A 45-year-old incarcerated man with long-standing AIDS was admitted for management of lower extremity pain secondary to peripheral neuropathy.

In the United States, 56,300 new HIV infections occurred in 2006, according to the CDC’s first national estimate of HIV incidence based on direct measurement. The CDC released the report July 26 at the 17th International AIDS Conference in Mexico City (Stannard MB. San Francisco Chronicle. August 3, 2008).

A 24-year-old man with a history of HIV infection (CD4+ cell count, 746/µL [32%]; HIV RNA level, 980 copies/mL; nadir CD4+ cell count, 482/µL [29%]), secondary syphilis, major depression, and intermittent crystal methamphetamine use presented to the emergency department with a 1-week history of gradually increasing pain and swelling in the left side of his scrotum, 2 days of fever (temperature to 38.6°C [101.5°F]), and chills.

In addressing a press conference this summer at the United Nations High-Level Meeting on AIDS, Dr Anthony Fauci of the NIH commented on the “40,000 to 52,000 new infections each year” occurring in the United States.

A 24-year-old woman presents with severe, persistent, left-sided abdominal pain that began about 12 hours earlier. Over-the-counter medications have provided no relief. The pain is not associated with dietary intake, nausea, vomiting, diarrhea, or dysuria. The patient denies fevers, chills, and recent trauma to her abdomen.

Colonoscopy has become the preferred method for colorectal cancer screening in the United States. For patients at average risk, the procedure is typically performed every 10 years, beginning at age 50.

Within the past decade, the incidence of methicillin-resistantStaphylococcus aureus (MRSA) has increased significantly,spreading from the hospital to the community setting. Patientswith skin infections whose condition is stable should be treatedwith antibiotic therapy as well as with incision and drainage,whereas patients with severe disease require hospitalizationand intravenous therapy. In addition to community-acquiredMRSA, a new strain of Clostridium difficile, BI/NAP1, has led toclinical challenges in infectious diseases medicine. The strainhas been associated with recurrent infection; more severe diseasethat mandates urgent colectomy; and dramatically highermortality in vulnerable populations, such as older adults. Oralvancomycin, rather than metronidazole, may be slightly moreeffective in patients with severe disease. Also, new strains of Chlamydia and Treponema are posing potential complications tothe treatment of sexually transmitted diseases such that cliniciansneed to be judicious in selecting antibiotic therapy in accordancewith factors related to geography and patient population.[Infect Med. 2008;25:421-424]

Previous case reports have suggested an association betweenhuman T-cell lymphotropic virus (HTLV) types 1 and 2infection and chronic nonprogressive HIV infection. Evidenceis lacking about the specifics of how the two are related. Wereport 2 cases of chronic nonprogressive HIV infection (of9 and 13 years' duration, respectively) in women in whomHTLV coinfection was diagnosed. These cases provide clinicalsupport that HTLV coinfection may serve as a protective factoragainst progression of HIV infection. Possible reasons for thisrelationship and potential future research are discussed.[Infect Med. 2008;25:416-420]

The successful management of immunosuppression followingsolid organ transplant requires a delicate balance betweenpreventing allograft rejection and minimizing the risk ofinfection. Strategies that may reduce the risk of de novoopportunistic infection and emergence of latent infectionduring the early posttransplant period-specifically infectioncaused by Cytomegalovirus, opportunistic fungi such as Aspergillus and Candida, and bacteria such as Pneumocystisjiroveci and Mycobacterium tuberculosis-are presented in thisreview. [Infect Med. 2008;25:403-415]

WNV first appeared in the United States in 1999.1 This infection "got no respect" even though it caused significant morbidity and mortality while crossing the United States unabated for the past 9 years. Patients died mainly of neuroinvasive complications such as encephalitis and a polio-like paralysis. The lack of respect became a reality to clinicians in Phoenix in 2004 when they found themselves poorly prepared to manage the many acutely ill patients affected by WNV. That there was a lack of practical information about how to manage WNV became readily apparent to these clinicians.

Ehrlichia species, which are transmitted by ticks, may causehuman monocytotrophic ehrlichiosis and human granulocyticanaplasmosis. Symptoms of infection include fever, headache,myalgia, progressive leukopenia, thrombocytopenia, and anemia.Diagnosis is based on clinical findings, although serologicaltests can identify the specific infectious ehrlichial organism.Tick repellents, particularly permethrin, can help prevent tickbites and lower the risk of infection by tick-borne pathogens.Tetracycline antibiotics are therapeutic for treatment ofehrlichial infections. [Infect Med. 2008;25:425-429]

In 2004, 391 cases of West Nile virus (WNV) infection werereported in Arizona. This represented an epidemic thatchallenged area clinicians. We treated 34 patients with WNVinfection and reviewed their medical records. They werehospitalized at 3 community hospitals during the epidemic.These patients represented 9% of all WNV infection casesreported in Arizona. Meningitis was diagnosed in 13 patients,encephalitis in 12, fever of unknown origin in 5, transversemyelitis in 3, and carditis in 1. Respiratory failure requiringmechanical ventilation developed in 6 patients. Five of thesickest patients were empirically treated with interferon alfa 2band ribavirin. The epidemic and associated clinical challengesprompted evaluation of the available diagnostic and treatmentstrategies to optimize care of very ill patients. The consensusamong clinicians was that they were poorly prepared todiagnose and treat WNV infection in hospitalized patients.All patients survived hospitalization, although 4 patientsdied after discharge because of factors attributable to WNVinfection. [Infect Med. 2008;25:430-434]

A 51-year-old man with a long history of alcohol abuse and heavy cigarette smoking presented to our hospital with worsening of a chronic cough, which had become productive of thick green sputum and was associated with posttussive emesis. He denied fevers and chills but had a recent and unintentional weight loss of about 5 kg. He had a history of squamous cell carcinoma of the right tonsil, which remained in remission for more than 4 years after chemotherapy, radiation therapy, and resection. There was no recent history of travel or any occupational exposures or known contacts with tuberculosis or animals (wild or domestic).

The differential diagnosis forendobronchial lesions includesbut is not limited toneoplastic causes, benign tumors,infections, and foreignobjects. We report a case of anunusual cause of endobronchiallesions.

This question deserves a broad answer, considering how much has changed since the old high-resolution CT (HRCT) scans with 1-mm slices and 1-cm intervals.1-3 The advent of multidetector row CT has had a significant effect on the versatility and diagnostic capabilities of CT in general. Coupled with novel processes of image postprocessing-including quantification of lung disease using advanced software-the availability of multiplanar projections and the opportunity to perform virtual bronchoscopy have led to an improvement in what is available for the evaluation of COPD.

Since the introduction of highly active retroviral therapy and with the improvement in the survival of persons with HIV/AIDS, the spectrum of renal disease in HIV-infected persons has expanded.

Because widespread use of highly active antiretroviral therapy has made it possible for persons with HIV infection to live longer, the epidemiology of HIV/AIDS has shifted in several ways

On Thursday, July 17, plans to conduct a large-scale test of an experimental therapeutic AIDS vaccine were canceled, the latest setback following last year’s failed Merck AIDS vaccine trial (Russell S. San Francisco Chronicle. July 18, 2008).

In recent years, few breakthroughs in HIV prevention science have been realized. Preexposure prophylaxis (PrEP), involving the use of antiretrovirals just before a potentially risky sexual encounter, is an intriguing concept, although it’s not new.

Many different antiretroviral regimens can be used as initial therapy for infection with HIV.