Infection

BUENOS AIRES -- Patients with relapsing-remitting multiple sclerosis who also had parasitic worm infections had significantly better clinical courses than non-infected MS patients, investigators here found on a small study.

PITTSBURGH -- Small children with persistent middle-ear effusion who did not get immediate insertion of tympanostomy tubes developed as well as peers given rapid treatment when they grew to ages nine to 11 years, investigators here reported.

WINNIPEG, Manitoba -- The 1918-19 Spanish flu may have killed 50 million persons by unleashing an uncontrolled immune response that fatally damaged lung tissue, according to researchers here.

ATLANTA -- For the second year in a row, the absolute number of cancer deaths edged downward in the United States, the American Cancer Society said today.

NEW YORK -- Men from large families, particularly those who are the youngest siblings, are at increased risk for Helicobacter pylori-related stomach cancer, researchers said.

BOSTON -- Universal one-time melanoma screening of adults ages 50 or older by dermatologists would cost about ,000 per quality-adjusted life year gained, which compares favorably with the cost of breast or colon cancer screening.

LONDON -- As a quick screening tool, the ratio of a patient's white blood cell types differentiated acute purulent tonsillitis from infectious mononucleosis, researchers here reported.

BOSTON -- A history of gonorrhea may translate into a twofold increased risk of bladder cancer for men, researchers here reported.

BOSTON -- For women in developing countries who are HIV-positive, a dose of Viramune (nevirapine) during labor to prevent mother-to-child viral transmission does not preclude the safe renewed use of Viramune-based antiretroviral therapy after a six-month delay.

SEATTLE -- Persons newly released from prison, within their first two weeks of freedom, have a nearly 13-fold higher risk of death than those in the general population.

VILLEJUIF, France -- Risk factors for new-onset diabetes following liver transplantation include hepatitis C status, weight, and impaired fasting glucose status, French investigators reported.

BOSTON -- Clinical and research developments in neurology in 2006 seemed to be as much about prevention as treatment.

ATLANTA -- A more comprehensive vaccination schedule for children and adolescents has been issued by the CDC for 2007.

ATLANTA -- Those cute little hamsters can carry nasty salmonella pathogens. A rodent is a rodent.

BOSTON -- The so-called Bacterial Meningitis Score remains a useful tool, even as the condition has become less common in the U.S., a collaborative research committee says.

The introduction of effective antiretroviral therapy has resulted in dramatic clinical benefits for those persons who have access to it. Adherence to such therapy has emerged as both the major determinant and the Achilles' heel of this success. Many patients have levels of adherence too low for durable virologic control.

The elimination of perinatal HIV transmission in the United States is within reach. When antiretroviral therapy is effective in controlling maternal viremia during pregnancy, the risk of perinatal transmission is less than 1%.

HIV can be transmitted from an infected mother to her child during pregnancy or labor and postnatally through breast milk. Nearly 25 years after the first documented case of HIV infection, the decrease in perinatal HIV infections in the United States represents a major success in public health.

Liver disease, particularly hepatitis C, has emerged as a major cause of morbidity and mortality for people with HIV/AIDS in the era of potent antiretroviral therapy. Mortality is increased in patients with HIV–hepatitis C virus (HCV) coinfection compared with that in patients with HIV alone.1,2

The title of this column is the slogan from World AIDS Day 2006, and as we look to 2007 and a new Congress, a more appropriate slogan could not have been chosen. However, rather than keeping the promise, we are only slightly farther ahead than we were 1, 5, 10, or even 20 years ago and at some risk of going backward, as evinced by the sobering information made available through the World Health Organization (WHO) and the CDC.

Salivary gland enlargement, most commonly involving one or both parotid glands, is sometimes seen in association with HIV infection. Enlargement of the parotid gland may be due to diffuse infiltrative lymphocytosis syndrome; lymphoepithelial cysts; or malignant tumors, such as squamous cell carcinoma, Kaposi sarcoma, and Hodgkin and non-Hodgkin lymphomas.1,2 Non–HIV-related causes of parotid enlargement include acute and chronic viral infection, granulomatous disease, malnutrition, alcoholism, and diabetes mellitus.3,4 Here we report the case of a 41-year-old HIV-infected man with fat maldistribution syndrome associated with type 2 diabetes and hyperlipidemia. Sialadenosis developed presumably as a result of HIV infection and hypertriglyceridemia.

Shortly after the introduction of combination antiretroviral therapy, it was noted that a significant fraction of patients, from 8% to 17%, had poor CD4+ T-cell recovery despite suppression of HIV RNA to undetectable levels for at least 6 to 12 months.1

The authors report a case of adult-onset acute lymphoblastic leukemia (ALL) presenting with a right upper lobe infiltrate associated with acute fibrinous and organizing pneumonia (AFOP), which resolved spontaneously during the course of chemotherapy.

abstract: Pulmonary disease caused by nontuberculous mycobacteria (NTM) can be challenging to diagnose and manage. Patients typically present with nonspecific symptoms, such as cough and fever, and they often have underlying lung disease, which further complicates both diagnosis and treatment. To avoid treating pseudoinfection, the diagnosis should be based on a combination of the history and results of physical examination, radiographic imaging, and smears and cultures of at least 3 sputum samples. Occasionally, it is necessary to perform bronchoalveolar lavage or obtain tissue via transbronchial or open lung biopsy for histopathology and to assess for tissue invasion. Treatment involves a long course of often costly multiple antimycobacterial drugs. However, treatment with the second-generation macrolides, clarithromycin and azithromycin, has significantly improved cure rates for specific NTM infections. (J Respir Dis. 2007;28(1):7-18)

A 44-year-old man presented to the emergency department with complaints of neck swelling, bothersome cough, and difficulty in breathing. His breathing difficulty began 3 days earlier and progressively worsened.

The authors report a case of idiopathic eosinophilic pneumonia in a man with sclerosing cholangitis and ulcerative colitis associated with features of sarcoidosis.

Asked to evaluate bilateral unexplained upper-thigh bruises on a profoundly impaired woman newly admitted to our rehabilitation unit 2 weeks after an intracerebral hemorrhage. Patient received high-dose dexamethasone to reduce perihemorrhage edema.

ABSTRACT: Irritable bowel syndrome (IBS) is characterized by abdominal pain or discomfort, bloating, and constipation or diarrhea; the pain is typically relieved by defecation. The diagnosis is not one of exclusion; it can be made based on the answers to a few key questions and the absence of "alarm" symptoms. Fiber therapy, the elimination of particular foods, and regulation of bowel function can help relieve symptoms. Tegaserod or polyethylene glycol can be used to treat IBS with constipation. Loperamide and alosetron are of benefit in IBS with diarrhea (although the latter carries a small risk of ischemic colitis). Low-dose tricyclic antidepressants may be used to treat the abdominal pain associated with IBS. Probiotic therapy or rifaximin may help reduce bloating. Psychological therapies seem to improve well-being in patients with IBS.

With the significant rise in methicillin-resistant Staphylococcus aureus (MRSA) infections, a small rise in the number of cases of Clostridium difficile colitis appears to be an unfortunate but unpreventable consequence of using the few effective antibiotics remaining that can be prescribed in the outpatient setting.

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