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The Infectious Diseases Society of America (IDSA) conducted a survey in 1998 to characterize its membership and to determine their needs. The response rate was 39%. Although only 23% of the respondents spent most of their time in the field of teaching and research, 62% of the respondents listed an academic institution as their primary employer. According to survey results, 17% of respondents indicated that care of HIV-infected patients comprised one-half or more of their practices. Respondents noted shortcomings in their training as a result of recent changes in the clinical practice arena and the health care system; more than one-fourth of the respondents identified deficits in their preparation for administration, infection control, pharmacoeconomics, quality assurance, transplantation, and outcomes research. This survey discloses that the IDSA membership perceives a need for changes in IDSA-sponsored fellowship training programs and graduate educational activities.

A Feshbach resonance associated with the 1s3s4s{sup 4}S state of He{sup {minus}} has been observed in the He(1s2s{sup 3}S)thinsp+thinspe{sup {minus}}({epsilon}s) partial photodetachment cross section. The residual He(1s2s{sup 3}S) atoms were resonantly ionized and the resulting He{sup +} ions were detected in the presence of a small background. A collinear laser-ion beam apparatus was used to attain both high resolution and sensitivity. We measured a resonance energy E{sub r}=2.959thinsp255(7) eV and a width {Gamma}=0.19(3) meV, in agreement with a recent calculation. {copyright} {ital 1997} {ital The American Physical Society}

OBJECTIVE To determine the cause of meningitis associated with Cryptococcus neoformans in two patients with recent ventricular-peritoneal (VP) shunt placement. DESIGN A retrospective review of materials, records, and concurrent cases of VP shunt procedures. Isolates of C neoformans from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis. SETTING Two 400-bed community hospitals. PATIENTS Two immunocompetent patients presented with symptoms of progressive hydrocephalus in August 1991. Each received a VP shunt on the same day by the same surgeon using materials from a common vendor and hospital. RESULTS Both patients presented within six to eight weeks with symptoms of fever, headache, rash, and cultures of cerebrospinal fluid (CSF) that yielded C neoformans. Each patient recovered after therapy with amphotericin B and flucytosine followed by several months of fluconazole, although one required replacement of the VP shunt for cure. Review of each patient's history and CSF characteristics at the time of shunt placement suggested reactivation of a preexisting infection. Isolates of C neoformans from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis. Each isolate was found to be unique by chromosomal karyotyping. CONCLUSIONS Our data and previous reports suggest that cryptococcal VP shunt infections appear to be a complication of shunts placed in previously infected persons rather than nosocomial transmission of cryptococcus during placement.

Disseminated infection with the rapidly growing mycobacteria Mycobacterium chelonae and Mycobacterium fortuitum is uncommon. Only eight cases were diagnosed at Duke University Medical Center (Durham, NC) over the last 14 years. We identified 46 other cases by review of the medical literature since 1960. We categorized these 54 cases into three groups according to underlying disease and outcome. Group 1 comprised patients with no identified immune defect, a kidney transplant, collagen vascular disease, or chronic renal failure; these patients usually presented with skin involvement and responded well to antimicrobial therapy (survival rate, 90%). Group 2 comprised patients with cell-mediated immune deficiency, lymphoma, or leukemia; they presented with widespread, multiorgan involvement and severe illness. The survival rate in this group was only 10%. Patients in group 3 (who had other underlying diseases) had intermediately severe illnesses and intermediate responses to therapy. These groups provide the basis for an understanding of disseminated infection secondary to rapidly growing mycobacteria and of the profound effect that unresolved immunosuppression has on survival.

Infectious disease physicians in university and community practices completed a standard data form following each of 1,366 inpatient consultations during a 7-month period. The rate of consultation was higher in the university practice than in the community practice (3.4 vs. 1.8 per 100 discharges, respectively). Known or suspected bacterial pathogens accounted for more than half of all consultations in both practice groups. The three organ systems most commonly affected by infection were pulmonary (20% in university practice vs. 19% in community practice), skin and soft tissue (13% in university practice vs. 20% in community practice), and musculoskeletal (12% in university practice vs. 16% in community practice). Bloodstream infection, pneumonia, unexplained fever, osteomyelitis, urinary tract infection, and cellulitis were the six most common disease processes that led to consultation in both practice groups. The percentage of patients with noninfectious diseases and the percentage for whom a change in antimicrobial therapy was advised was nearly identical in both practice settings. Physicians in private practice performed more consultations on weekends (20% vs. 11% in university practices, P < .001) and between 6:00 P.M. and 7:00 A.M. (15% vs. 6% in university practices, P < .001). The scope and diversity of the work of consultants in community practices are nearly identical to those of their colleagues in university-based practices.

Clinical Affairs Committee: Daniel J. Sexton, Chair, Duke University Medical Center, Durham, North Carolina; Jeffery Band, William Beaumont Hospital, Royal Oak Michigan; Steven Berman, University of Hawaii, Honolulu, Hawaii; John Bradley, Children's Hospital, San Diego, California; Joseph R. Dalovisio, Ochsner Clinic, New Orleans, Louisiana; Christopher Ingram, Raleigh Infectious Disease Associates, Raleigh, North Carolina; W. Patrick Joseph, ID Medical Group, San Ramon, California; Russell M. Petrak, Metro Infectious Disease Consultants, Hinsdale, Illinois; Thomas G. Slama, Hoosier Infectious Diseases, Indianapolis, Indiana; and Barbara H. Wade, Infectious Disease Associates, Pensacola, Florida.