A 48-year-old Hispanic man had a tender, bleeding growth within a darkly pigmented plaque on the right flank. The pigmented lesion had been present since birth; it was previously asymptomatic. The tumor arose out of the mainly flat patch 6 months earlier and had slowly enlarged. The patient worked indoors, wore sunscreen daily, and generally avoided outdoor activities. He had no family history of skin cancer.
The effectiveness of oseltamivir in preventing nosocomialinfluenza (influenza Avirus infection) during an influenzaepidemic was carried out in several wards of a universityhospital. Asurvey conducted during the 2005 influenza seasonidentified 30 staff members (nurses and doctors) and 3hospitalized patients who met the case definition for influenza.Adefinitive influenza diagnosis was made in 17 staff members(57%) and in 2 inpatients (66%) based on the results of a rapiddiagnostic test. Most of the 30 symptomatic staff membershad been vaccinated for influenza. Symptomatic staff memberswere sent home for 1 week, and the infected inpatients wereisolated. Oseltamivir (75 mg/d for 5 days) was administered to99 staff members and 2 inpatients who had close contact withthe infected patients. Although a relatively large number of thestaff had an influenza virus infection, the use of oseltamivirmay have effectively prevented a nosocomial outbreak.[Infect Med. 2008;25:49-50a]
A 25-year-old woman presented with a rash of 4days' duration, fever, arthralgia, and headache.The rash, which was localized to the hands, feet,and elbows, was intensely pruritic and was associatedwith swelling and pain in the hands and feet.
Loxoscelism is often misdiagnosed, in part because the clinical presentation of loxoscelism is similar to that of other conditions, such as cutaneous anthrax and Lyme erythema migrans (EM). Differentiating these disorders is important because some of these conditions require early treatment to achieve the best clinical outcomes. Unfortunately, using geography to make or exclude a diagnosis is becoming less reliable.
Multiple atypical presentations of acute retroviral syndromehave been reported in the literature, but rarely has acute retroviralsyndrome been associated with disseminated intravascularcoagulation (DIC). We detail a case of a 19-year-old manadmitted to the hospital with initially unexplained severe DICthat on workup was found to be secondary to acute retroviralsyndrome. [Infect Med. 2008;25:24-28]
The incidence of cryptococcal infections in the HIV-infectedpopulation has diminished because of the effectiveness of anti retroviraltherapy, whereas the incidence in non–HIV-infectedhosts has grown. Despite improvements in antifungal therapy,successful outcomes in the management of cryptococcalmeningitis are dependent on a high index of clinical suspicion,appropriate use of diagnostic assays, early and aggressiveantifungal therapy, and recognition of complications such asincreased intracranial pressure and immune reconstitutionsyndromes. Published guidelines for the care of patients withcryptococcal meningitis are available and may be adapted toindividual patient requirements. Basic and clinical studies areneeded to further define the components of immune protection,optimal therapy in special patient populations, and the recognitionand treatment of complications of cryptococcal meningitis.[Infect Med. 2008;25:11-23]
In patients with HIV/AIDS, multifocal choroiditis has been associated with numerous life-threatening disseminated opportunistic infections. Optic neuropathy in patients with AIDS is also associated with opportunistic infection.
A 55-year-old man was admitted after presenting to the hospital emergency department with short-term memory loss and headache and a 1-month history of intermittent fevers, weight loss, and chills.
Human herpesvirus 8 (HHV8) is associated with Kaposi sarcoma (KS) and 4 lymphoproliferative disorders: multicentric Castleman disease, primary effusion lymphoma, B-cell plasmablastic lymphoma, and germinotrophic lymphoproliferative disorder.
Breathable indoor air has become so commonplace in the United States (and, increasingly, worldwide) that many forget that it has been less than a quarter century since the major push to limit indoor smoking really began to have an impact.
This gay white man was your patient several years ago. He originally presented to you in 1995 with diffuse cutaneous Kaposi sarcoma (KS) and a CD4+ cell count of 15/µL.
Trimeris and its partner Roche said they are withdrawing an application to sell their injectable AIDS drug Fuzeon (enfuvirtide) in a needle-free device. "While the device has shown potential benefit for some patients, we don't believe it's the real alternative delivery option for all patients," said Michelle Zupancic, vice president, HIV, at Roche (Vollmer S. News & Observer [Raleigh]. October 4, 2007).
In 1985, only 7% of AIDS cases occurred among female adults and adolescents older than 13 years, but by 2005, they represented 27% of US AIDS cases.
Blowing bubbles is an effective way to gain a young patient's attention.
Despite meticulous titration of anticoagulation therapy and careful attention to confounding medications, serious bleeding complications occur in some patients who receive warfarin.
Some of my patients who are being treated for hypertension, hyperlipidemia, or both claim that an elevated blood pressure reading or lipid level measurement resulted from a sodium- or fat-laden meal that they had eaten 1 or 2 days before their office visit.
For easier application of eye ointment, have the patient lie down or sit with his head tilted back.
The differential diagnosis of generalized weakness is enormous; it includes disorders at all levels of the neur-axis. A variety of electrophysiological, pathological, radiographic, and other laboratory studies may be indicated depending on the specific diagnostic possibilities; costs can be controlled if such investigations are selected judiciously.
A 50-year-old woman had a 6-month history of severe generalized itchiness and fatigability. There was no associated fever, abdominal pain, or joint pain. A cholecystectomy had been performed 20 years earlier. She had no family history of hypercholesterolemia or liver disease.
Identifying the cause of a persistent, asymptomatic aminotransferase elevation can be challenging. The possible diagnoses are many and varied. To narrow the differential, begin with a detailed history.
