Infection

A 37-year-old man presents with moderately pruritic urticarial papules on areas of his skin that are not covered by his shorts and T-shirt. He recently returned from a trip to Upstate New York, where he had stayed in several rustic cabins that were used by different people daily.

Determining the cause of generalized weakness can be a daunting task, since the differential diagnosis is vast. An overall approach to the patient who complains of generalized weakness is presented in our article

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.

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.

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged?

A Photo Quiz to Hone Dermatologic Skills

The notoriously adaptable and increasingly common pathogen requires a new approach including routine I&D and culturing of infected tissues; the use of more-potent antibiotics, but only when needed; and a focus on hygiene in patients with recurrent infections.

For 2 weeks, a 43-year-old white female had worsening nausea and multiple episodes of vomiting. Her symptoms began with increased malaise and decreased appetite. The emesis was unrelated to meals and was sometimes accompanied by mild abdominal distention. She had occasional fevers but denied any recent contact with ill persons. She also reported a 12-lb weight loss, decreased energy level, and an increased tan complexion over the past several months.

For 6 weeks, a 56-year-old man had worsening dyspnea on exertion and a cough productive of yellow sputum with scant hemoptysis. He reported subjective fever over the past month but no weight loss.

A 66-year-old woman was hospitalized because of severe anemia secondary to myelodysplastic syndrome. She had had associated fatigue and throbbing pain in both legs for several days.

For 2 weeks, a previously healthy 40-year-old man has had excessive thirst and increased frequency of urination. He awakens at least 5 times every night to urinate. He reports no nausea, vomiting, change in bowel habits, chest pain, or dyspnea.

Worsening painful ulcers on both legs prompted a 62-year-old woman to seek medical attention. She had a history of rheumatoid arthritis (RA), demonstrated by the markedly deformed interphalangeal joints in her thumbs (A), and scleroderma-polymyositis overlap syndrome.

Fear of bioterrorism persists because of new reports of biological warfare, including the most recent attack that involved a Russian spy who was poisoned with polonium-210. However, vaccination against potential biological weapons, such as anthrax and smallpox, is controversial because of associated adverse effects.

A painful necrotic lesion, a pruritic rash that recurs after corticosteroid therapy, an ulcer on the tongue-do you recognize the disorders pictured here?

Six months after testing positive for HIV in 10 bands, a 24-year-old homosexual man presented with a macular rash on his palms and soles. He first noticed the lesions 2 weeks earlier; they were not pruritic or painful. He also had a brighter, more inflamed rash in the groin and antecubital fossae that was presumed to be a yeast infection and was treated with fluconazole. He had no other symptoms.

Hidradenitis suppurativa is a chronic acneiform infection of the cutaneous apocrine glands.

ROME -- Simple measures -- such as handwashing with soap and water -- could be the best way to reduce the spread of respiratory viruses that cause illnesses like flu and SARS, a new Cochrane review has found.

MONTREAL -- Viral testing to detect cervical cancer appears to outperform the conventional Pap smear in some respects, researchers here have concluded.

DUNDEE, Scotland -- Early treatment of Bell's palsy with prednisolone significantly increases the chance of a full recovery by three to nine months from facial paralysis, investigators here reported.

SAN FRANCISCO -- HIV-positive African-Americans have a six-fold higher risk for end-stage renal disease than whites with HIV, investigators here reported.

ATLANTA -- Invasive infections of methicillin-resistant Staphylococcus aureus (MRSA) may be more common than suspected, according to the first nationwide surveillance estimates.

ROCHESTER, N.Y. -- A strain of pneumococcus resistant to all of the antibiotics approved for use in children has emerged in the wake of widespread use of the heptavalent pneumococcal vaccine, researchers here said.

WHITEHOUSE STATION, N.J. -- The FDA has approved raltegravir (Isentress) as part of a combination regiment for treatment for multi-resistant HIV-1 infection in adults, according to an announcement from Merck.

PHILADELPHIA -- Helicobacter pylori infection has been associated with the development of adenomatous polyps of the colon, according to a study reported here.

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IOWA CITY, Iowa -- A new picture of adenoviruses and the disease associated with them in the U.S. is emerging from a novel molecular technique, according to researchers here.

NEW YORK -- If standard intravenous antibiotics don't relieve persistent or recurrent memory deficits in Lyme encephalopathy, a 10-day IV course of ceftriaxone (Rocephin) may do so -- but the benefit doesn't last.

BRISBANE, Australia -- Obesity even without reflux disease is associated with six times the risk of developing esophageal adenocarcinoma compared with those of normal weight, researchers here found.

SAN DIEGO -- Rushing the decision to treat suspected pneumonia with antibiotics may lead to unnecessary treatment in a majority of cases, according to a small study reported here.

ROCKVILLE, Md. -- The FDA has alerted physicians to the need for children with cochlear implants to be fully immunized against bacterial meningitis, citing two recent deaths that might have been prevented.