A 38-year-old HIV-infected man with a CD4+ cell count of 4/?L and an HIV RNA level of more than 750,000 copies/mL was admitted to the hospital after 1 month of painful right neck swelling and 1 week of dysphagia. His history was also notable for methicillinresistant Staphylococcus aureus (MRSA) bacteremia, which occurred 2 months earlier; adrenal insufficiency; chronic hepatitis C; remote Cytomegalovirus retinitis; and recurrent bacterial pneumonia.

ABSTRACT: The diagnosis of asthma in older persons may becomplicated by a number of factors, including atypical presentationsand comorbid conditions, such as chronic obstructivepulmonary disease and congestive heart failure (CHF). Ahigh index of suspicion for the diagnosis of asthma is warrantedin patients with isolated dyspnea or cough. The diagnosisshould be based on demonstration of reversible airwayobstruction on pulmonary function tests. Additional tests thatmay be useful in the initial evaluation include chest radiography,arterial blood gas analysis, and standard electrocardiography.CT may help exclude pulmonary embolism and certainneoplasms that can masquerade as asthma. High-resolutionCT scans are valuable when pulmonary function testresults are consistent with interstitial lung disease. When thediagnosis is uncertain, measurement of brain natriuretic peptidecan help distinguish between obstructive lung disease andCHF. (J Respir Dis. 2008;29(10):391-396)

Two studies-one conducted in Philadelphia, and the other in San Francisco-demonstrate that crowding in the emergency department (ED) is associated with a delay in providing antibiotic therapy for patients with pneumonia.

To what extent are patients with obstructive sleep apnea syndrome (OSAS) at increased risk for postoperative complications? Are there any specific interventions that reduce the risks?

ABSTRACT: The diagnosis of invasive pulmonary aspergillosis remainschallenging because of atypical clinical presentations,comorbid diseases, and the difficulty in culturing Aspergillus bystandard microbiological techniques. Serial monitoring withCT scans of the chest and serological markers can help withearly identification in high-risk patients, such as hematopoieticstem cell transplant recipients. The most common radiographicfindings are single or multiple nodules, wedge-shapedpleural-based infiltrates, and cavities. The halo sign is the mostsuggestive clue to aspergillosis and is manifested by a macronodulesurrounded by a perimeter of ground-glass opacity.(J Respir Dis. 2008;29(10):405-410)

HIV testing and prevention were two important, and sometimes controversial, research themes at the 17th International AIDS Conference (IAC) held from August 3 to 8, 2008, in Mexico City. Both topics, usually low-tech activities, saw a renewed interest in an evidence-based approach and pleas for more data.

With an improved life expectancy, HIV-positive patients now face interactions between antiretroviral therapy and medications for chronic medical problems. One example is thromboembolism and its treatment with oral anticoagulants.

A 48-year-old woman with hypertension, HIV infection, anemia, and chronic kidney disease presented with generalized body weakness and diarrhea of several months’ duration.

Case 1: A 19-year-old man seeks evaluation of leg pain of 1 month’s duration. The increased pigmentation on his legs has been present for about 8 to 9 months.

An 81-year-old woman with Alzheimer dementia is admitted to an acute geropsychiatry hospital unit because of agitation. Medical problems include a seizure disorder, perhaps of recent onset, well-controlled on phenytoin with therapeutic levels. Grew up in Puerto Rico. Unexplained eosinophilia of 15%.

Management of treatment-experienced patients with multidrug resistance can be challenging. Fortunately, since 2006, 4 new antiretroviral agents-darunavir, maraviroc, raltegravir, and etravirine-with activity against drug-resistant HIV have been approved.

Although more than 20 years of antiretroviral therapy use has resulted in the selection of multidrug-resistant (MDR) HIV-1, new drugs in the traditional and newer antiretroviral drug classes provide an increasing range of options for the effective treatment of HIV-1 infection.

A 45-year-old incarcerated man with long-standing AIDS was admitted for management of lower extremity pain secondary to peripheral neuropathy.

In the United States, 56,300 new HIV infections occurred in 2006, according to the CDC’s first national estimate of HIV incidence based on direct measurement. The CDC released the report July 26 at the 17th International AIDS Conference in Mexico City (Stannard MB. San Francisco Chronicle. August 3, 2008).

A 24-year-old man with a history of HIV infection (CD4+ cell count, 746/µL [32%]; HIV RNA level, 980 copies/mL; nadir CD4+ cell count, 482/µL [29%]), secondary syphilis, major depression, and intermittent crystal methamphetamine use presented to the emergency department with a 1-week history of gradually increasing pain and swelling in the left side of his scrotum, 2 days of fever (temperature to 38.6°C [101.5°F]), and chills.

An important study demonstrated the efficacy of chlorthalidone for the treatmentof systolic hypertension in elderly persons,1 and the results have been validatedby other studies.

In addressing a press conference this summer at the United Nations High-Level Meeting on AIDS, Dr Anthony Fauci of the NIH commented on the “40,000 to 52,000 new infections each year” occurring in the United States.

A 24-year-old woman presents with severe, persistent, left-sided abdominal pain that began about 12 hours earlier. Over-the-counter medications have provided no relief. The pain is not associated with dietary intake, nausea, vomiting, diarrhea, or dysuria. The patient denies fevers, chills, and recent trauma to her abdomen.

Colonoscopy has become the preferred method for colorectal cancer screening in the United States. For patients at average risk, the procedure is typically performed every 10 years, beginning at age 50.

Within the past decade, the incidence of methicillin-resistantStaphylococcus aureus (MRSA) has increased significantly,spreading from the hospital to the community setting. Patientswith skin infections whose condition is stable should be treatedwith antibiotic therapy as well as with incision and drainage,whereas patients with severe disease require hospitalizationand intravenous therapy. In addition to community-acquiredMRSA, a new strain of Clostridium difficile, BI/NAP1, has led toclinical challenges in infectious diseases medicine. The strainhas been associated with recurrent infection; more severe diseasethat mandates urgent colectomy; and dramatically highermortality in vulnerable populations, such as older adults. Oralvancomycin, rather than metronidazole, may be slightly moreeffective in patients with severe disease. Also, new strains of Chlamydia and Treponema are posing potential complications tothe treatment of sexually transmitted diseases such that cliniciansneed to be judicious in selecting antibiotic therapy in accordancewith factors related to geography and patient population.[Infect Med. 2008;25:421-424]