A34-year-old man with HIV/AIDS presented to the emergency department with fatigue, dyspnea on exertion, headache, subjective fevers, and chills of 1 month's duration. He also had blurry vision and a pruritic facial rash of 2 weeks' duration. He admitted to being noncompliant with antiretroviral therapy for the past 18 months and was not taking other medications at the time of presentation.

Highlights of upcoming recommendations of the Infectious Diseases Society of America (IDSA) for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and community-associated urinary tract infections (CA-UTIs) were presented at the joint 48th Annual Interscience Conference of Antimicrobial Agents and Chemotherapy/ IDSA 46th Meeting, which took place in Washington, DC, from October 25 to 28. The recommendations are scheduled to be finalized and officially disseminated in the spring of 2009. Some salient points are summarized here.

Bacteremia caused by viridans streptococci frequently presentsin a subacute fashion and can lead to complicated infections.It usually manifests from an oral source and may result inseeding of the heart valves. We describe a case of viridansstreptococci bacteremia that developed after a dental procedureand was complicated by endocarditis and vertebral osteomyelitis.Symptoms and signs that may heighten suspicion forcomplicated bacteremia caused by viridans streptococci arediscussed. [Infect Med. 2008;25:552-555]

Immunocompromised hosts are at high risk for opportunisticinfections caused by endemic fungi such as Cryptococcus,Histoplasma, and Coccidioides. Moulds other than Aspergillusalso are being implicated in opportunistic fungal infections inimmunocompromised patients. Infections attributed toZygomycetes and Fusarium and Scedosporium species are beingreported with increased frequency. Because infection with theseorganisms cannot be distinguished from aspergillosis onradiographic imaging or histological examination, culture isrequired to confirm the diagnosis. Therapeutic success mayhinge on correct identification of the infectious organism.

Although many physicians are not up to speed onthe CDC 2006 recommendations on HIV screening,institution of routine voluntary testing inhealth care settings does enhance identification of undiagnosedcases of HIV infection. Furthermore, patients-especially those in high-risk groups-are generally receptiveto the opportunity to be screened for HIV infection.These were the findings from several studies on HIVtesting that were presented during a poster session at thejoint 48th Annual Interscience Conference on AntimicrobialAgents and Chemotherapy and 46th Annual Meetingof the Infectious Diseases Society of America, which tookplace in Washington, DC, from October 25 to 28, 2008.

The 17th International AIDS Conference was held in Mexico City from August 3 to 8, 2008. This conference attracted more than 20,000 participants and provided some significant new insights into HIV therapeutics.

In most HIV-infected persons, one or more dermatological conditions develop at some point during their lifetime.1 Among the spectrum of dermatological diseases, those associated with pruritus are among the most common.

In addition to standard therapy for sinusitis, suggest that patients breathe in steam from water that contains eucalyptus leaves or oil.

Change is in the air. By the time this column is published, the nation will know who will next occupy the White House; many appointees of the departing administration will most likely have already moved on to new positions; and potential appointees will be polishing their résumés and pressing the wrinkles out of their good interview suit.

What’s The “Take Home”? Elderly Man With Late-Night Confusion and Hypoglycemia

New research suggests that AIDS among humans occurred at least 3 decades earlier than previously thought. Rapid urbanization in west-central Africa “was the turning point that allowed the pandemic to start,” said Michael Worobey, an evolutionary biologist at the University of Arizona, Tucson, and the study’s lead author (Avasthi A. National Geographic News. October 1, 2008).

One fun thing to do at an International AIDS Conference-aside from the social aspects and the presentations, protests, and theatre found in the Global Village-is to match your wisdom and art in the selection of antiretroviral drug regimens to that of a large audience of HIV-treating physicians and expert panel members. In this sense, the 17th International AIDS Conference, held this year in Mexico City, did not disappoint.

Because the medical literature and direct-to-consumer advertising have focused mainly on the burden of osteoporosis in postmenopausal women, recent screening guidelines for this disease in men may catch some by surprise.

A previously healthy 16-year-old boy presents for evaluation of a slightly pruritic, nontender, generalized rash.

It was not until she went to have an impression made for a broken dental retainer that this 17-year-old girl became aware of a mass on the left side of the palate.

It’s been 10 years since you first started to see our “What’s The ‘Take Home’?” feature every month in CONSULTANT. Our goal then, as it remains today . . . to bring you real-life clinical cases that keep you up-to date on the latest thinking-and that offer a “takehome message” you can put to immediate use in your daily practice.

Pneumonia remains a concern for persons with long-standing HIV infection. We pre­sent a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose pre­sentation suggested the cause was a bacterial pathogen.

A 36-year-old man presents to the emergency department (ED) after a single tonic-clonic seizure. He has a history of numerous male sexual contacts. HIV infection was diagnosed 5 months earlier. At that time his CD4+ cell count was 66/μL and his HIV RNA level was 20,000 copies/mL.

A 14-month-old infant was brought by his mother for evaluation of fever (temperature, 39.4ºC [103ºF]) and a tender, indurated, warm area with surrounding edema and a centrally located papule in the left groin.

A 75-year-old man is brought to the emergency department (ED) after awakening in the night very confused and disoriented. His wife had called 911; when the paramedics arrived, they found his blood glucose level to be 36 mg/dL.