Infectious Disease

SAN DIEGO -- Pediatric infectious disease specialists have no consensus about the optimal approach to treatment of methicillin-resistant Staphylococcus aureus infections in children, a nationwide survey indicated.

SAN DIEGO -- Older patients with HIV infection have robust responses to highly active antiretroviral therapy (HAART), with no increased risk of metabolic disorders or other adverse effects, according to two studies.

SAN DIEGO -- Adolescents and teenagers with perinatally acquired HIV infection have high rates of neurologic, psychiatric, and cognitive problems that can confound attempts to treat them, investigators reported here.

BORAS, Sweden -- Keeping HIV at bay with highly active anti-retroviral therapy (HAART) may also forestall AIDS-related neurodegeneration, investigators have found.

SAN DIEGO -- Once stereotyped as wasting away, HIV patients have joined the rest of America in fighting the battle of the bulge, according to results of a study reported here.

WACOL, Australia-Schizophrenia leads to an age-related mortality rate that is about 2.5 times that of the general population, and the difference appears to be increasing, researchers here reported.

SAN DIEGO -- Eradication of Helicobacter pylori may have had the unintended consequence of unleashing an asthma threat even as the risk of gastric ulcer and cancer declined, results of a study reported here suggest.

LA JOLLA, Calif. -- A single injection provided both protection against and treatment for anthrax in rats.

ROCHESTER, N.Y. -- A combination vaccine that adds hepatitis B and polio to the standard DTP (diphtheria, tetanus, pertussis) vaccine was found safe and just as immunogenic as the customary five separate shots, according to a 22-center study.

MINNEAPOLIS -- Influenza vaccination reduces older adults' risk of hospitalization and mortality, researchers affirmed, despite lingering questions.

LONDON -- Five-year survival rates for liver transplant patients 60 and older matched rates for younger patients and the older patients had fewer rejection episodes, researchers here found.

ROCKVILLE, Md. -- The FDA has approved terbinafine oral granules (Lamisil), which can be sprinkled on food, for treatment of tinea capitis in children four years and older.

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).