Infectious Disease

ABSTRACT: In patients with jaundice and normal liver function, the cause of hyperbilirubinemia is an isolated disorder of bilirubin metabolism. In patients with hyperbilirubinemia who have abnormal liver enzyme levels, hepatocellular disease must be differentiated from cholestatic liver injury. In general, if the cause of jaundice is global hepatocellular dysfunction, the serum alanine aminotransferase and aspartate aminotransferase levels will be predominantly elevated. If the cause is cholestasis, the serum alkaline phosphatase and gγ-glutamyl peptidase levels will be elevated. In most patients, imaging studies will be needed. The initial workup should include abdominal ultrasonography, which can identify dilated intrahepatic and extrahepatic biliary ducts as well as findings that may suggest cirrhosis or signs of portal hypertension, including splenomegaly and ascites.

Images in HIV/AIDS: HIV-Associated Lymphogranuloma Venereum Proctitis

LOS ANGELES -- An investigational anti-HIV drug called maraviroc, the first CCR5 inhibitor, significantly outperformed placebo in patients who were failing anti-retroviral therapy, according to interim results from two major phase III trials.

LOS ANGELES -- Like the traditional HIV-associated opportunistic infections, the toll of conditions such as heart and liver disease is affected by the immune status of a patient, researchers reported here.

SAN DIEGO -- Allergic fungal sinusitis deserves a place of its own at the table of nasty chronic rhinosinusitis infections, researchers asserted here.

MILWAUKEE -- Treatment with vancomycin for bacterial sepsis can lead to life-threatening immune thrombocytopenia, researchers here reported.

FARMINGTON, Conn. -- Treating periodontal disease may pay off for cardiovascular health, researchers here found.

ATLANTA -- One in four women in the U.S. ages 14 to 59 are infected with human papillomavirus (HPV), according to the first nationally representative study. Some 3.4% of the women tested positive for the four major strains against which the new HPV vaccine protects, representing an estimated 3.1 million women.

LOS ANGELES -- Raltegravir (MK-0518), an investigational anti-retroviral drug that targets the HIV enzyme integrase, seems highly effective in patients resistant to existing classes of drugs.

SAN DIEGO -- A wheezing illness before the age of three years signals the likelihood of asthma by age six, and frequent rhinoviral infections in infancy may have something to do with it, according to investigators here.

CHICAGO -- The verdict on male circumcision and HIV transmission has been validated. Now the question is how to implement the finding that male circumcision cuts the risk of HIV infection by more than 50%.

NASHVILLE, Tenn. -- In a year-long study, more than one in four children admitted to the hospital with acute respiratory symptoms had a rhinovirus infection, according to researchers here.

SHANGHAI, China -- More than 80% of drug resistance among treated tuberculosis patients here is the result of a new infection with the resistant strain, called reinfection, rather than inadequate therapy, according to researchers here.

LONDON -- Treating herpes simplex with valacylovir (Valtrex) reduces the levels of HIV in women who are infected with both viruses, according to researchers here.

ORLANDO -- Swabbing the oral cavity with chlorhexidine (Peridex) reduces the risk of ventilator-associated pneumonia in some intubated intensive care patients, a Richmond, Va., researcher said here.

HOUSTON -- For establishing the tumor status of women with breast cancer, a gene-expression microarray appears to have accuracy approaching standard tests, researchers found here.

BETHESDA, Md. -- An atomic-level snapshot of a key HIV protein as it binds to a neutralizing antibody, a feat accomplished here, may be a step toward an effective vaccine, the researchers said.

MELBOURNE, Australia -- For children with intermittent asthma, a short course of Singulair (montelukast), a leukotriene antagonist, given at the first sign of an episode may reduce acute care visits, reported Australian investigators.

BOSTON -- For children with Kawasaki's disease, a single pulsed dose of intravenous methylprednisolone added to conventional therapy drew a therapeutic blank, researchers reported.

ST. LOUIS -- A live attenuated flu vaccine -- administered in a nasal spray -- outperformed the traditional inactivated vaccine in a large study of children from six months to five years old.

MEMPHIS -- Some people may have at least a partial immunity to the highly pathogenic H5N1 avian influenza virus, according to researchers here, but while that might limit the virulence of the disease, it would probably not prevent infection.

SAN FRANCISCO -- Smoking marijuana significantly reduces nerve pain associated with HIV infection, according to researchers here.

ROCKVILLE, Md. -- The FDA announced today that concerns about toxicity had led it to rescind two indications for the antibiotic Ketek (telithromycin).

CINCINNATI -- Antimicrobial functions of neutrophils are impaired in patients with pulmonary alveolar proteinosis, a rare condition, because of the auto-antibodies to growth factors that are associated with the disease, according to researchers here.

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