Infection

GENEVA, Switzerland -- The risk of late-onset ventilator-associated pneumonia in ICU patients rises as the nurse-to-patient ratio declines, reported investigators here.

DENVER -- Andrew Speaker's much-documented battle with drug-resistant tuberculosis took another a turn today, with the sudden announcement that he would have surgery this morning to remove diseased and damaged lung tissue.

PROVIDENCE, R.I. -- Occurrence rates for cutaneous T-cell lymphoma more than tripled from 1973 to 2002, with the rise varying by race, sex, and geographic area, researchers found.

HERSHEY, Pa. -- Diabetes complicates hospital trauma care much as it does for in-patient acute care, researchers here reported.

MINNEAPOLIS -- The frequency and severity of Clostridium difficile colitis in hospitalized patients have increased dramatically since the early 1990s, leading to greater morbidity and mortality, investigators here reported.

RICHMOND, Va. -- Longer is better when it comes to treatment for hepatitis C, researchers here said.

BOSTON -- Incretin-based therapies offer an alternative to hypoglycemic agents for type 2 diabetes with little if any weight gain, a meta-analysis showed.

PHILADELPHIA -- Not only did prophylactic antibiotic therapy fail to reduce recurrence of urinary tract infections in young children, it was linked to an increase in resistant infections.

PARIS, July 9 -- Episodic impaired memory, not dementia, is the crucial clinical symptom required for diagnosis of Alzheimer's disease, according to a proposal for revised diagnostic criteria.

ROCKVILLE, Md. -- Calcium and ceftriaxone (Rocephin) are a dangerous combination that can increase the risk of lethal precipitates forming in the lungs and kidneys of infants, according to the FDA.

DENVER -- In a surprising turn of events, the tuberculosis that turned Andrew Speaker into an international cause celebre was misdiagnosed, physicians said today.

abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown etiology that leads to progressive fibrosis and respiratory failure. Patients with IPF typically present in their sixth to seventh decade of life with the insidious onset of progressive dyspnea and cough. Lung histopathology reveals the distinct lesion of usual interstitial pneumonia (UIP), and other causes of UIP, such as collagen-vascular disease, drug exposure, or occupational exposures, must be excluded. A confident clinical diagnosis of IPF can often be made without resorting to surgical lung biopsy if certain clinical features are present and a typical pattern is identified on high-resolution CT (HRCT) scanning of the thorax. Changes on HRCT scans that are typical for UIP include a predilection for peripheral and basilar lung zones with patchy involvement and sparing of more central areas, especially in upper lung zones. (J Respir Dis. 2007;28(7):283-292)

abstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged? Inadequate application of practice guidelines may be the chief reason, according to a committee from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS).1

Acute invasive fungal rhinosinus- itis occurs predominantly in immunocompromised patients, such as those with neutropenia and transplant recipients. The diagnosis requires biopsy, but permanent section can be time-consuming and result in a delay in treatment. Ghadiali and colleagues conducted a study to evaluate the accuracy of frozen-section biopsy in this setting.

A 53-year-old woman presented to the emergency department complaining of substernal chest pain that awoke her from sleep. The chest pain was associated with left shoulder numbness, radiating to her back, and was partially alleviated with sublingual nitroglycerin. During this episode, the patient had a cough productive of yellow phlegm and one instance of cough productive of 1 tbs of bright red blood.

A 22-year-old man complained of jaw pain, sore throat, and dysphagia to solids and liquids. A month earlier, he presented to another hospital with similar symptoms; an infection of the lower right third molar (tooth no. 32) was diagnosed, and oral penicillin and hydrocodone were prescribed. He finished the course of the antibiotic but failed to follow up with a dentist.

Heart failure is prevalent in both primary care and cardiology practices. It develops in about 1 in 5 persons during their lifetime and in about 1 in 8 of those who have not sustained a myocardial infarction (MI). Heart failure is also the leading cause of hospitalization in the elderly.

Your Observations About the Man With the Tripod Sign

Photo Finish

How strong is the link between antibiotic use and resistance? Patients with upper respiratory tract infections (URTIs) have come to expect an antibiotic even if their clinical presentation is consistent with a viral infection.

A Photo Quiz to Hone Dermatologic Skills

An 82-year-old man is seen for annual physical examination in the nursing home. He has resided there for 1 year because of the aggregate impact of multiple medical problems including, most prominently, laryngeal swallowing dysfunction associated with vocal cord paralysis.

LONDON -- Bolstering the GI tract with a mix of disease-fighting microbes significantly reduced the incidence of diarrhea associated with antibiotics and Clostridium difficile, according to results of a placebo-controlled trial.

HELSINKI -- About 90% of early signs of cervical cancer in young women can be prevented by an investigational vaccine against human papillomavirus, according to interim data.

SAN FRANCISCO -- The rate of methicillin-resistant Staphylococcus aureus in U.S. hospital patients is now nearly 5% -- dramatically higher than previously thought, according to a nationwide survey of healthcare facilities.

BALTIMORE -- A needle stick injures more than four of every five surgical residents during their training, researchers here said, and about half of the incidents go unreported.

HARTFORD, Conn. -- Echinacea, the irrepressible alternative cold remedy, is ascendant again in the topsy-turvy world of evidence-based medicine.

INDIANAPOLIS -- Although the recent withdrawal of tegaserod from the market has left a hole in the options available to treat irritable bowel syndrome (IBS), there are still many available.

TORONTO -- If avian flu holds the potential for a human pandemic, one possible strategy is to vaccinate the birds.