Kawasaki syndrome (KS) is a common and serious disorder
that most often affects children aged 1 to 8 years but mimics
a range of other diseases of childhood. Diagnosis of KS is
based on physical examination findings coupled with the
exclusion of other causes. To provide optimal care for patients,
it is important to be aware of the differential diagnosis of KS.
We report a case of a 4-year-old boy who presented with
persistent fever and cervical lymphadenitis; later, mucous
membrane changes, rash, and conjunctival injection
characteristic of KS developed. [Infect Med. 2008;25:320-322]
Infections In Medicine Journal
Kawasaki syndrome (KS) is a common and serious disorder
Acute suppurative thyroiditis (AST) is a rare inflammatory
complication in patients with hematological malignancy.
Infection spreads to the thyroid from a distant site through
the bloodstream or the lymphatics. Defects such as persistent
thyroglossal duct and pyriform sinus fistula are associated
with the development of AST. Ultrasonography, barium
swallow testing, CT, and fine-needle aspiration are used
for diagnosis. Treatment includes the administration of
parenteral antibiotics, drainage, and excision. We describe
a patient with aplastic anemia and bacteremic AST.
[Infect Med. 2008;25:339-342]
A 45-year-old Hispanic man who acquired HIV infection in April 2003 presented with a 24-hour history of worsening right lower quadrant pain accompanied by fever, decreased appetite, nausea, and vomiting. The pain was described as sharp, constant, and nonradiating. He denied any accompanying diarrhea, constipation, urinary frequency, dysuria, dyspepsia, reflux symptoms, or previous episodes of abdominal pain. There was no history of recent travel. His current CD4+ cell count was 239/?L. In May 2003, he had a CD4+ cell count nadir of 133/?L. His HIV RNA level has remained undetectable at less than 50 copies/mL since starting firstline antiretroviral therapy in June 2003. Therapy consists of coformulated zidovudine/lamivudine/abacavir and efavirenz. He has never had opportunistic infections or other major medical illnesses.
Drug-induced aseptic meningitis should be included in the
differential diagnosis of viral/aseptic meningitis. Clinicians
should use historical clues in patients presenting with signs and
symptoms of viral meningitis to aid in the differentiation of
drug-induced aseptic meningitis from other causes of aseptic
meningitis. Viruses are the most common cause of aseptic
meningitis, with enteroviruses being the most common among
viruses in cases presenting as aseptic meningitis. Ibuprofen is
currently the most common cause of drug-induced aseptic
meningitis. Drug-induced aseptic meningitis is a benign condition
without long-term sequelae. The diagnosis of druginduced
aseptic meningitis is made by establishing a causal
relationship between the use of the drug and the onset of signs
and symptoms, supported by negative tests for infectious
causes of symptoms and rapidity of resolution after the drug
is discontinued. [Infect Med. 2008;25:331-334]
The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that all persons older than 60 years be immunized against the varicella-zoster virus that causes herpes zoster with a single dose of the live, attenuated virus vaccine Zostavax (Merck & Co, Inc, Whitehouse Station, NJ). Furthermore, it urges clinicians to offer the vaccine on the first available clinical encounter.
A66-year-old white man with tuberculosis of the shoulder
joint had a severe hypersensitivity reaction to antituberculosis
medications. Symptoms included development of pulmonary
infiltrates, hepatic dysfunction, renal insufficiency, and
neutropenia. The patient improved after the medications
were withdrawn. [Infect Med. 2008;25:287-291]
Traveler's diarrhea (TD) occurs in persons traveling from
industrialized countries to less developed regions of the world.
Because of the growing ease of travel and an increasingly
globalized economy, TD is becoming more common. Increasing
antibiotic resistance among causative bacterial organisms and
also emergence of new pathogens are additional challenges in
the management of TD. Enterotoxigenic and enteroaggregative
pathotypes of Escherichia coli are the principal causes of TD.
This review discusses the epidemiology of these pathogens, as
well as elements of prevention, diagnosis, and management.
[Infect Med. 2008;25:264-276]
A 56-year-old woman with type 2 diabetes mellitus and hypertension presented with acute left-sided weakness and altered mental status, for which she was hospitalized. The patient, who was obese, was in her usual state of well-being until 2 months before this presentation, when she noted a gradual onset of generalized weakness. She received a diagnosis of severe hypokalemia that was refractory to oral potassium supplementation. The outpatient workup of the cause of her hypokalemia was in progress.
Life-threatening heart failure associated with itraconazole
antifungal therapy developed in a patient with disseminated
Coccidioides immitis infection. This was documented by
cardiac studies that demonstrated a deterioration of cardiac
function during therapy and an improvement after itraconazole
therapy was discontinued. Heart failure associated
with itraconazole can be missed by those unfamiliar with this
complication. In any patient with a fungal infection who is
being treated with itraconazole, this serious complication can
occur; however, it can be reversible with discontinuation of
the drug. [Infect Med. 2008;25:292-293]
Shapiro discussed the numerous studies that reiterate- despite a troubling grassroots opinion among lay Lyme disease advocates and a select group of physicians- that the term "chronic Lyme disease" is a misnomer for other symptom complexes and that long-term antibiotic therapy provides no benefit.1,2 "Patients with these symptoms have been studied at many different scientific centers," explained Shapiro, extrapolating from an article he coauthored that appeared in the October 14, 2007, issue of the New England Journal of Medicine.1 "The majority have no evidence of ever having been infected with the bacteria that causes Lyme disease, either by clinical history or by laboratory tests.