Infectious Disease

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This friable lesion with rapid and destructive growth is classic for granuloma inguinale. This patient was treated successfully with trimethoprim/sulfamethoxazole.

An update to the adult immunization schedule has been released by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practice.

Condylomata acuminata this extensive are beyond the capacity of all topical therapies. The area was initially treated by carbon dioxide laser ablation, and residual small foci of infection were subsequently treated with topical 5% imiquimod cream.

Topical treatment for oral candidiasis is not as effective when there is esophageal involvement. Topical treatments include nystatin, amphotericin B solution, and miconazole tablets. Systemic therapy given orally includes the azoles, of which fluconazole remains the most effective commonly prescribed. Voriconazole is effective against some resistant strains of Candida. Echinocandins, a newer class of drugs, inhibit cell wall synthesis.

The patient received standard acyclovir dosage for first outbreak genital herpes: 200 mg orally, 5 times daily, for 10 days total. At this point, there is no way to predict how often or how severe future recurrences will be.

Medication is seldom necessary. Education is the key element of therapy. An explanation of the process and a discussion of possible triggers-lack of sleep, stress, missed meals etc-is the most key intervention.

This patient had unilateral petechiae on the dorsum of the left foot. If the petechiae were symmetric, the first condition on the differential diagnosis would be thrombocytopenia. Here, though, the platelet count was normal. The patient also had a duplex of both the arterial and venous systems that showed complete thrombosis of both the arterial AND venous systems.

Chlamydia trachomatis, serovar L2b-a recently discovered microbe-was the cause of atypical lymphogranuloma venereum in this HIV-positive patient.

This multi-factorial eruption requires topical or systemic antifungal treatment in conjunction with broad-spectrum antibacterial therapy, topical desiccating maneuvers (such as Burrow’s soaks), and discontinuation of OTC interventions that might be worsening the problem.