Infectious Disease

SAN FRANCISCO -- The season of conception may be a factor in the risk for preterm delivery, researchers will report here this weekend.

ATLANTA -- Teen and childhood suicides rose sharply in 2004, for the first time in more than 10 years, and some are linking this to a reduced use of antidepressants that year because of black box label warnings mandated by the FDA.

TOTTORI, Japan -- A third of patients with hepatitis C infections and hepatic fibrosis could be spared liver biopsies by the use of a new index that predicts significant fibrosis with three blood tests, according to researchers here.

ROCKVILLE, Md. -- The FDA has approved Alphanate (antihemophilic factor/von Willebrand factor complex) for von Willebrand's disease in surgery.

WASHINGTON -- A 12-week course of Raptiva (efalizumab) significantly improved chronic severe plaque psoriasis of the hands and feet, researchers here reported today.

This polymicrobial infection, characterized by rapidly advancing deep tissue necrosis, is caused by Gram-positive and Gram-negative bacteria and anaerobes such as Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.

Furunculosis is a deeper infection of the hair follicle generally attributable to S aureus.

Declining cardiovascular function, poor circulation, diabetes, obesity, cancer, immunodeficiency, renal disease, and thinned, xerotic skin provide the setting for a host of bacterial infections in elderly persons that can involve any level or structure of the skin.

This vesiculopustular eruption manifests with honey-colored crusted erosions. As it resolves, the crusts can turn brown; hyperpigmentation and scale may be evident.

ATLANTA -- Much like the power of hurricanes, future influenza pandemics will be rated on a demonstrated case fatality rate as they spread to shore, with a scale of increasingly drastic recommended defenses, the CDC said today.

ARLINGTON, Va. -- For the second time, efforts to create a topical microbicide that would protect against HIV transmission during sex have ended in failure.

Herpes zoster occurs in 10% to 20% of the general population as a result of reactivation of the varicella-zoster virus (VZV) and is generally benign. It occurs more frequently in persons with cellular immunodeficiency and older age. The association between herpes zoster and HIV was confirmed early in the course of the HIV epidemic by numerous studies. Zoster was noted to precede AIDS in high-risk groups. Both the incidence and complication rate of herpes zoster are increased in HIVinfected patients.

The CDC estimates that more than 850,000 people are living with HIV/AIDS in the United States today,1 with African Americans and Latinos being disproportionately affected.2 Over the past decade, the Latino population in the United States has been growing. In fact, in 2002 for the first time, Latinos surpassed African Americans as the largest US minority group. However, the term "Latino" is applied to a very heterogeneous group from different countries and different cultures.3 In addition, a large proportion of Latinos is undocumented in the United States and thus marginalized from the health care system.

A 49-year-old white man, in whom HIV infection had been newly diagnosed (CD4+ cell count, 25/µL; HIV-1 RNA level, 274,000 copies/mL), was transferred to our hospital for further workup and treatment of multiple neurologic deficits. He had presented to another hospital with a 4-day history of left-sided weakness and numbness, left-sided facial droop, dysphonia, and dysphagia that led to the initial diagnosis of an acute stroke.

From the Editor's Desk: In This Month's IssueThis month, you will find a report of the results of a clinical trial evaluating HIV infection in our Latino population. Although clinical trial write-ups are rarely published in The AIDS Reader–which instead prefers to provide reviews that help explain the relevance of clinical research to practice–an article drawing attention to the problem of HIV infection and its management in this ethnic minority is of increasing importance in clinical care.

The investigators employed the HIV Epidemiological Research Study, a longitudinal prospective cohort study, along with semiannual interview, physical examination, and laboratory assays. They recruited 773 HIV-positive women aged 16 to 55 years from 4 academic medical facilities in Baltimore; Bronx, New York; Providence, RI; and Detroit.

Tenofovir disoproxil fumarate is approved to treat HIV infection in combination with other antiretroviral agents. Although tenofovir is generally well tolerated, the potential for nephrotoxicity exists based on preclinical data, case reports, and observational studies.

Although the observations of del Rio and colleagues1 stemming from their study of foreign-born, HIV-infected Latinos are limited to a certain geographic area, their findings should stimulate further research to better understand and provide better health care to ethnic and minority groups living with HIV/AIDS in the United States.

Although most persons infected with Coccidioides immitis (Figure) are asymptomatic or have only mild illness, those who are immunocompromised are at increased risk for more severe disease. This is also true for patients with diabetes mellitus.

Blastoschizomyces capitatus is an emerging pathogen that causes infection primarily in patients who have immune system dysfunction. The author reports a case of pulmonary blastoschizomycosis in an immunocompetent man who was successfully treated with voriconazole.

abstract: In the past, constrictive pericarditis was most often caused by tuberculosis. Today, however, it is more likely to be preceded by injury or trauma, infection, or previous cardiac surgery. Most patients with constrictive pericarditis present with dyspnea and have elevated jugular venous pressure. Other potential symptoms and signs include peripheral edema, abdominal fullness, hepatomegaly, ascites, and chest pain. Electrocardiography demonstrates nonspecific ST-segment and T-wave changes and generalized T-wave inversion or flattening. In many cases, chest radiography and CT reveal pericardial calcification, and echocardiography shows increased pericardial thickness and calcification. Treatment may include NSAIDs, corticosteroids, antibiotics, angiotensin-converting enzyme inhibitors, and diuretics. Surgery is the treatment of choice for chronic disease, and pericardiectomy is typically effective. (J Respir Dis. 2007;28(2):49-56)

A 69-year-old man with a history of atrial fibrillation, pulmonary embolism, asthma, and obstructive sleep apnea presented to the emergency department for evaluation of dyspnea and light-headedness. He had been treated for paroxysmal atrial fibrillation over the past 5 years; fairly good control had been achieved with metoprolol and amiodarone. However, over the past several months, he had been experiencing intermittent episodes of atrial fibrillation.

ABSTRACT: Heel pain that occurs with the first several steps in the morning and diminishes as walking continues is the classic symptom of plantar fasciitis. Assessment of risk factors, such as improper footwear, a change in physical activities, and a new running surface, is important. Radiographs are rarely useful. Plantar fasciitis is generally self-limited; symptoms typically take 6 to 18 months to resolve. Conservative measures may include relative rest, stretching, strengthening, shoe modifications, orthoses, night splints, NSAIDs, and ice therapy. A corticosteroid injection may be warranted in resistant cases. If extensive conservative treatment is unsuccessful, referral to an orthopedic surgeon may be indicated.

A 26-year-old woman presented with a1-week history of pleuritic chest painand abdominal pain, which was associatedwith nausea but unrelated tofood intake or bowel movements. Shehad also had gross hematuria for thepast 10 days and swelling around hereyes and ankles as well as fatigue andarthralgias for 2 weeks.

In his recent editorial Putting Guidelines for Chronic Kidney Disease IntoPractice (CONSULTANT, October 2006, page 1295), Dr Gregory Ruteckidiscussed the results of a study that shows many clinicians fail to follow evidence-based guidelines for the management of chronic kidney disease(CKD), such as when to consult a nephrologist.1 A sampling of the feedbackwe received appears below, along with Dr Rutecki's responses.