Infections due to Rhodococcus species are being reported with increasing frequency, especially among immunocompromised and HIV patients. R equi is the most commonly isolated species, usually from HIV patients with chronic cavitary pneumonia. Other species of Rhodococcus involved in human infections include R bronchialis, R terrae, R rhodochrous, and R aurantiacus.

Organisms belonging to the genus Rhodococcus are widely distributed in nature, but are particularly abundant in soil. Trauma, steroids, immunosuppressive therapy, surgical procedures, HIV and immune-compromised status predispose patients to infection with Rhodococcus.

Computed tomography (CT) imaging plays an important role in the acute evaluation and management of children with head trauma. When routine quality improvement (QI) meetings with representatives from the Children’s Hospital radiology and emergency departments revealed disagreement regarding the utilization and appropriateness of CT in children presenting with head trauma, an interdepartmental QI team was formed to address this issue. Because formal criteria for obtaining CTs for head trauma were unavailable, internal institutional criteria were developed by consensus after literature review. Contrary to perceptions of some staff members, the majority (95%) of children who received CT met at least one of the established criteria over a one-year study period. There was little relationship between the presence of criteria and abnormal CT results, but decisions whether to admit patients to the hospital or to send them home were influenced by CT results. Follow-up studies suggested that patients who were discharged home with a normal CT or no CT had uniformly good outcomes.

Our nation's attention has recently been focused on the resurgence of tuberculosis as a significant public health problem. The human immunodeficiency virus (HIV) epidemic has played a seminal role in this development. In addition, the concurrent increase in poverty and homelessness, particularly in our inner cities, and the changes in patterns of immigration into the United States have also played a contributing role. Finally, the deterioration of our public health infrastructure, together with decreasing access to medical care, served as the perfect breeding environment for Mycobacterium tuberculosis infection to gain new and dangerous ground. The abrupt change in 1985 in the persistently downward trend in the incidence of tuberculosis cases in the U.S. signaled the first “shot across the bow” in what is now a full-scale war against this old enemy. In the 1990s, tuberculosis has now resumed its historical position of importance and danger in our inner cities. Tuberculosis control strategies -- once thought to be destined solely for the history books -- have regained public health and institutional attention, especially in settings serving inner-city, impoverished, or immunosuppressed populations.