. This polyene macrolide antifungal agent continues to play a major role in the treatment of systemic fungal infections, despite the introduction of newer agents such as the azoles. Given the proved efficacy of amphotericin B--and the increasing number of indications for antifungal agents--an extensive review of this drug is warranted. This paper discusses the clinical uses of amphotericin B, including its application in AIDS-related fungal infections, in neutropenic cancer patients who are persistently febrile, and in infections of the central nervous system, lung, peritoneum, genitourinary system, eye, and skin. The paper also reviews the drug's adverse reactions, with a discussion of administration techniques that may reduce these reactions, and its spectrum of activity, pharmacokinetics, and dosage and administration.

Amphotericin B: 30 Years of Clinical Experience

Confirmed infection with HTLV-II (human T cell leukemia virus type II) has been described only in rare cases. The major limitation to serological diagnosis of HTLV-II has been the difficulty of distinguishing HTLV-II from HTLV-I (human T cell leukemia virus type I) infection, because of substantial cross-reactivity between the viruses. A sensitive modification of the polymerase chain reaction method was used to provide unambiguous molecular evidence that a significant proportion of intravenous drug abusers are infected with HTLV, and the majority of these individuals are infected with HTLV-II rather than HTLV-I. Of 23 individuals confirmed by polymerase chain reaction analysis to be infected with HTLV, 21 were identified to be infected with HTLV-II, and 2 were infected with HTLV-I. Molecular identification of an HTLV-II--infected population provides an opportunity to investigate the pathogenicity of HTLV-II in humans.

https://science.sciencemag.org/content/sci/244/4903/471.full.pdf

High Rate of HTLV-II Infection in Seropositive IV Drug Abusers in New Orleans

The epidemiology of the human T-cell lymphotrophic virus type I and type II: etiologic role in human disease

Infection with human T-cell lymphotrophic virus-I (HTLV-I) is now a global epidemic, affecting 10 million to 20 million people. This virus has been linked to life-threatening, incurable diseases: adult T-cell leukemia/lymphoma (ATLL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The cumulative lifetime risk of developing these incurable diseases is approximately 5% in asymptomatic patients. For the emergency physician practicing among patients from high-risk groups, HTLV-I and its associated diseases are presenting an increasing challenge. This report describes its transmission, seroprevalence, treatment, and methods of controlling spread of this retrovirus. Coinfection with HTLV-I and HIV has been shown to accelerate the progression of acquired immune deficiency syndrome (AIDS).

Global epidemic of human T-cell lymphotropic virus type-I (HTLV-I).

Among 211 adults with leukemia who received multiple transfusions, 6 were found to be seropositive for human T-cell leukemia virus Type I (HTLV-I). Before the positive serum specimens were obtained, these patients received a mean of 14 units of red cells and 78 units of platelets. Seroconversion could be documented in three patients. None of the 6 patients seropositive for HTLV-I had a T-cell leukemia, other illnesses attributable to HTLV-I infection, or risk factors for HTLV-I infection other than transfusion: none were seropositive for human immunodeficiency virus. Patients with leukemia who receive multiple transfusions appear to be at risk for HTLV-I infection.

Infection with human T-cell leukemia virus type I in patients with leukemia.

Fungal Infections in AIDS Histoplasmosis and Coccidioidomycosis

To the Editor: We describe a 38-year-old woman with human immunodeficiency virus (HIV) infection and West Nile viral encephalitis. She had a CD4+ lymphocyte count of 351 per cubic millimeter, less than 50 copies of HIV RNA per milliliter on polymerase-chain-reaction assays, and was receiving lamivudine, nevirapine, and zidovudine. She presented with a one-week history of headache and fever and a three-day history of neck stiffness, photophobia, and vomiting. She lived in the Bronx, New York, and had not traveled outside the United States. On admission, she had a temperature of 40°C, nuchal rigidity without focal neurologic signs, and a . . .

West Nile viral encephalitis in an HIV-positive woman in New York.

Human immunodeficiency virus infection in patients with leukemia

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Infection with human T-cell leukemia virus type I in patients with leukemia.

Fungal Infections in AIDS Histoplasmosis and Coccidioidomycosis

West Nile viral encephalitis in an HIV-positive woman in New York.

Human immunodeficiency virus infection in patients with leukemia