Infectious Disease

Invasive aspergillosis is a common and often deadly infection in immunocompromised patients, such as neutropenic patients who are being treated for malignancies. Does it have similar features and outcomes in nonneutropenic patients? This study by Cornillet and colleagues provides some interesting answers.

Abstract: Our understanding of the pathobiology of pulmonary arterial hypertension (PAH) has evolved considerably over the past 2 decades, with increasing recognition of the important role that aberrant vasoproliferative responses play in conjunction with disordered vasoconstriction. Classification of the many forms of PAH into categories sharing a similar pathophysiology and clinical presentations help the practicing clinician approach a complex differential diagnosis. Noninvasive tests can be used to narrow this differential but must be applied with an appreciation for their limitations. Transthoracic echocardiography is the screening tool of choice; the workup should also include chest radiography and electrocardiography. However, right heart catheterization is ultimately required to establish the diagnosis. While PAH remains a progressive and generally fatal disease, existing therapies have a significant impact on survival and new therapeutic targets offer great hope for improving the prognosis. (J Respir Dis. 2006;27(11):487-493)

The 2006-2007 influenza season is upon us. Influenza epidemics have been associated with an average of about 36,000 deaths per year in the United States from 1990 to 1999.1 In July of this year, the Advisory Committee on Immunization Practices (ACIP) updated its recommendations for the prevention and control of influenza.2

Abstract: Allergic drug reactions are mediated by IgE. Other immunologic drug reactions are mediated by IgG and complement, T cells, systemic cytokine release, and mast cell activation. True drug allergies, which are IgE-mediated, account for less than 10% of all adverse drug reactions. IgE-mediated reactions are commonly seen with penicillins, but also occur with some other antibiotics, chemotherapeutic agents, therapeutic proteins, and neuromuscular blockers. They are often limited to urticaria but also include life-threatening anaphylaxis. Skin testing to identify patients who are allergic is available for many agents associated with IgE-mediated reactions. Protocols for desensitization permit the use of some culprit agents when indicated. (J Respir Dis. 2006;27(11):463-471)

A 38-year-old African American man with HIV infection presents with numerous dyspigmented macules and patches on the extremities, abdomen, and chest; the lesions are smooth, nontender, and minimally pruritic. He has been noncompliant with antiretroviral therapy since his diagnosis 3 years earlier.

A 26-year-old woman with dull left-sided chest pain, nausea, body aches, and low-grade fever is admitted to the hospital. She has been to other emergency departments (EDs) in the area recently with similar complaints and was sent home with diagnoses of anxiety and costochondritis.

When I repair facial lacerations on toddlers, I find that they are likely to start pulling at the bandage as soon as I put it on. This endangers the repair and increases the risk of infection. An effective solution is to put a colorful children's adhesive bandage on each of the patient's thumbs. This gives the child something new to focus on and distracts him or her from the facial bandage. The thumb bandages are more difficult to pull off, thus giving the face more time to heal.

Red imported fire ants (Solenopsis invicta) were introduced into the United States in the 1930s by ships from South America that docked in Mobile, Ala. Fire ants are now active throughout the southeast Sunbelt states. Colonies are also found in California; one of the largest is in Orange County.

ABSTRACT: Risk factors for oral cancer include tobacco use and alcohol intake (especially in conjunction with tobacco use). Many benign conditions may be confused with squamous cell carcinoma, the most common type of intraoral neoplasm. Any red and/or white lesion that has surface corrugation, stippling, or induration is considered dysplastic or neoplastic until proved otherwise. Even without these clinical signs, white plaques of any size that persist for several months may represent dysplasia. These lesions should be assessed by biopsy. Risk factors for lichen planus include stress, exposure to certain foods and medications, and systemic illness. Erosive lichen planus may cause significant pain and oral dysfunction.

An asymptomatic loss of pigment around the eyelids of several weeks' duration prompts a 53-year-old woman to seek evaluation. She has not started wearing any new eye makeup; her only medication is an antihypertensive.

If Rip Van Winkle were a primary care physician who fell asleep a generation ago and woke up today, what would he think? He would have missed the arrival of managed care. He wouldn't know what a hospitalist does. He might ask how this evasive concept called quality is measured . . . and then cringe at the idea of "report cards" and "pay for performance."

Generalized papular, erythematous, nonpruritic, hyperpigmented lesions had appeared on the face, arms (A), chest, and abdomen of a 25-year-old homosexual man with AIDS during the previous month. Anupama Ravi, MD, of Atlanta also noted purple-red, nodular lesions in the right conjunctiva (B) and oral cavity, especially the lower gingiva (C). Other pertinent physical findings included facial edema and hepatosplenomegaly.

ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.

A 38-year-old African American man with HIV infection presents with numerous dyspigmented macules and patches on the extremities, abdomen, and chest; the lesions are smooth, nontender, and minimally pruritic.

A 26-year-old woman with dull left-sided chest pain, nausea, body aches, and low-grade fever is admitted to the hospital. She has been to other emergency departments (EDs) in the area recently with similar complaints and was sent home with diagnoses of anxiety and costochondritis.

Over the past several years, I have encountered many patients in my practice with a basal temperature of less than the average 37°C (98.6°F). While I consider them to simply be part of a bell-shaped curve, these patients are convinced that they are febrile at a temperature of 37.2°C (99°F).

Patients stung by fire ants instantly feel intense burning pain at the site, hence the name "fire" ants; the small pustular lesions typically develop about a half hour afterward and evolve over several days.

ABSTRACT: Risk factors for oral cancer include tobacco use and alcohol intake (especially in conjunction with tobacco use). Many benign conditions may be confused with squamous cell carcinoma, the most common type of intraoral neoplasm. Any red and/or white lesion that has surface corrugation, stippling, or induration is considered dysplastic or neoplastic until proved otherwise. Even without these clinical signs, white plaques of any size that persist for several months may represent dysplasia. These lesions should be assessed by biopsy. Risk factors for lichen planus include stress, exposure to certain foods and medications, and systemic illness. Erosive lichen planus may cause significant pain and oral dysfunction.

If Rip Van Winkle were a primary care physician who fell asleep a generation ago and woke up today, what would he think?

When I repair facial lacerations on toddlers, I find that they are likely to start pulling at the bandage as soon as I put it on. An effective solution is to put a colorful children's adhesive bandage on each of the patient's thumbs.

An asymptomatic loss of pigment around the eyelids of several weeks' duration prompts a 53-year-old woman to seek evaluation. She has not started wearing any new eye makeup; her only medication is an antihypertensive.

Generalized papular, erythematous, nonpruritic, hyperpigmented lesions had appeared on the face, arms, chest, and abdomen of a 25-year-old homosexual man with AIDS during the previous month. Anupama Ravi, MD, of Atlanta also noted purple-red, nodular lesions in the right conjunctiva and oral cavity, especially the lower gingiva. Other pertinent physical findings included facial edema and hepatosplenomegaly.

SAN DIEGO -- For a variety of factors, HIV-infected children appear to have more psychiatric problems than uninfected children, researchers reported here.

BOSTON -- An investigational drug that inhibits programmed cell death could help to prevent fibrosis in hepatitis C-infected livers, even when standard therapies fail to clear the virus, researchers reported here.

BOSTON -- The presence of diabetes may triple the risk of hepatocellular carcinoma in patients with advanced fibrosis or cirrhosis from hepatitis C infection, researchers reported here.

BOSTON -- The newly approved nucleoside analog Tyzeka (telbivudine) was superior to Epivir (lamivudine) at reducing hepatitis B virus to undetectable levels at two years of follow-up, reported investigators in studies presented here.

DENVER -- The trivalent influenza vaccine appears to be safe in children between the ages of six and 23 months, according to researchers here who reviewed more than 69,000 vaccinations among more than 45,000 children.

LAS VEGAS -- College students with pierced nipples, bellybuttons, and other body parts are risking hepatitis C virus infection when they share their jewelry, according to a study reported here.

GRENOBLE, France -- The risk of deep venous thromboembolism (DVT) in older patients could be significantly reduced if clinicians in post-acute care settings took to heart evidence-based guidelines, according to French researchers.

ROCHESTER, Minn. -- A lifetime of infections with rhinoviruses, enteroviruses, or other members of the picornavirus family could lead to cumulative memory loss, according to Mayo Clinic neuroscientists.