A 55-year-old man with no past medical problems presented with headache, difficulty in walking, and loss of balance of 3 days' duration. Physical examination findings and laboratory test results were unremarkable except for lethargy, slurred speech, positive Romberg sign, hyponatremia, and leukocytosis with left shift.
Infections In Medicine Journal
Third-degree perineal lacerations reputedly occur in
2.2% to 19% of vaginal deliveries in the United
States.1,2 Breakdown of a third- or fourth-degree
perineal repair can lead to incontinence of stool or flatus,
rectovaginal fistula, or sexual dysfunction.3,4 Infection at
the operative site occurs in up to 12% of cases,5 and a key
factor in successful anal sphincter repair is the absence of
Many advances and challenges have occurred in
the field of pediatric infectious disease medicine
during the past 10 years. Because this is the 10th
anniversary of this column, a summarization of what, in
my opinion, are the most clinically significant developments
is presented here.
A 28-year-old man presented with a 1-year history of nodular, plaque-like, nontender, pruritic lesions on his face, ears, elbows, and feet. He was born in Mexico but had been residing in the United States for the past 6 years. He worked in construction, was an active smoker, and denied use of alcohol or illicit drugs. The patient had not been taking any oral medications and had no recent history of trauma.
Morbidity and mortality attributed to Candida and Aspergillus
infections can be quite high in immunocompromised hosts.
The epidemiology and clinical manifestations as well as clinical
pearls on prevention of infections caused by Candida and
Aspergillus are discussed in this second installment of a 3-part
series on opportunistic infections in immunosuppressed
patients. [Infect Med. 2008;25:498-505]
Herpes zoster is a painful, blistering rash that typically manifests in a dermatomal distribution and is caused by reactivation of varicella-zoster virus infection. A classic presentation of herpes zoster involving the right T4 dermatome is illustrated in Figure 1. The patient was a 90-year-old man who experienced severe pain on the right side of his neck and chest followed by development of maculopapular lesions. The lesions, which ranged from macular to vesicular, resolved with no scarring or postherpetic neuralgia following 10 days of therapy with oral acyclovir and intramuscular injections of γ-globulin.
Opportunistic fungal infections are increasingly common in
patients who undergo hematopoietic stem cell transplant
(HSCT). Voriconazole is frequently used in allogeneic
SCT recipients who receive immunosuppressant therapy for
graft versus host disease to prevent invasive aspergillosis.
Indications for voriconazole use include invasive aspergillosis,
candidemia, Scedosporium apiospermum infection, and fusariosis.
We describe a case in which disseminated Fusarium infection
developed in an HSCT recipient who was receiving voriconazole
therapy. [Infect Med. 2008;25:528-530]
A 38-year-old HIV-infected man with a CD4+ cell count of 4/?L and an HIV RNA level of more than 750,000 copies/mL was admitted to the hospital after 1 month of painful right neck swelling and 1 week of dysphagia. His history was also notable for methicillinresistant Staphylococcus aureus (MRSA) bacteremia, which occurred 2 months earlier; adrenal insufficiency; chronic hepatitis C; remote Cytomegalovirus retinitis; and recurrent bacterial pneumonia.
A zoonosis is any disease-bacterial, mycotic, viral, or parasitic-that is transmissible from an animal to a human. More than 200 zoonoses have been identified. The newly emerging zoonosis that has achieved star status in the medical press is avian influenza. Another emerging threat is Nipah virus, which is transmitted from pigs to humans in the agricultural setting and causes encephalitis. But animal to human transmission of zoonoses are multimodal: from exposure to animal secretions in the agricultural setting, to transmission through insect vectors and ingestion of contaminated animal products, to more insidious routes, such as petting or being scratched or nipped at by one's pet dog, bird, cat, lizard, or other creature. A few interesting cases are presented here.
Because widespread use of highly active antiretroviral therapy
has made it possible for persons with HIV infection to live
longer, the epidemiology of HIV/AIDS has shifted in several
ways. The number of persons 50 years and older living with
HIV/AIDS has risen in recent years, and there has been a
substantial increase in common comorbidities associated with
aging in this population. These changes place new emphasis on
the important role of primary care in HIV/AIDS management.
[Infect Med. 2008;25:477-480]