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Previous case reports have suggested an association betweenhuman T-cell lymphotropic virus (HTLV) types 1 and 2infection and chronic nonprogressive HIV infection. Evidenceis lacking about the specifics of how the two are related. Wereport 2 cases of chronic nonprogressive HIV infection (of9 and 13 years' duration, respectively) in women in whomHTLV coinfection was diagnosed. These cases provide clinicalsupport that HTLV coinfection may serve as a protective factoragainst progression of HIV infection. Possible reasons for thisrelationship and potential future research are discussed.[Infect Med. 2008;25:416-420]

The successful management of immunosuppression followingsolid organ transplant requires a delicate balance betweenpreventing allograft rejection and minimizing the risk ofinfection. Strategies that may reduce the risk of de novoopportunistic infection and emergence of latent infectionduring the early posttransplant period-specifically infectioncaused by Cytomegalovirus, opportunistic fungi such as Aspergillus and Candida, and bacteria such as Pneumocystisjiroveci and Mycobacterium tuberculosis-are presented in thisreview. [Infect Med. 2008;25:403-415]

WNV first appeared in the United States in 1999.1 This infection "got no respect" even though it caused significant morbidity and mortality while crossing the United States unabated for the past 9 years. Patients died mainly of neuroinvasive complications such as encephalitis and a polio-like paralysis. The lack of respect became a reality to clinicians in Phoenix in 2004 when they found themselves poorly prepared to manage the many acutely ill patients affected by WNV. That there was a lack of practical information about how to manage WNV became readily apparent to these clinicians.

Ehrlichia species, which are transmitted by ticks, may causehuman monocytotrophic ehrlichiosis and human granulocyticanaplasmosis. Symptoms of infection include fever, headache,myalgia, progressive leukopenia, thrombocytopenia, and anemia.Diagnosis is based on clinical findings, although serologicaltests can identify the specific infectious ehrlichial organism.Tick repellents, particularly permethrin, can help prevent tickbites and lower the risk of infection by tick-borne pathogens.Tetracycline antibiotics are therapeutic for treatment ofehrlichial infections. [Infect Med. 2008;25:425-429]

In 2004, 391 cases of West Nile virus (WNV) infection werereported in Arizona. This represented an epidemic thatchallenged area clinicians. We treated 34 patients with WNVinfection and reviewed their medical records. They werehospitalized at 3 community hospitals during the epidemic.These patients represented 9% of all WNV infection casesreported in Arizona. Meningitis was diagnosed in 13 patients,encephalitis in 12, fever of unknown origin in 5, transversemyelitis in 3, and carditis in 1. Respiratory failure requiringmechanical ventilation developed in 6 patients. Five of thesickest patients were empirically treated with interferon alfa 2band ribavirin. The epidemic and associated clinical challengesprompted evaluation of the available diagnostic and treatmentstrategies to optimize care of very ill patients. The consensusamong clinicians was that they were poorly prepared todiagnose and treat WNV infection in hospitalized patients.All patients survived hospitalization, although 4 patientsdied after discharge because of factors attributable to WNVinfection. [Infect Med. 2008;25:430-434]

A 51-year-old man with a long history of alcohol abuse and heavy cigarette smoking presented to our hospital with worsening of a chronic cough, which had become productive of thick green sputum and was associated with posttussive emesis. He denied fevers and chills but had a recent and unintentional weight loss of about 5 kg. He had a history of squamous cell carcinoma of the right tonsil, which remained in remission for more than 4 years after chemotherapy, radiation therapy, and resection. There was no recent history of travel or any occupational exposures or known contacts with tuberculosis or animals (wild or domestic).

The differential diagnosis forendobronchial lesions includesbut is not limited toneoplastic causes, benign tumors,infections, and foreignobjects. We report a case of anunusual cause of endobronchiallesions.

This question deserves a broad answer, considering how much has changed since the old high-resolution CT (HRCT) scans with 1-mm slices and 1-cm intervals.1-3 The advent of multidetector row CT has had a significant effect on the versatility and diagnostic capabilities of CT in general. Coupled with novel processes of image postprocessing-including quantification of lung disease using advanced software-the availability of multiplanar projections and the opportunity to perform virtual bronchoscopy have led to an improvement in what is available for the evaluation of COPD.

Since the introduction of highly active retroviral therapy and with the improvement in the survival of persons with HIV/AIDS, the spectrum of renal disease in HIV-infected persons has expanded.

Because widespread use of highly active antiretroviral therapy has made it possible for persons with HIV infection to live longer, the epidemiology of HIV/AIDS has shifted in several ways

On Thursday, July 17, plans to conduct a large-scale test of an experimental therapeutic AIDS vaccine were canceled, the latest setback following last year’s failed Merck AIDS vaccine trial (Russell S. San Francisco Chronicle. July 18, 2008).

In recent years, few breakthroughs in HIV prevention science have been realized. Preexposure prophylaxis (PrEP), involving the use of antiretrovirals just before a potentially risky sexual encounter, is an intriguing concept, although it’s not new.

An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration. Her symptoms persisted despite her usual allergy medications, allergen immunotherapy, and 2 courses of antibiotics. A sinus CT scan showed complete opacification of the right maxillary sinus with increased attenuation of the mucin. Allergic fungal rhinosinusitis was suspected, and an otolaryngologist was contacted.

I often inject patients’ knees with a mixture of a corticosteroid and an anesthetic agent to alleviate arthritis pain. However, some patients with knee pain have difficulty in climbing onto the examination table.

Many different antiretroviral regimens can be used as initial therapy for infection with HIV.

Is the Seventh Report of the Joint National Committee for Prevention, Detection, Evaluation, and Treatment of Hypertension (JNC 7) still considered current, or are newer guidelines available?

Medication errors contribute substantially to unsafe hospital and ambulatory environments. The Institute of Medicine estimates that on average each hospitalized patient experiences 1 medication error per day.1

A 58-year-old man was brought to the medical ICU after almost an hour of field and emergency department resuscitation following cardiac arrest (intermittent rhythms of ventricular fibrillation, ventricular tachycardia, pulseless electrical activity, and asystole). He had hypertension, diabetes mellitus, and end-stage renal disease managed with hemodialysis. His medications included atenolol, enalapril, amlodipine, and insulin. His last hemodialysis session was 10 days earlier.