Recurrent neck infection in a person with HIV/AIDS.

Link: 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.

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