Recurrent neck infection in a person with HIV/AIDS.
A case of recurrent methicillin-resistant Staphylococcus aureus (MRSA) neck infection in an HIV-infected patient is presented. HIV infection is a known risk factor for the development of MRSA infections; this report suggests that HIV infection may also increase the risk of recurrent disease. Among HIV-infected persons, risk factors for MRSA infection include injection drug use, low CD4+ cell count, high HIV viral load, sex partners with skin infections, absence of trimethoprim/sulfamethoxazole prophylaxis, and recent receipt of a beta-lactam antibiotic. The diagnosis of MRSA infection should be entertained and the appropriate cultures obtained when HIV-infected persons present with soft tissue infections. Given the rising rates of MRSA infection among HIV-infected persons, empiric antibiotics may be recommended. Since inducible resistance to clindamycin is increasing in MRSA isolates, an erythromycin/clindamycin "D-zone" test should be performed before this antibiotic is used. Educating HIV-infected patients about the risk factors for MRSA infection and hygienic measures to potentially reduce infection is advocated; further studies of preventive strategies in this population are needed.
Division of Infectious Diseases, Department of Internal Medicine, Naval Medical Center, San Diego, USA.
Nancy F
NF
Crum-Cianflone
D000328:Adult; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D009333:Neck; D012008:Recurrence; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000150:complications* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*