Pseudomonas aeruginosa is a major cause of nosocomial infections, including ventilator-associated pneumonia (VAP). Effective management of pneumonia caused by this pathogen has been hindered by the increased incidence of multidrug resistance and limited treatment options. The results of a study conducted in Spain underscore the importance of choosing the right antibiotic-or combination of antibiotics-for the initial empiric therapy.

Two studies provide further evidence that relatively low levels of air pollution have adverse respiratory effects. However, one of the studies suggests that improvement in air quality can slow the decline in pulmonary function.

We present a case of a 52-year oldwoman with exudativepleural effusion. Her workuprevealed an ovarian tumor,and the effusion completely resolvedafter resection of the tumor.Pathology revealed granulosacell tumor, which is anunusual cause of Meigs syndrome.This case shows theimportance of considering abdominopelvicpathology in unsolvedcases of pleural effusion.

The case presented here illustratesthe diagnostic challengesand potential severity of a fungalinfection.

Vaccines have substantially reduced the incidence ofpediatric pneumonias caused by Haemophilus influenzae type band certain serotypes of Streptococcus pneumoniae. However,other organisms are being identified more frequently, includingmethicillin-resistant Staphylococcus aureus (MRSA) and serotypesof S pneumoniae that are not covered by the pneumococcalvaccine. Although chest radiographs are still a basic componentof the assessment of pneumonia, CT scans are increasinglybeing used to differentiate effusion from empyema and consolidationand to evaluate for pleural fluid loculations, lung abscesses,and lung necrosis. ß-Lactams, particularly extendedspectrumcephalosporins, remain an important cornerstone ofthe treatment of complicated pneumonia. In areas where community-acquired MRSA is a concern, empirical coverage for thispathogen should be considered in patients with a severe ornecrotizing pneumonia. (J Respir Dis. 2008;29(2):85-92)

Dull, intermittent, midepigastric abdominal pain of 1 day's duration prompted a 73-year-old man to seek medical attention. He had no other symptoms.

A 26-year-old white man had blurred vision for 4 weeks. A sluggish light reflex was noted in the left eye. Funduscopic examination showed left-sided optic disc swelling with dot hemorrhages and hard exudates.

Methicillin-resistant Staphylococcus aureus (MRSA) first came to the attention of health care providers as a nosocomial pathogen.1 More recently, MSRA has emerged as an important community-acquired pathogen2 and has been a cause of infection in men who have sex with men (MSM)3,4 and in persons with HIV-1 infection.5-7 Other reports include clusters of MRSA infection in prison inmates,8 military recruits,9 and athletes.10

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. Although immunocompetent persons with H capsulatum infections are usually asymptomatic, several clinical syndromes can manifest in immunocompromised patients.

How best to reduce the risk of osteonecrosis of the mandible in patients who take bisphosphonates? Bisphosphonates have a profound effect on osteoclast function: they inhibit bone remodeling, and then cellular apoptosis occurs. These drugs have been remarkably effective in the management of diverse diseases.

Systemic lupus erythematosus (SLE) is an unpredictable multisystem disease that affects more than 1.5 million Americans and at least 5 million persons worldwide, according to the Lupus Foundation of America (LFA).

A 39-year-old woman complained of excruciating pain that radiated from a chronic lesion on the left upper lip to the entire left side of the face. She had AIDS (CD4+ cell count, 68/µL; HIV RNA level, greater than 750,000 copies/mL) but was not receiving antiretroviral therapy. The lesion first appeared as a blister, which ruptured after it was struck by a toy thrown by her son. It enlarged and became more painful despite antibiotic therapy and a 1-month course of valacyclovir. During this period, she had no fever. She used marijuana and alcohol for pain control.

Case 1: During the past few weeks, a 14-year-old boy has noticed blood on the proximal nail folds of the second and third fingers of his dominant hand. He denies any pain or pruritus. The patient is otherwise healthy and takes no prescription medications.Which of these questions do you ask the patient?A. What sports do you play?B. What are your extracurricular activities?C. Do you bite your nails?D. Do you take any over-the-counter medications or alternative remedies?E. All of the above. (Answer on next page.)

Cancer of the anal canal is a relatively uncommon disease in the United States. It accounts for about 2% of the cancers of the GI tract; about 5000 cases will be diagnosed this year. Squamous cell carcinoma of the anus (anal SCC) is of particular interest to the infectious disease specialist because it is one of the cancers associated with HIV infection in men who have sex with men (MSM).

Although adenoviruses are a recognized cause of serious pulmonary and disseminated disease among stem cell transplant recipients, their importance in other immunocompromised patient populations is less clearly documented.

Mr D is a 38-year-old African American man in whom AIDS had been diagnosed in 2001; he had responded well to antiretroviral therapy, with a recent CD4+ cell count of 376/µL and an HIV RNA level less than 50 copies/mL. He presented to our clinic complaining of a mildly tender "lump" on the left side of his neck, which he first noticed a week ago. He denied fever, chills, sweats, cough, anorexia, weight loss, and urinary symptoms but had a sore throat for 2 days.

An 8-week-old boy is brought for evaluation of gradually worsening yellow skin discoloration of about 1 week's duration. His parents report that he has had constipation for the past several days; before that, he had green diarrhea and occasionally spit up after breast-feeding.

Study Finds Antiretroviral Drugs May Prevent HIV Infection A study involving monkeys found that the use of 2 antiretroviral drugs, emtricitabine (FTC) and tenofovir, prevented transmission of a primate version of HIV (Berman J. Voice of America. February 5, 2008).

Little of promise in terms of HIV prevention science was reported at the 15th annual Conference on Retroviruses and Opportunistic Infections (CROI), held from February 3 to 6, 2008, in Boston. Coupled with several other pieces of disappointing news related to early HIV diagnosis and efficacy of vaginal microbicides, most hope continued to relate to disease treatment.

A 71-year-old man complains of left elbow pain that increases with movement and has worsened over the past 12 hours. He has also had a cough with sputum production for the past several days.