Infection

If left untreated, sinusitis can cause significant physical symptoms and can negatively affect quality of life by substantially impairing the daily functioning of sufferers. For children, this can mean learning difficulties at school and for adults, a loss of efficiency at work.

I have recently seen several patients who were treated for infections by emergency department physicians and who were given oral corticosteroids along with antibiotics. My understanding of the action of corticosteroids is that they suppress the immune system. If this is true, why would they be given to someone who already has an infection?---

An 89-year-old woman, who has long lived on the special care (dementia) unit of a nursing home because of advanced Alzheimer disease, is seen to assess possible injuries after a fall. Many prior falls have been ascribed to her lack of safety awareness in negotiating the environment, rather than to neuromuscular, sensory, or cerebellar deficits.

Slowly progressive depigmentation; asymptomatic petechiae; a mildlypruritic, crusty rash--do you know the cause of the disorderspictured here?

Acute parotiditis is characterized by unilateral swelling of the parotid gland with associated erythema and tenderness. Purulent secretions from the Stensen duct may be noted in more than 50% of the cases.

Because the manifestations of Parkinson disease are protean and complex, the diagnosis can be difficult and treatment challenging. However, an awareness of the key clinical features and familiarity with 2 or 3 of the dopaminergic medications can facilitate management.

SAN FRANCISCO -- The debate about mercury in amalgam dental fillings not withstanding, amalgam is superior to composite material in reducing adherence of caries-causing Streptococcus mutans, researcher said here.

SAN FRANCISCO -- Immunogenically enhanced cow's milk may sharply reduce the relapsing diarrhea associated with Clostridium difficile infection, according to a study from Holland.

SAN FRANCISCO -- The antibiotic Tygacil (tigecycline) is highly effective against multidrug resistant strains of acinetobacter, which are an increasing problem in intensive care units, researchers reported here.

SAN FRANCISCO -- Even with appropriate antibiotics, methicillin-resistant Staphylococcus aureus (MRSA) infections relapse about 25% of the time, researchers reported here. And for MRSA-related osteomyelitis, there is a 46% relapse rate.

SAN FRANCISCO -- A porcine wrinkle has emerged in the struggle against community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in The Netherlands, researchers recounted here.

SAN FRANCISCO -- Though antibiotic exposure typically increases the risk of Clostridium difficile colitis, tetracycline may protect against it, researchers reported here.

SAN FRANCISCO -- Gloves impregnated with antimicrobial compounds may bar a route for nosocomial infections, researchers reported here.

HOUSTON -- Children with acute bacterial infections of skeletal muscle caused by methicillin-resistant Staphylococcus aureus (MRSA) strains are showing up with increasing frequency in pediatric clinics and hospitals, researchers here reported.

BALTIMORE -- Acute diverticulitis is not as rare an occurrence in younger adults as commonly believed, particularly for obese men.

TORONTO -- Experience in treating tuberculosis, even if it is outside a physician's main area of expertise, appears to play a key role in patient survival, according to researchers here.

BIRMINGHAM, Ala. -- The American Gastroenterology Association has issued recommendations aimed at balancing the gastrointestinal and cardiovascular pluses and minuses when using nonsteroidal anti-inflammatory drugs (NSAIDs).

ROCKVILLE, Md. -- The FDA has approved Noxafil (posaconazole) to prevent invasive Aspergillus and Candida infections in immunosuppressed patients.

SHEFFIELD, England -- Smoking cigarettes seems to be an independent risk factor for HIV infection, according to researchers here. But smoking doesn't appear to be a risk factor in progression to AIDS.

OTTAWA, Ontario -- A large study of women with cosmetic breast implants found they had a suicide rate over two decades that was 73% higher than the general population -- but the rate was similar to that of women who had other cosmetic procedures.

HOUSTON -- One-quarter to one-third of children infected with bacterial meningitis develop hearing loss, investigators here reported. The loss may be preventable with the early use of antibiotics.

OKLAHOMA CITY -- A strategy for transfusion-free liver transplantation, developed for Jehovah's Witness patients, reduced overall blood use when applied to all patients, researchers here reported.

ROCKVILLE, Md. -- Several hospitalizations and one death caused by an outbreak of Escherichia coli 0157:H7 has prompted the FDA to warn consumers to avoid bagged fresh spinach, which the agency said is a possible cause of the outbreak.

ROCKVILLE, Md. -- Several hospitalizations and one death caused by an outbreak of Escherichia coli 0157:H7 has prompted the FDA to warn consumers to avoid bagged fresh spinach, which the agency said is a possible cause of the outbreak.

Two children--one with a history of infection, the other with a history of an allergic reaction--were noted to have postinflammatory hyperpigmentation.

A 38-year-old man sought treatment for the intensely pruritic swellings that had arisen on his upper lip 2 weeks earlier (A). These sharply demarcated, tender, boggy, granulomatous, pustular tumefactions are kerions, write Florence Isaac, MD, of Mohammad Dossary Hospital in Saudi Arabia and Shaun Isaac, MD, of St Petersburg, Fla. The diagnosis is based on the history of acute onset, the clinical appearance of the lesions, and the demonstration of a fungus by a potassium hydroxide (KOH) preparation of loose hairs removed from the affected area and by fungal culture. In this case, the KOH preparation revealed fungal filaments, which on culture grew Microsporum canis. A pus swab test should be performed to detect any bacterial copathogen. The differential diagnosis of kerion includes impetigo and carbuncle.

A 19-day-old infant was brought to the emergency department (ED) after a day of fever, coughing, and difficulty in breathing. He had been born at full term via vaginal delivery. There was no history of prolonged rupture of membranes. The mother was group B streptococcus-positive and had been treated appropriately before the delivery. The infant received 48 hours of empiric antibiotic therapy after his birth; blood cultures were negative at the birth hospital. The infant had been doing well before the ED visit.

A 62-year-old previously healthy man is admitted for right upper quadrant pain; a workup reveals acute cholecystitis as the cause. During evaluation for surgery, his creatinine level is found to be 6.0 mg/dL; 1 year earlier it was 1.0 mg/dL. A trial of fluids does not lower the creatinine level. Renal ultrasonography shows no obstruction but reveals increased kidney size (left, 11.4 3 4.4 3 5.0 cm; right, 10.1 3 4.6 3 4.5 cm) with increased diffuse echogenicity.

A 6-year-old boy has a rash on his hands and feet that erupted shortly after he started first grade. His parents are concerned that he may be allergic to something at school, such as chalk. He is otherwise healthy.

This 18-year-old girl had been taking divalproex for seizure disorder for 2 years. Because she had gained weight while taking this medication, the patient asked for another drug. Her neurologist prescribed lamotrigine. Ten days after starting the new agent, a generalized, painful, pruritic, ery- thematous dermatitis; fever; and sore throat developed.