Infectious Disease

For several months, a 59-year-oldwoman has had numerous asymptomaticlesions on her arms andlegs. During this period, she has notbeen exposed to the sun and hastaken no new medications.

A 67-year-old man with poorly controlled type 2 diabetes mellitus presents withleg pain and swelling that began 3 days earlier. Multiple ulcers are noted at thelateral malleolus. His temperature is 38.9°C (102.1°F). Right lower extremitycellulitis is diagnosed, blood samples are taken for culture, and the patient ishospitalized.

A 28-year-old woman complains that her acne has worsened since she startedtaking minocycline for the skin condition 6 weeks earlier. She also uses a norgestimate/ethinyl estradiol oral contraceptive, which has an indication for acnetreatment. Numerous small, pruritic, erythematous follicular papules are presenton the patient’s forehead, cheeks, and nose

A 29-year-old woman presents with a painful erosive dermatitis that has spreadin a perioral distribution during the last 2 days. She complains of a low-gradefever and swollen lymph nodes. The patient has a history of atopy; she isotherwise healthy and takes no medications.

During the past few weeks, a 14-year-old boy has noticed blood on the proximalnail folds of the second and third fingers of his dominant hand. He deniesany pain or pruritus. The patient is otherwise healthy and takes no prescriptionmedications.

An 82-year-old man suddenly became extremely short of breath while helpinghis wife wash dishes. The dyspnea was not accompanied by pain, and it was notrelieved by sitting. He was taken to the emergency department after diaphoresisand cyanosis developed.

A39-year-old man is brought to theemergency department (ED)after his car struck a tree. He experienceda transient loss of consciousnesswith a 3-minute episode of retrogradeamnesia at the scene of the accident,despite wearing a seat belt andshoulder harness. He was disorientedto date and place.

For 2 days, a 43-year-old woman has had a slightly tender rash on her trunk andextremities. Five days earlier, the patient was given levofloxacin for an upperrespiratory tract infection; because she is prone to yeast infections while takingantibiotics, fluconazole also was prescribed. Her only other medication is an oralcontraceptive, which she has been taking for several years.

For 2 weeks, a 35-year-old woman has had a mass on her hand.Although it was initially painless, it now causes discomfort in the forearm,especially when the patient extends her wrist. She has no history of recenttrauma, illness, or a similar mass.

The parents of a 6-year-old child are concerned about blisterson her hands that erupted 3 days earlier and are spreading. The child isotherwise healthy and had attended a summer day camp. The parents areunaware of any trauma or exposure to allergens or toxic substances.

An 88-year-old woman is admitted for severe dyspnea thathas worsened over the past month. Dyspnea on exertionis now elicited by everyday activities, even walking acrossthe room. Orthopnea and paroxysmal nocturnal dyspneahave progressed to the point that she has been unable tosleep at all the past several nights. She also tires very easilyand thinks her ankles are more swollen than previously.She denies chest pain or pressure.

For several months, a 16-year-old girl has had an asymptomatic papulosquamousdescending linear eruption on 1 leg.

A 34-year-old man has had Crohn disease for 12years. He presented initially with ileitis and has had 3surgeries for obstructive complications. Ileum resectionhas resulted in bile salt and fat malabsorption. Recently,the Crohn disease has spread to the large bowel. For thelast 2 years, he has also had seronegative spondyloarthropathy-another complication of Crohn disease.

For 3 months, a 57-year-old woman has had a persistent green nail that is occasionallyslightly sore; the nail plate has lifted. Another physician prescribed a7-day course of levofloxacin for a suspected Pseudomonas infection; the treatmenthad no effect on the nail. A subsequent 7-day course of norfloxacin wasalso unsuccessful. The patient is otherwise healthy.

During a routine skin examination,periungual erythema and increasedcurvature of the nail plate are notedin a 78-year-old man. The patient hasemphysema and a smoking historyof more than 50 pack-years. Currently,he requires oxygen support forregular daily activity.

For the past 2 days, an elderly woman has had severe pain in and discharge from the right ear. She has diabetes, which is well controlled with anoral hypoglycemic agent, and eczematous dermatitis.

A 41-year-old woman with a 4-yearhistory of polymyositis with lupus featureshas had constant rectal pain for4 months. She has not noticed any factorsthat either aggravate or relievethe pain. The patient complains of intermittentconstipation (but no dischargeor rectal bleeding), generalizedweakness and malaise for the past 2months, a low-grade fever for the pastmonth, and a 4.1-kg (9-lb) weight lossover the past 6 weeks. She denies nightsweats or chills, anorexia, vision problems,drug allergies, and tobacco oralcohol use.

A 24-year-old woman complains ofa pruritic rash that erupted after shesoaked in a hot tub a few days earlier.The patient is otherwise healthy;her only medication is an oralcontraceptive.

This painful, blistery eruption recentlydeveloped on the hand of ateenage girl. She claims she has hadno other such lesions. What doesthis look like?

A 67-year-old woman who is being treated as an inpatient for head traumacomplains of vague tenderness during an abdominal examination. Othercomplaints are difficult to assess. She had been placed on an oxygen ventilator;however, her cognitive function and pulmonary function are improving, andher cerebral edema is diminished.

A 25-year-old man complains of moderate discomfort, burning, redness, serousdischarge, and slightly impaired vision in his right eye; he also has mild photophobia.His symptoms began suddenly about 36 hours earlier, and the discomforthas increased steadily since that time. The left eye is unaffected.

The parents of a 6-year-old boy are concerned about the asymptomatic bumpsthat have developed on their son’s abdomen during the last few months.

A 22-year-old man presents to theemergency department with a2-week history of a worsening nonproductive,irritating dry cough andexertional dyspnea. The patient hasbeen otherwise healthy. He deniesfever, rigors, night sweats, hemoptysis,chest pain, palpitations, orthopnea,paroxysmal nocturnal dyspnea,ankle edema, and lymphadenopathy.

A 26-year-old man who presentswith acne mentions that he has had“Raynaud’s” for 10 years. His eyelidsare pinkish violet and swollen. Nailfold telangiectases are present,and violaceous papules and scaleoverlie the joints. The patient deniesany other symptoms.

Infections continue to be the leading killer of children worldwide.This text-now in its 11th edition-provides comprehensiveyet concise information on the natural history, diagnosis,treatment, and prevention of the major infections thataffect children. New to this edition are chapters on fungal infections,eye infections, cholera, dengue and dengue hemorrhagicfever, helminthic infections, and malaria. All otherchapters have been extensively revised and updated to coversuch topics as smallpox vaccination, bioterrorism, newer hepatitisviruses, and Pseudomonas infections in patients withcystic fibrosis. Included in the appendices are the indications,contraindications, adverse effects, and drug interactions ofantimicrobials used in children; the recommended childhoodand adolescent immunization schedule; and a discussion ofsevere acute respiratory syndrome. More than 50 color photographs-as well as numerous radiographs, photomicrographs,diagrams, charts, and tables-accompany the text.