Endocarditis (IE) is defined by an infection of a native or prosthetic heart valve, the mural endocardium, or an indwelling cardiac device. Although viridan-group streptococci (VGS) and Staphylococci species have collectively been considered as the most common cause of endocarditis, uncommon pathogens may also lead to the disease with significant morbidity and mortality. Abiotrophia defectiva, a nutritionally variant streptococci (NVS), is a virulent bacterium that preferentially affects endovascular structure and is implicated in many culture-negative endocarditis with dreadful complications such as heart failure, septic embolization, and valve destruction. Here, we report a case of a 60-year-old male patient, with a past medical history significant for hypertrophic obstructive cardiomyopathy, who was incidentally found to have mitral valve vegetative mass with an uncommon agent, A. defectiva. The patient was successfully treated with antimicrobial therapy. The objective of this article is to describe the possibility of uncommon cause of common diseases and raises awareness of infective endocarditis caused by A. defectiva among clinicians and microbiologists. Early and proper identification of this pathogen is important to achieve a better outcome.

Enfuvirtide (formerly T20) is an injectable fusion inhibitor that has established effective antiretroviral activity and excellent tolerability in extensively pretreated patients. This fusion inhibitor does not affect the metabolism of other co-administrated drugs for metabolic drug interactions involving enfuvirtide. Few mathematical models have considered co-administration of antiretroviral drugs. We develop a mathematical model to study the effect of enfuvirtide upon this process in combination with protease inhibitors (PIs) using impulsive differential equations. We divide the T cells into several classes to describe the drug activity. Analytical results show that a combination of enfuvirtide and PIs gives a better outcome than single drug activity; furthermore, use of enfuvirtide clearly outranks PIs if only one class of drugs were to be used. We determine the threshold value for the dosage and dosing intervals to ensure the stability of the disease-free state and illustrate our results with numerical simulations. We recommend that use of enfuvirtide, in combination with PIs, be expanded beyond salvage therapy.

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Bonhoeffer et al. 1 studied the long-term dynamics of HIV drug therapy and virus load dynamics. It is well known that highly active anti retroviral therapy (HAART) can effectively control the HIV replication. It is also well known that reverse transcriptase inhibitors (RTIs) could block new infection and as a result control HIV infection. The positive feedback control on such dynamics plays an important role and CD4 + T cells are not only produced from a source but also produced from existing T cells. The present investigation takes into account these factors in the original model of Bonhoeffer et al. The optimal control therapy and the effect of time delay in the positive feedback control function have been investigated. Numerical simulation of the nonlinear model has confirmed our analytical studies.

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