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Needle transmission occurs from injection drug users who acquired the infection in malaria-endemic areas outside the United States

00032 Wb = 050 T (008 m )(008 m )

This chronic pulmonary infection caused by Burkholderia pseudomallei occurs occasionally in debilitated drug users, but most cases are reported in Asia and Australia



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Secure Copy Protocol (SCP) One of the first SSH-enabled programs to appear after the introduction of SSH SCP was one of the first protocols used to transfer data securely between two hosts and thus might have replaced FTP SCP works well but lacks features such as a directory listing Secure FTP (SFTP) Designed as a replacement for FTP after many of the inadequacies of SCP (such as the inability to see the files on the other computer) were discovered Secure Hash Algorithm (SHA) A popular cryptographic hash





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A common and difficult clinical problem is management of the parenteral drug user who presents with fever In general, after obtaining appropriate cultures (blood, urine, and sputum if the chest radiograph is abnormal), empiric therapy is begun If the chest radiograph is suggestive of a communityacquired pneumonia (consolidation), therapy for outpatient pneumonia is begun with a third-generation cephalosporin, such as ceftriaxone, 1 2 g intravenously every 24 hours, plus azithromycin, 500 mg orally or intravenously every 24 hours, or doxycycline, 100 mg orally or intravenously twice daily If the chest radiograph is suggestive of septic emboli (nodular infiltrates), therapy for presumed endocarditis is initiated, usually with a combination of vancomycin 15 mg/kg/dose every 12 hours intravenously (due to the high prevalence of methicillin-resistant S aureus and the possibility of enterococcus) and gentamicin, 1 mg/kg/dose every 8 hours intravenously If the chest radiograph is normal and no focal site of infection can be found, endocarditis is presumed While awaiting the results of blood cultures, empiric treatment with vancomycin and gentamicin is started If blood cultures are positive for organisms that frequently cause endocarditis in drug users (see above), endocarditis is presumed to be present and treated accordingly If blood cultures are positive for an organism that is an unusual cause of endocarditis, evaluation for an occult source of infection should go forward In this setting, a transesophageal echocardiogram may be quite helpful since it is 90% sensitive in detecting vegetations and a negative study is strong evidence against endocarditis If blood cultures are negative and the patient responds to antibiotics, therapy should be continued for 7 14 days (oral therapy can be given once an initial response has occurred) In every patient, careful examination for an occult source of infection (eg, genitourinary, dental, sinus, gallbladder) should be done

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Gordon RJ et al Bacterial infections in drug users N Engl J Med 2005 Nov 3;353(18):1945 54 [PMID: 16267325] Infections in injection drug users (entire issue) Infect Dis Clin North Am 2002 Sep;16(3)

Cyclospora, cryptosporidia, and Isospora are protozoans capable of causing disease in both immunocompetent and immunocompromised patients Characteristics of disease include profuse watery diarrhea that is prolonged but usually selflimited (1 2 weeks) in the immunocompetent patient but can be chronic in the compromised host Epidemiologic features may be helpful in determining etiology Recent hospitalization or antibiotic use suggests C difficile; recent foreign travel suggests Salmonella, Shigella, Campylobacter, E coli, or V cholerae; undercooked hamburger suggests E coli, especially O157:H7; and fried rice consumption is associated with B cereus toxin Prominent features of some of these causes of diarrhea are listed in Table 30 3

Diarrhea is acute if lasts < 2 weeks and chronic if lasts > 2 weeks Disease is mild if there are three or fewer stools per day, moderate if there are four or more stools in association with local symptoms (abdominal cramps, nausea, tenesmus), and severe if there are four or more stools per day with systemic symptoms (fevers, chills, dehydration)

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The magnetizing intensity H required to produce a flux density of 050 T can be found from Figure 1-10c It is 70 A t/m Similarly, the magnetizing intensity H required to produce a flux density of 100 T is about 160 A t/m Therefore, the total MMF needed is

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