Infection

Two of the numerous geriatrics offerings at this year’s ACP convention were part of a series entitled “Modifying Your Office Practice for the Tsunami of Older Adults.” This eminently apropos title was actually something of a theme for the convention as a whole. This year, only 3 clinical categories boasted more offerings than geriatrics. Clearly, primary care physicians are beginning to feel the impact of the baby boomers’ coming of age.

Michael F. Holick, MD, PhD, the Boston University professor of medicine and well-known “apostle of vitamin D,” attracted a standing-room-only crowd Friday for a presentation on his favorite topic. It was a performance that had the audience at rapt attention for a full hour-not just because of the celebrity of the speaker, but because of the extraordinarily clever and engaging nature of his presentation.

Probiotics and prebiotics are now widely used by patients – and even present in many common foods.

A 5-year-old boy was brought for evaluation of left leg pain. He had awoken with the pain 2 days earlier.

A 60-year-old laboratory technician complained of a pruritic rash on and around her left ear. It had appeared a few days earlier, shortly after she cleaned her telephone receiver with a disinfectant. A tentative diagnosis of contact dermatitis was made, and treatment with a hydrocortisone cream was initiated.

One of the most important roles for primary care practitioners is the review and implementation of necessary immunizations across a broad spectrum of age.

On the second day of hospitalization for recurrent acute pancreatitis of unknown cause, a 32-year-old man awoke with difficulty in swallowing, throat discomfort, and a swelling in the back of his mouth. He had no history of similar oral symptoms.

Match the following characteristics with the clinical disorders pictured in the photographs of Cases 1 and 2. Then read the brief descriptions that follow on the next page to see how well you did.

For every recognized case of celiac disease, 8 more remain undiagnosed. The reason for this disparity is contingent on the varying presentations of the disease.

A 13-year-old girl is seen because of a genital injury sustained during a fall from her bicycle. Is post-menarchal. Denies any past or present sexual activity, consensual or coercive. Parents report that she has not been ill-adjusted at school and has had no more behavioral issues than her age cohort in recent months.

For several weeks, a 33-year-old man has had an asymptomatic lesion on the head of the penis. He has had a new sex partner in the past few months but is unaware of any health problems she may have. What is the likely cause of this lesion?

A 35-year-old man presents with a scaling rash on the penis of several weeks’ duration. Which of the following would you include in the differential?

Is this penile rash the result of lichen planus? Candidiasis? A dermatophyte infection? Seborrhea? Psoriasis? Click here for the answer.

With advances in chemotherapy, transplantation, and the treatment of diabetes and HIV infection, fungal sinusitis has become increasingly recognized in patients in these at-risk groups.

As a screener and admissions committee member at our medical school (University of California School of Medicine at Davis), I am privileged to review the personal statements of many, many applicants who want to be doctors in spite of the recent hard times in our country that have led more than a few American physicians to believe that our profession is less valued and less desirable as a life work than it has been in the past.

A 62-year-old woman presents with epistaxis from the right nostril. Thenosebleed has lasted about 90 minutes, and she has become alarmedby the amount of blood on the tissues and washcloth she has applied to hernose.

Read the details from 3 unique cases on GI disorders: dieulafoy lesion, colovesical fistula, and intussusception.

Physical changes that occur in aging skin (eg, dryness and thinning) can result in pruritus and cause patients to rub, scratch, and pick at their skin. These activities produce various dermatoses and reactive changes in the skin, such as postinflammatory pigmentary alteration. Lichen simplex chronicus (LSC) develops as a physiological cutaneous response to repetitive scratching or rubbing. First-line treatment consists of topical corticosteroids and application of ice to reduce the sensation of itching. Like LSC, prurigo nodularis results from rubbing and scratching the skin. Treatment is similar; however, intralesional corticosteroids and UV therapy play more of a role because prurigo nodularis is more intensely pruritic than LSC.

What is the role of the primary care practitioner in the care of patients with HIV infection?Although the treatment of human immunodeficiency virus type 1 (HIV-1) infection is usually directed by subspecialists, many patients who are taking highly active antiretroviral therapy (HAART) continue to see their primary care physician. What is the most effective regimen-and what complications should we be on the lookout for?

We lie awake in our one-room hut before dawn listening to the cacophony of sounds emanating from the forest as the birds awake. The Bwindi Impenetrable Forest of Southwest Uganda contains over 350 species of birds, and it seems that they are all chattering to each other at once. The Bwindi Forest is also home to more than half of the world’s 650 mountain gorillas.

A documented anti–varicella-zoster virus (VZV) titer is generally accepted as evidence of protection against VZV infection, and a known case of shingles, such as that described in the Photoclinic case of an older man with ophthalmic zoster (Tran KT, Qualm AS, Shannon MA. CONSULTANT, December 2009, page 767), might reasonably be expected to boost anti-VZV titers in the affected patient. Why then would administration of the zoster vaccine be included in this patient’s treatment plan?

A 51-year-old man is seen because of a painful groin rash. Has not cleared despite 3 months’ topical corticosteroids and antifungals.

H1N1 influenza has paid an unwelcome visit to a number of nursing homes, reports the CDC.

Most travelers to Third World countries encounter health-related problems during their stay and may require medical attention on returning home. Although malaria is still the most common diagnosis among travelers to the developing world, several other infectious diseases, such as dengue fever, chikungunya fever, and leishmaniasis, are growing in importance. Clinicians need to stay informed about travel requirements and vaccine recommendations for US citizens.

A 38-year-old man had fever and fatigue for the past 6 days and tenderness in the left upper abdominal quadrant for the past 3 days. He also had a facial butterfly rash that had been present for 10 years and a 1-year history of lupus nephritis, treated with prednisone and mycophenolate. He denied respiratory complaints or recent weight loss.

In 2010, CONSULTANT marks its 50th year of service to primary careclinicians. On our golden anniversary, it seems appropriate to reflect onthe challenges, rewards, and frustrations of current medical practice.

MedImmune is recalling 13 lots of monovalent 2009 H1N1 influenza nasal spray vaccine whose potency has decreased or is expected to decrease shortly.

A single dose of 2009 influenza A (H1N1) vaccine induced protective antibody titers in more than 90% of children in an Australian study.

For 1 month, a 60-year-old white man has had increasing fatigue, generalized weakness, and exertional dyspnea. He becomes short of breath after he walks only 100 to 150 yards on level ground or climbs only 1 flight of stairs. In addition, he has unintentionally lost 12 lb in the past month and has experienced intermittent dysphagia with solid foods. He attributes this last symptom to long-standing gastroesophageal reflux disease (GERD), for which he regularly takes over-the-counter omeprazole.

For 3 months, a 43-year-old Bolivian woman had worsening thoracic and lumbar pain associated with tingling and tightness in the anterior upper and lower abdominal area, and numbness in the lower extremities. Her symptoms also included difficulty in walking (with frequent falls from imbalance), occasional urinary incontinence for the past few weeks, occasional afternoon low-grade fevers, and poor appetite with an associated 10-lb weight loss within the past 4 months.