Infectious Disease

MUNSTER, Germany -- Children who have a cerebral venous thrombosis before the age of two are unlikely to have another, found researchers here.

MINNEAPOLIS -- For children with leukemia who need a transplant, five-year disease-free survival rates from allogeneic cord blood appear to equal those from allele-matched marrow or peripheral blood stem cells.

CHICAGO -- A new regimen that includes both a targeted agent and cytotoxic drugs appears to be at least as effective as standard regimens for the treatment of unresectable metastatic colorectal cancer.

SAN FRANCISCO -- After a 43-year-old woman returned from Peru with fever and an enlarged spleen, researchers here have identified a previously unknown pathogen related to those that cause trench fever and cat-scratch fever.

CHICAGO -- Bevacizumab (Avastin) given before surgery for curative resection of liver metastases from colorectal cancer did not increase the risk of bleeding, researchers reported here.

CHICAGO, June 5 -- Docetaxel (Taxotere) added to both concurrent radiation and platinum-based chemotherapy did not significantly improve survival in patients with non-resectable phase III non-small cell lung cancer.

SAN FRANCISCO -- A standard six-month course of treatment for tuberculosis may not be sufficient to cure patients co-infected with HIV, researchers here say.

ANN ARBOR, Mich. -- Veterans Affairs hospitals are more likely than non-VA facilities to follow recommendations for preventing bloodstream infections from central venous lines.

We present a case of a 35-year-old man with fever and pancytopenia, who had rapid progression to acute respiratory distress syndrome (ARDS), multiorgan failure, and disseminated intravascular coagulopathy secondary to disseminated tuberculosis (TB). Although both sputum and bronchoalveolar lavage (BAL) fluid smears were negative for acid-fast bacilli, the polymerase chain reaction (PCR) assay on the BAL fluid was positive for Mycobacterium tuberculosis. This case emphasizes the need to include TB in the differential for ARDS and the value of PCR testing of BAL fluid, especially in high-risk patients.

abstract: The use of fiberoptic bronchoscopy (FOB) in HIV- infected patients has sharply declined since the availability of highly active antiretroviral therapy and the resulting decrease in the incidence of opportunistic infections. Nevertheless, FOB continues to be an important diagnostic tool in this patient population. For example, FOB is useful in evaluating for Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) in patients with CD4+ cell counts of less than 200/µL who have diffuse pulmonary infiltrates and in whom sputum induction has not been performed or is nondiagnostic. It is also useful for evaluating patients who have not responded adequately to empiric therapy for bacterial pneumonia or PCP. Other applications include the visual diagnosis of endobronchial Kaposi sarcoma or the assessment of suspected lung cancer. (J Respir Dis. 2007;28(6): 244-252)

Marijuana is the most commonly used illicit drug in the United States. The prevalence of marijuana use has remained stable over the past several years, with 14.6 million persons older than 12 years reporting past-month use in 2005. Given the prevalence of illicit use and interest in the medicinal use of marijuana, an understanding of the potential negative health consequences of marijuana smoking is needed. While tobacco smoking is clearly associated with numerous adverse respiratory complications, including increased cough and wheeze, the development of chronic obstructive pulmonary disease (COPD), lung cancer, and an increased incidence of infections,1-3 the relationship between marijuana and pulmonary disease is controversial, despite similarities in many compounds found in marijuana and tobacco smoke.

Tinea corporis appears as an annular plaque with a rim of scaly erythema.

Tinea that occurs on the hands is referred to as tinea manuum.

Maceration or scale between isolated web spaces of the fingers suggests erosio interdigitalis blastomycetica (interdigital candidiasis). It most often occurs in the web space between the middle and ring fingers; sometimes the toes are affected. Erosio can spread and can be painful.

A fungal folliculitis (Majocchi granulomas) can occur if a superficial fungal infection is treated with topical corticosteroids. Fungal folliculitis is best treated with a short course of oral itraconazole or fluconazole.

ABSTRACT: Undiagnosed or persistent Helicobacter pylori infection and surreptitious or unrecognized NSAID use are the most common causes of refractory peptic ulcers. The use of antibiotics, bismuth, or proton pump inhibitors (PPIs) suppresses the H pylori bacterial load and may obscure the diagnosis. H pylori infections have also become more difficult to cure because of increased antibiotic resistance. For refractory infection, select an antibiotic based on in vitro susceptibility testing. When this is not available, combination therapy with a PPI, tetracycline, metronidazole, and bismuth is often effective. To detect surreptitious or inadvertent NSAID use, review the drug history in detail. When there is any doubt about such use, check platelet cyclooxygenase function.

ABSTRACT: Atypical clinical presentations in the quality, intensity, and radiation of pain are common in patients with acute coronary syndromes. Women with an acute myocardial infarction (AMI) are more likely to have atypical symptoms, such as dyspnea, than men. A history of acute anxiety or a psychiatric diagnosis does not preclude the possibility of an acute coronary event in a patient with chest pain. The clinical response to a GI cocktail, sublingual nitroglycerin, or chest wall palpation does not reliably identify the source of pain. Over-reliance on tests with poor sensitivity, such as the ECG, or on the initial set of cardiac biomarkers will miss many patients with MI. Serial troponin levels obtained at 3- to 6-hour intervals are recommended to evaluate the extent of myocardial damage. Coronary angiography that detects mild non-obstructive disease does not exclude the possibility of sudden plaque rupture and acute coronary occlusion.

Candidal infection can also occur at the lateral angles of the mouth; it causes erosions and breakdown of the skin. Angular cheilitis, or perleche, resembles the relationship between intertriginous candidiasis and intertrigo in that it is part infection and part inflammatory response to the impairment of epidermal integrity.

Lyme disease-the most common arthropod-borne illness in the United States-has become entrenched in the Northeast, upper Midwest, and northern California, and it is spreading to other regions of the country. Diagnosis and management remain a significant challenge because of the diverse manifestations of the disease and the limitations of current tests.

This infection is usually caused by Candida albicans, whichis often present in body folds. Candidiasis is common in persons with diabetes and in obese persons. Other predisposing factors are the use of antibiotics, topical corticosteroids, or immunosuppressive drugs; poor nutrition; and immunosuppression.

Tinea pedis, or athlete's foot, is common in elderly persons. It manifests as maceration in the interdigital web folds and as scaly plaques on the plantar surfaces of the feet. A potassium hydroxide evaluation can establish the diagnosis. Tinea pedis is commonly associated with xerosis. It is best treated with a topical antifungal agent; treatment can be aided by a keratolytic such as lactic acid 12% cream.

Routine blood work revealed liver function abnormalities in a 55-year-old woman. She had recently undergone extensive dental work that resulted in severe pain; to relieve the pain she took oxycodone and acetaminophen, 3 to 4 g/d, for more than a week. She has not taken any acetaminophen for the past 5 days.

Oral candidiasis, or thrush, is not uncommon in elderly persons. It can be related to poor dentition or immunosuppression, particularly as a result of oral corticosteroid use.

The incidence offluoroquinoloneresistantgonorrheacontinues torise in the UnitedStates, and the CDC isnow urging physicians toprescribe cephalosporinsfor patients with gonococcalinfections.

The prevalence of onychomycosis increases with age; it is less than 1% in persons younger than 19 years and rises to about 18% in those who are 60 to 79 years. The infection is more common in men than in women. Among the predisposing factors are diabetes mellitus, psoriasis, a family history of onychomycosis, use of immunosuppressive drugs, and peripheral vascular disease.