Infectious Disease

NEW YORK -- Giving bigger ribavirin doses to heavier hepatitis C patients appears to result in better outcomes, especially for African Americans, researchers here said.

HONG KONG -- In a head-to-head comparison in patients with chronic hepatitis B, telbivudine (Tyzeka) reduced viral loads more effectively than adefovir (Hepsera), researchers said here.

PRAGUE, Czech Republic -- Donated kidneys at the extreme end of acceptability because of donor age, storage time, or kidney condition may have good short-term outcomes, researchers said.

A comatose 82-year-old woman is brought to the emergency department. Her husband reports that after dinner she began to have difficulty in speaking, lost consciousness, and fell to the floor. He tried to rouse her, but was unsuccessful and called for an ambulance.

Forty-eight hours ago, a 39-year-old man presented to the emergency department with emesis and severe upper abdominal pain of semi-acute onset, which radiated slightly to the back.

For 2 weeks, a 31-year-old man has had a nonhealing, painful abscess on his left shoulder. A week before presentation, he sought treatment at a walk-in clinic; the abscess was incised and drained, and he was given gatifloxacin.

Within the past 7 years, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections has significantly increased. Risk factors for MRSA infection include previous antibiotic therapy and living arrangements such as prisons or military barracks that involve close, frequent contact with infected persons. Treat stable patients with MRSA skin infections with oral antibiotics in addition to incision and drainage; hospitalization and intravenous antibiotics are recommended for patients whose condition is unstable or who are unlikely to adhere to an oral regimen. A new strain of C difficile, BI/NAP1, has been associated with recurrent infection; more severe disease that mandates urgent colectomy; and dramatically higher mortality in vulnerable populations, such as older adults. Although oral metronidazole has been the mainstay of treatment of C difficile infection, oral vancomycin may be slightly more effective in patients with severe disease.

As a new resident of "tick country" in northern California, I was recently introduced to a great way to remove ticks--both those that are newly attached and those that have been there for a day or two.

For the past month, a 67-year-old woman has had a pruritic rash under her left breast. She takes an antihypertensive and is otherwise healthy.

For more than 3 years, a 63-year-old man with a long history of parapsoriasis had multiple hyperpigmented, erythematous plaqueswith scaling on the abdomen, back, feet, and arms. Some lesions had a hypopigmented center. The patient denied systemic symptoms.

Sharp, shooting posterior neck pain prompted a 29-year-old man to seek medical attention. The pain began 4 days earlier and progressed to the point that it occurred with swallowing. He wore a wool scarf to restrict his cervical range of motion. During the history taking, he remained rigid and avoided rotation and flexion or extension of the spine.

This 8-year-old boy's mother thought her son had a fungal infection on his feet. Examination disclosed malodorous, nontender plaque formation on the weight-bearing surfaces of both feet. Within the plaques were round pits and furrows.

Although many lacerations are treated in the emergency department, primary care clinicians still see their share of such wounds. Most lacerations are incurred on the face and head (as a result of falls or altercations) or on the hand or lower arm (caused by tools, broken glass, or other sharp objects).

ROCKVILLE, Md. -- Afluria was approved today by the FDA as the sixth seasonal influenza vaccine on the U.S. market. Manufactured by Australia's CSL Limited, the company will produce about two million doses for this year's flu season.

SEATTLE -- There is something about farming, nursing, and teaching that seems to predispose those who work at these professions to death from systemic autoimmune diseases, reported investigators here.

MILWAUKEE -- A Clostridium difficile infection sharply increases the risk of death for patients with underlying inflammatory bowel disease, researchers here said.

CHICAGO -- The incidence and economic burden of hospital-acquired Staphylococcus aureus infections have increased significantly in recent years, investigators here have concluded.

ATLANTA -- Children who were given thimerosal-containing vaccines a decade ago showed no causal decline in neuropsychological outcomes by ages seven to 10, CDC researchers here found.

WASHINGTON -- Influenza vaccination may save many fewer older patients' lives than generally claimed, according to researchers here.

ATLANTA -- Influenza vaccination rates have not rebounded after widespread vaccine shortages in the 2004-2005 flu season, CDC investigators said.

SAN FRANCISCO -- In another setback to the effort to create a preventive vaccine against HIV, a key trial has been halted because of a lack of efficacy, according to Merck and the HIV Vaccine Trials Network.

CHICAGO -- Rubella vaccination reduces the risk of Fuchs heterochromic iridocyclitis (FHI), investigators here reported, providing additional support for a link between rubella virus infection and inflammation.

CHICAGO -- A gene that allows micro-organisms to resist the carbapenem antibiotics -- first seen in New York -- is spreading to the Midwest, a St. Louis researcher said here.

CHICAGO -- Infants vaccinated against pertussis at birth have a powerful immune response that outstrips the immunity seen in babies vaccinated on the normal schedule, a researcher said here.

CHICAGO -- Statins, widely used for their anti-cholesterol properties, also appear to have anti-microbial and anti-fungal properties, researchers said here.