No abstract

The ongoing outbreak of Zika virus infection that began in South America and Central America in 2014 is worrisome because of associations with fetal microcephaly and with Guillain-Barré syndrome. Here we summarize what has happened and what is known so far. As the outbreak continues to evolve, we urge clinicians to watch for updates at cdc.gov.

The current national monitoring of routine wellness care and vaccine uptake does not provide data on health maintenance among pediatric populations with chronic medical conditions. In this case-control study that analyzes wellness visits and vaccine uptake among adolescents, ages 16 to 18 years, we identified 938 without (controls) and 74 with (cases) 1 of 12 specific chronic medical conditions. The PPSV23 (23-valent pneumococcal polysaccharide vaccine) is recommended by the Advisory Committee on Immunization Practices for these 12 conditions and served as a measure of uptake for medically indicated vaccines. Our controls were twice as likely as cases to have a documented well visit in the past year, and there was a significantly higher proportion of controls than cases vaccinated with Tdap (tetanus toxoid, reduced diphtheria toxoid, acellular pertussis), MCV-4 (quadrivalent meningococcal conjugate), and HPV (human papillomavirus), all P < .05. More than 60% of cases failed to receive PPSV23. Adolescents with chronic medical conditions are at high risk of neglecting routine health maintenance.

A 7-week-old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self-resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.

A 21-year-old male with T-cell acute lymphoblastic leukemia (ALL) was admitted for fever and neutropenia. Despite 72 hours of antibiotic therapy, he remained febrile and developed new abdominal and pleuritic chest pain. A computerized tomography (CT) scan demonstrated necrotizing enterocolitis and a left lower lobe pneumonia with early cavitation versus abscess formation. His antimicrobial regimen was broadened to meropenem and voriconazole. On hospital day 5, an asymptomatic rash appeared on his left face consisting of erythematous macules that blanched with pressure. Within 24 hours, the skin lesions expanded and developed a central, nonblanching violaceous hue. Liposomal amphotericin B was added and a biopsy of the rash was obtained. Mucor spp was confirmed by tissue culture. Repeat imaging showed interval development of diffusely scattered and innumerable hypodense lesions throughout the liver and spleen, as well as diffuse myositis and within the brain and spine. Care was withdrawn and the patient expired on hospital day 11. Risk factors for developing invasive aspergillosis and mucormycosis are similar. This case illustrates similarities in their clinical presentations, highlights potential gaps in coverage by antifungal agents that are commonly used for empiric coverage, and reviews treatment options.