Infection

TORONTO -- HIV-positive patients are at a small but increased risk of cardiovascular disease from antiretroviral therapy, investigators reported here.

TORONTO -- Increased cholesterol and triglycerides in HIV-infected children being treated with highly active antiretroviral therapy (HAART) can be markedly reduced by switching regimens, researchers reported here.

TORONTO -- Even in HIV-infected patients who have tried and failed several drug regimens, the goal should still be to reduce the virus to undetectable levels, according to guidelines presented here.

TORONTO -- Once patients have controlled HIV with a standard drug cocktail, treatment with a "boosted" protease inhibitor may be all they need to keep the virus at bay.

TORONTO -- HIV patients ages 50 and over do a better job controlling the virus but may need more help managing adverse effects and comorbidities.

LOS ANGELES -- Unmarried life may impinge on life expectancy, according to researchers here.

SOUTHAMPTON, England -- Teens appear to have problems using condoms properly, found investigators here.

GENEVA -- The notion of HIV-treatment interruption -- consigned not long ago to the ash heap of failed ideas -- should be revisited, said investigators here.

LONDON -- Improvements in highly active anti-retroviral therapy (HAART) has resulted in lower viral loads and higher immune cell counts but not a decline in mortality or progression to AIDS.

ATLANTA -- Stricter vaccine rules for international travelers might have prevented an outbreak of measles last year in Indiana, CDC public health workers suggested.

LONDON -- Surgery is a possible pathway for a self-sustaining epidemic of variant Creutzfeldt-Jakob Disease (vCJD), according to researchers here.

SEATTLE -- The human papillomavirus has a long racial memory. So concluded researchers here, who found that variants of two carcinogenic HPV types tend to linger longer in women whose ancestors came from the same area where the variants first arose.

ROCKVILLE, Md. -- The FDA has issued a nationwide warning to fans of raw Pacific northwest oysters to refrain from eating them raw, on pain of gastrointestinal distress, until the waters where they are harvested cool off.

NEW YORK -- A dramatic increase in foot infections from unclean yoga mats, reported by a podiatrist last week, remains a mystery to other podiatrists who have seen no such increase.

Abstract: Tracheobronchomalacia is a form of expiratory central airway collapse characterized by softening of the airway wall cartilaginous structures. Symptoms often mimic asthma and chronic obstructive pulmonary disease. Pulmonary function test results may suggest a diagnosis, but findings are neither sensitive nor specific. Bronchoscopy and novel dynamic radiographic studies contribute to the diagnosis and help differentiate true malacia from other forms of expiratory central airway collapse. Treatment options include medication; noninvasive ventilatory support; interventional bronchoscopy with airway stent insertion; and open surgical procedures, such as tracheostomy, tracheal resection, and tracheoplasty. (J Respir Dis. 2006;27(8):327-335)

An 8-year-old boy presented with a 6-week history of shortness of breath, cough, and myalgias, but no fever. His pediatrician had made the diagnosis of bronchiolitis, and the patient was treated with azithromycin and albuterol via a metered-dose inhaler. Because the patient did not improve, he was given a 10-day course of amoxicillin, followed by a course of clarithromycin after a chest radiograph revealed bilateral infiltrates, suggesting atypical pneumonia.

Abstract: A number of factors can contribute to a delay in the diagnosis of tuberculosis in pregnant women, including the presence of nonspecific symptoms, such as fatigue and cough; extrapulmonary manifestations; and asymptomatic disease. The diagnostic evaluation is the same as for nonpregnant patients and includes tuberculin skin testing and, when indicated, chest radiography (with appropriate shielding) and acid-fast bacillus stain and culture. Antituberculous therapy during pregnancy is generally safe and effective, although streptomycin should not be used because of the risk of vestibular or auditory damage to the fetus. For patients with active tuberculosis, treatment should be initiated as soon as the diagnosis is established. The treatment of latent infection is somewhat more controversial. The timing of the initiation of therapy is based on the risk of progression to active disease. (J Respir Dis. 2006;27(8):338-347)

Extrahepatic manifestations of chronic hepatitis C virus (HCV) infection should prompt appropriate serologic investigation.

A 25-year-old woman presents with fever, rash, mild headache, and decreased appetite. Six days after being prescribed TMP/SMX for urinary tract symptoms, fever developed and her temperature has been gradually rising since then.

Child With Dysphagia, Fever, and Weight Loss

An 81-year-old Asian woman was at a family function when she briefly complained of a severe headache, then quickly lost consciousness. She was brought to the hospital within 2 hours of symptom onset.

Kaposi sarcoma (KS) is a hyperplasia or neoplasia caused by human herpesvirus 8 (HHV-8).

An extensive, highly pruritic rash; hypopigmented macules; a scaly,pruritic plantar eruption that resists antifungals--can you identify thedisorders pictured here?

A succinct review of hyperkalemia . . . its various causes, clinical manifestations and consequences, ECG findings, and treatment approaches.

A 6-year-old girl with a nonproductive cough for 4 days and chest pain for 2 days was brought to the emergency department. According to the mother, the child had no fever or wheezing. She had no history of surgery, was not taking any medications, and had no contact with ill persons.

Several asymptomatic, erythematous papules and plaques had appeared on the hands of an otherwise healthy 11-year-old girl. The personal and family medical histories were noncontributory. A punch biopsy from the largest lesion on the palm confirmed the clinical diagnosis of localized granuloma annulare, a self-limited inflammation of the dermis.

This 30-year-old man complained of "perpetually dry" feet. He was in good health, took no medications, and had a noncontributory social and family history.

The patient had 3 circular healing wounds of varying diameters on the lateral and inner aspects of his upper left arm. The patient volunteered that he had inflicted these wounds with a cigarette in an attempt to tattoo himself to symbolize his "crazy life." (He was right-handed.) "Smiley faces" had also been tattooed on his hand with a lighter. There were no tattoos, body piercings, or body mutilation other than those mentioned.

SACRAMENTO, Calif. -- Even when HIV has all but disappeared from the peripheral blood after the start of therapy, the virus may still be lurking in the gut, slowing the restoration of immune response, according to researchers here.

LOS ANGELES -- A synthetic version of a peptide called chlorotoxin -- found in the venom of a scorpion - can be safely used to carry radioactive iodine to glioma cells, according to investigators here.