Infection

abstract: The use of fiberoptic bronchoscopy (FOB) in HIV- infected patients has sharply declined since the availability of highly active antiretroviral therapy and the resulting decrease in the incidence of opportunistic infections. Nevertheless, FOB continues to be an important diagnostic tool in this patient population. For example, FOB is useful in evaluating for Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) in patients with CD4+ cell counts of less than 200/µL who have diffuse pulmonary infiltrates and in whom sputum induction has not been performed or is nondiagnostic. It is also useful for evaluating patients who have not responded adequately to empiric therapy for bacterial pneumonia or PCP. Other applications include the visual diagnosis of endobronchial Kaposi sarcoma or the assessment of suspected lung cancer. (J Respir Dis. 2007;28(6): 244-252)

Marijuana is the most commonly used illicit drug in the United States. The prevalence of marijuana use has remained stable over the past several years, with 14.6 million persons older than 12 years reporting past-month use in 2005. Given the prevalence of illicit use and interest in the medicinal use of marijuana, an understanding of the potential negative health consequences of marijuana smoking is needed. While tobacco smoking is clearly associated with numerous adverse respiratory complications, including increased cough and wheeze, the development of chronic obstructive pulmonary disease (COPD), lung cancer, and an increased incidence of infections,1-3 the relationship between marijuana and pulmonary disease is controversial, despite similarities in many compounds found in marijuana and tobacco smoke.

Tinea corporis appears as an annular plaque with a rim of scaly erythema.

Tinea that occurs on the hands is referred to as tinea manuum.

Maceration or scale between isolated web spaces of the fingers suggests erosio interdigitalis blastomycetica (interdigital candidiasis). It most often occurs in the web space between the middle and ring fingers; sometimes the toes are affected. Erosio can spread and can be painful.

A fungal folliculitis (Majocchi granulomas) can occur if a superficial fungal infection is treated with topical corticosteroids. Fungal folliculitis is best treated with a short course of oral itraconazole or fluconazole.

ABSTRACT: Undiagnosed or persistent Helicobacter pylori infection and surreptitious or unrecognized NSAID use are the most common causes of refractory peptic ulcers. The use of antibiotics, bismuth, or proton pump inhibitors (PPIs) suppresses the H pylori bacterial load and may obscure the diagnosis. H pylori infections have also become more difficult to cure because of increased antibiotic resistance. For refractory infection, select an antibiotic based on in vitro susceptibility testing. When this is not available, combination therapy with a PPI, tetracycline, metronidazole, and bismuth is often effective. To detect surreptitious or inadvertent NSAID use, review the drug history in detail. When there is any doubt about such use, check platelet cyclooxygenase function.

ABSTRACT: Atypical clinical presentations in the quality, intensity, and radiation of pain are common in patients with acute coronary syndromes. Women with an acute myocardial infarction (AMI) are more likely to have atypical symptoms, such as dyspnea, than men. A history of acute anxiety or a psychiatric diagnosis does not preclude the possibility of an acute coronary event in a patient with chest pain. The clinical response to a GI cocktail, sublingual nitroglycerin, or chest wall palpation does not reliably identify the source of pain. Over-reliance on tests with poor sensitivity, such as the ECG, or on the initial set of cardiac biomarkers will miss many patients with MI. Serial troponin levels obtained at 3- to 6-hour intervals are recommended to evaluate the extent of myocardial damage. Coronary angiography that detects mild non-obstructive disease does not exclude the possibility of sudden plaque rupture and acute coronary occlusion.

Candidal infection can also occur at the lateral angles of the mouth; it causes erosions and breakdown of the skin. Angular cheilitis, or perleche, resembles the relationship between intertriginous candidiasis and intertrigo in that it is part infection and part inflammatory response to the impairment of epidermal integrity.

Lyme disease-the most common arthropod-borne illness in the United States-has become entrenched in the Northeast, upper Midwest, and northern California, and it is spreading to other regions of the country. Diagnosis and management remain a significant challenge because of the diverse manifestations of the disease and the limitations of current tests.

This infection is usually caused by Candida albicans, whichis often present in body folds. Candidiasis is common in persons with diabetes and in obese persons. Other predisposing factors are the use of antibiotics, topical corticosteroids, or immunosuppressive drugs; poor nutrition; and immunosuppression.

Tinea pedis, or athlete's foot, is common in elderly persons. It manifests as maceration in the interdigital web folds and as scaly plaques on the plantar surfaces of the feet. A potassium hydroxide evaluation can establish the diagnosis. Tinea pedis is commonly associated with xerosis. It is best treated with a topical antifungal agent; treatment can be aided by a keratolytic such as lactic acid 12% cream.

Routine blood work revealed liver function abnormalities in a 55-year-old woman. She had recently undergone extensive dental work that resulted in severe pain; to relieve the pain she took oxycodone and acetaminophen, 3 to 4 g/d, for more than a week. She has not taken any acetaminophen for the past 5 days.

Oral candidiasis, or thrush, is not uncommon in elderly persons. It can be related to poor dentition or immunosuppression, particularly as a result of oral corticosteroid use.

The incidence offluoroquinoloneresistantgonorrheacontinues torise in the UnitedStates, and the CDC isnow urging physicians toprescribe cephalosporinsfor patients with gonococcalinfections.

The prevalence of onychomycosis increases with age; it is less than 1% in persons younger than 19 years and rises to about 18% in those who are 60 to 79 years. The infection is more common in men than in women. Among the predisposing factors are diabetes mellitus, psoriasis, a family history of onychomycosis, use of immunosuppressive drugs, and peripheral vascular disease.

abstract: Inflammatory bowel disease (IBD) can have a variety of extraintestinal manifestations, including pulmonary disease. Bronchial involvement is the most common, but other manifestations include upper airway disease; parenchymal involvement, such as bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial lung disease; and serositis, including pleural effusions and pericarditis. Patients with BOOP may present with fever, dyspnea, cough, and pleuritic chest pain. Chest radiographs show bilateral patchy airspace opacities or a diffuse process; CT scans often demonstrate the opacities to be pleural-based. Corticosteroids appear to be effective in the management of certain pulmonary manifestations of IBD, such as BOOP and pulmonary infiltrates with eosinophilia. (J Respir Dis. 2007;28(6):227-234)

What is the most likely cause of these painful plantar ulcers? Can youidentify this well-demarcated rash that arose at the site of vein grafting?

PHILADELPHIA -- In the frantic moments after being bitten by a poisonous snake, many people try first aid that does more harm than good, according to an emergency medicine specialist here.

ATLANTA -- The Georgia man with extensively drug-resistant tuberculosis (XDR-TB) who sparked an international hunt for contacts is asymptomatic and feeling well, officials said today.

SAN FRANCISCO -- Extensively drug resistant tuberculosis (XDR-TB) continues to be unearthed around the globe, with implications for U.S. clinicians, researchers said here.

ATLANTA -- For the first time in four decades, the CDC has quarantined a man as a public health risk, the government announced today. The Georgia man is infected with extensively drug resistant tuberculosis (XDR-TB).

ROCKVILLE, Md., May 29 -- A possible parasitic contamination of a solution for soft contact lens wearers has triggered a national recall.

CHICAGO -- Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) may target certain vulnerable populations and does not displace community-acquired methicillin-sensitive S. aureus.

HO CHI MINH CITY, Vietnam -- Antibodies from human survivors of an infection with the highly pathogenic avian influenza H5N1strain appear to offer mice protection against the virus.

ANAHEIM, Calif. -- Quinolone antibiotics for prostate-biopsy prophylaxis are showing signs of increased resistance.

WASHINGTON -- Bacterial overgrowth in the gut, a factor in irritable bowel syndrome, may also be at work in restless legs syndrome and antibiotics can help both conditions, one small study suggests.

ATLANTA -- Clinicians need to act quickly and appropriately to minimize morbidity and mortality of U.S. patients with malaria, CDC researchers said.

WASHINGTON -- This special report from Stanton M. Paddock, a MedPageToday contributing photographer, presents Ted Bader, M.D., of University of Oklahoma, discussing infection of Hepatitis C in Vietnam veterans.

BUFFALO, N.Y. -- An increased risk of tongue cancer in men has been associated with chronic peridontitis, independent of smoking status, researchers here reported.