Infectious Disease

NASHVILLE, Tenn. - Nearly one in every 1,000 pre-schoolers is hospitalized for influenza every year and the rate is more than four times higher for children six months or younger.

A 17-year-old boy hashad severe pharyngitis, fever, anddysphagia for the past 2 days. Althoughhe took an NSAID and triedgargling with hydrogen peroxide, heobtained no relief.

What is the next step when a patient’s urine culture shows -hemolytic streptococci?

A 49-year-old man presented to theemergency department (ED) andcomplained of fever and cough thatproduced bloody sputum for 1 day.He had AIDS and recently receiveda diagnosis of large B-cell lymphoma.His most recent CD4+ cellcount was 24/µL. He had optedagainst receiving highly active antiretroviraltherapy and prophylaxisfor opportunistic infection.

Abstract: Elderly persons with active tuberculosis may present with the classic features, such as cough, hemoptysis, and fever, but some patients present with less typical signs, such as hepatosplenomegaly, liver function abnormalities, and anemia. A high index of suspicion is required when a patient presents with cough or pneumonia unresponsive to conventional therapy. Acid-fast smear and mycobacterial culture of a sputum specimen are recommended for diagnosis. For an elderly patient who tests positive with purified protein derivative, 9 months of isoniazid prophylaxis is recommended. For patients who are intolerant of isoniazid or have been exposed to or infected by an isoniazid-resistant strain, rifampin single-agent preventive therapy may be an effective alternative. (J Respir Dis. 2006;27(7):307-315)

abstract: There is increasing evidence that close monitoring and early intervention lead to better outcomes in patients with cystic fibrosis. At each office visit, spirometry should be performed and sputum culture specimens should be obtained; if the patient cannot produce sputum, a throat culture can be done instead. New respiratory symptoms or other evidence of worsening lung disease should prompt antibiotic therapy, increased airway clearance, and adjunctive anti-inflammatory medication as appropriate. Close attention should be paid to the patient's diet, appetite, stooling pattern, and growth measurements. Adolescents should be given additional information about their medications and adjunctive therapies to encourage them to take on a larger role in their own care. (J Respir Dis.2006;27(7):298-305)

The authors describe a patient who presented with episodic hemoptysis and other respiratory symptoms. His chest radiograph showed a diffuse reticulonodular pattern. Bronchoscopy led to the diagnosis of pulmonary blastomycosis.

Abstract: Patients who have aspirin-exacerbated respiratory disease (AERD) usually experience upper and lower respiratory tract symptoms about 1Z|x to 2 hours after taking aspirin or another NSAID that inhibits the enzyme cyclooxygenase-1. In addition to symptoms such as nasal congestion, rhinorrhea, paroxysmal sneezing, periorbital edema, laryngospasm, and intense flushing, patients may have severe--often life-threatening--exacerbations of asthma. AERD occurs in about 10% to 20% of patients with asthma and in about 30% of asthmatic patients with nasal polyposis. However, AERD also occurs in patients who do not have any of these predispos- ing conditions. In patients with AERD, aspirin desensitization can improve asthma control, reduce the need for corticosteroids, and reduce the need for sinus surgery. (J Respir Dis. 2006;27(7):282-290)

A 37-year-old man presents with new-onset fever and abdominal pain of several days' duration. What does the PA film show, and what further action would you take to arrive at a diagnosis?

Rates of gonorrhea and chlamydial infection are highest among females 15 to 24 years old. Annual screening of all sexually active adolescents is warranted.

A painful, vesicular eruption; an asymptomatic red macule; a rapidlyspreading erythematous plaque--can you identify the disorderspictured here?

Painful, 1- to 1.5-cm macules and papules had developed on the palms and dorsal hands and wrists of a 60-year-old man 2 weeks earlier, after a deer-hunting trip. He had not seen any ticks on his skin or clothing. The lesions persisted despite self-treatment with over-the-counter topical corticosteroids. The patient had general malaise but denied fever, chills, and arthralgia. He was not taking any medications.

A review of the environmental determinants of allergic rhinitis and asthma, including house dust mites, cats, dogs, and cockroaches.

Avoidance of allergens and irritants known to cause or aggravate allergic rhinitis and asthma is a key component in the management of these disorders.

Early diagnosis enables patients to derive maximum benefit from highly active antiretroviral therapy (HAART). Primary care practitioners can play a key role in the timely identification of HIV infection.

Which of the rashes pictured here is cellulitis?

A 40-year-old man complains of worsening lower extremity discomfort.

ROCKVILLE, Md. - The FDA has approved a label revision for the antibiotic Ketek (telithromycin) warning of possible severe and sometimes fatal liver injury during or immediately following treatment with the drug.

ROCKVILLE, Md. - The FDA has given accelerated approval to Prezista (darunavir), a novel protease inhibitor for salvage treatment of patients with HIV.

LOS ANGELES, June 26 - An anti-seizure agent can reduce the frequency of chronic migraine events, according to a researchers here.

ATLANTA, June 23 ? Americans returning after the World Cup in Germany should be wary of measles, according to the CDC, which issued a measles warning today aimed at soccer fans.

ATLANTA - Six unrelated clusters of community-acquired methicillin-resistant Staphylococcus aureus infection involving 44 people in three states have been linked to 13 unlicensed street-corner tattoo artists.

ROCHESTER, Minn. - Heartburn is mainly a phenomenon of western culture, according to a systematic review of gastroesophageal reflux disease (GERD).

SEATTLE - Among newly sexually active women, consistent condom use by their partners reduced the risk of human papilloma virus (HPV) infection, researchers reported.

LONDON - If the fates of former cannibals in New Guinea are an accurate indicator, British citizens may have a half-century to worry about whether they ate beef in the 1990s tainted with prion proteins that will lead one day to variant Creutzfeldt-Jakob disease.