Infectious Disease

ATLANTA -- If a flu pandemic materializes, Americans should avoid crowds and close contact, rather than relying on facemasks and respirators, the CDC said today.

LONDON -- More than a third of the HIV-positive gay men in England may be HIV-positive and not know it, according to researchers here.

FLORENCE, Italy -- An ultrasound measurement of liver thickness predicted portal hypertension in patients with hepatitis C-related cirrhosis, researchers here found.

NASHVILLE, Tenn. -- The rate of invasive pneumococcal disease among children with sickle cell disease has fallen by more than 90% since the introduction of a new vaccine, researchers here say.

BOSTON -- Six months of rituximab (Rituxan) for relapsing-remitting multiple sclerosis lesions appears to reduce active lesions significantly and retard relapses, investigators reported here.

PARIS -- Cystic fibrosis patients may develop bone density deficits in the first years of life regardless of nutritional status or disease severity, researchers here found.

abstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)

The results of this study suggest that ß-lactam antibiotics are safe to use in patients with a history of penicillin allergy if penicillin skin test results are negative.

An obese 52-year-old woman with a 5-year history of type 2 diabetes mellitus had odynophagia and dysphagia for several days. She described the sensation as food "sticking" in her chest. She also complained of vaginal itching, polyuria, and polydipsia. The only remarkable finding on physical examination was candidal vaginitis. The patient did not smoke cigarettes or drink alcoholic beverages, and there was no history of recent weight loss.

A 33-year-old woman with a history of severe asthma requiring multiple intubations was brought to the emergency department. She had completed a 14-day course of prednisone 3 days earlier. Since then, she had had increasing dyspnea that acutely worsened after she used her albuterol nebulizer that morning. Her other asthma medications were theophylline and fluticasone. Her history included one episode of bilateral pneumothoraces secondary to barotrauma, which required chest tube insertion.

A 77-year-old African American man with type 2 diabetes mellitus and coronary artery disease presented to the emergency department with acute scrotal swelling and pain. His testicles were erythematous with focal areas of necrosis and associated tissue destruction. Similar skin changes were apparent in the lower abdominal and inguinal regions.

Methicillin-resistant Staphylococcus aureus (MRSA) became a "bug" to be reckoned with nearly 50 years ago. At that time, however, it targeted only patients who were exposed to infection in the hospital.In recent years, the epidemiology of MRSA has significantly changed. The pathogen is now a major culprit in community-acquired infections.

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever (temperature, up to 38.8°C [102°F]) of 9 days' duration. Physical findings included subcutaneous crepitus, erythema, and swelling of the left arm, chest, and neck. White blood cell count was 27,000/µL with 91% neutrophils. Chest radiographs showed gas in the subcutaneous and soft tissue of the neck, arm, and chest . Necrotizing fasciitis was suspected.

I read with interest the case of lymphogranuloma venereum (LGV) featured in Dr Henry Schneiderman's recent "What's Your Diagnosis?" column (CONSULTANT, February 2007, page 187). As one who has had a career-long interest in sexually transmitted disease, I feel compelled to make a few remarks regarding this case.

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever.

For 4 days, a 58-year-old woman with type 1 diabetes mellitus had had increasing right vulval pain that spread to the suprapubic area and abdomen. She reported that swelling and a "heavy feeling" in the lower abdomen had developed during the last 24 hours; these symptoms were associated with fever and chills.

Yesterday, my laboratory reported to me that a pharyngeal swab tested positive for chlamydial infection (detected by DNA testing). This was not the first time I diagnosed sexually transmitted pharyngeal chlamydial infection in a patient. Readers beware: it does happen.

A 45-year-old man sought medical advice after suffering for 6 months with recurrent pain and a purulent discharge at the sacrococcygeal region. Two weeks before this consultation, an abscess on the patient's right buttock had been drained by another physician. The patient had type 1 diabetes mellitus for 5 years; his medical history was otherwise unremarkable.

This lesion had erupted on the back of an elderly man with diabetes mellitus. The inflammatory process involved contiguous follicles with pus evident at several openings.

or several years, a 71-year-old man has had a pruritic eruption on both legs that occurs every winter and resolves in the spring. He is scheduled to undergo knee surgery, but the surgeon will not perform the operation until the rash has cleared. The patient has not used a new soap or changed his bathing habits recently.

Frightened but lucid man who appears stated age. Vital signs are normal. No mass palpable in abdomen, though there is a faint suggestion of upper-abdominal distension. No supraclavicular lymphadenopathy, umbilical nodules, or upper-abdominal vascular bruit.

Phytobezoars commonly develop in the distal small bowel, where the lumen is narrow. Prevalence is higher after partial gastric resection.

ALAMEDA, Calif. -- In patients with chronic hepatitis C, a seven-gene test may outdo usual clinical risk factors in predicting the likelihood of advance to cirrhosis.

SILVER SPRING, Md. -- An FDA advisory panel has unanimously recommended accelerated approval of a novel antiretroviral drug as an add-on treatment for adult infected with CCR5-tropic HIV-1.

COPENHAGEN -- The use of protease inhibitors to treat HIV is associated with an increased risk of a heart attack, according to a large observational study.