Traveler's diarrhea (TD) occurs in persons traveling fromindustrialized countries to less developed regions of the world.Because of the growing ease of travel and an increasinglyglobalized economy, TD is becoming more common. Increasingantibiotic resistance among causative bacterial organisms andalso emergence of new pathogens are additional challenges inthe management of TD. Enterotoxigenic and enteroaggregativepathotypes of Escherichia coli are the principal causes of TD.This review discusses the epidemiology of these pathogens, aswell as elements of prevention, diagnosis, and management.[Infect Med. 2008;25:264-276]

Three weeks after returning from a family vacation in northern California, an 8-year-old boy presented with an unusual rash on his left forearm. He indicated that he had been bitten by an unknown insect while vacationing.

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In the early years of the HIV/AIDS epidemic, the physicians and nurses who provided care to patients with this puzzling and clearly complex infection identified the benefits of specialized knowledge of the virus and management of the symptoms associated with its attack on the immune system.

“It’s a completely different mechanism of action to what we have currently under development and what the field has under development,” said Dr Zeda Rosenberg, IPM’s CEO. “It’s pretty early in the life cycle for HIV. Most of us feel that for a microbicide to be really effective, it has to get at the infection in its earliest time points.”

My patient is a 26-year-old woman who has severe aphthous ulcers. These ulcers first appeared after a motor vehicle accident in which the patient saw her fiancé die.

The 15th Conference on Retroviruses and Opportunistic Infections (15th CROI) was held in Boston from February 3 to 6, 2008. There were more than 1000 oral and poster presentations at this conference and, as is usually the case, some were quite important.

Young adults are usually not considered to be susceptible to debilitating neurological disease, unless of course the brain injury is incurred as a result of trauma.

A 37-year-old HIV-infected white woman with a CD4+ cell count of 29/µL and an HIV RNA level of 538,000 copies/mL presented with a 2-month history of pruritic blistering eruptions on the dorsal aspects of her hands and feet and hyperpigmentation of the face.

Fusion inhibitors are novel antiretroviral agents, administered as subcutaneous injections, approved for use in treatment-experienced HIV-infected patients.

Lipoatrophy is a noteworthy adverse effect of antiretroviral therapy. A 2-part literature review was conducted to assess the impact of lipoatrophy in HIV-infected persons: the first reviewed the qualitative studies that reported lipoatrophy data, and the second reviewed the clinical studies that recorded patient-reported outcome end points.

Lipoatrophy is an important problem that emerged in 1998 with seminal findings reported by Carr and colleagues.1

For patients who complain that their axillae or feet are unusually smelly, prescribe a combination antibiotic/benzoyl peroxide product and tell them to apply it to the affected area 10 minutes before they shower.

ABSTRACT: The 2001 anthrax attack demonstrated the UnitedStates' vulnerability to bioterrorism. Governmental and publichealth agencies are preparing for the enormous logistical challengesrequired for a response to a large-scale bioterrorist attack.These include the stockpiling and distribution of antibioticsand vaccines for prophylaxis and treatment of exposedpopulations. Given that untreated inhalational anthrax is rapidlyfatal, early identification and timely initiation of appropriatetherapy are essential. The prodromal phase of illness ischaracterized by flu-like symptoms, such as cough, fever, andfatigue, followed by respiratory distress and shock. Chest radiographicfindings include pleural effusions and widening ofthe mediastinum. (J Respir Dis. 2008;29(5):215-221)

A SINGLE INJECTION of a sustained-release formulation of doxycylinehyclate may be highly prophylacticfor Lyme disease and relatedillnesses in patients presentingwith tick bites, according to researchersfrom the CDC in Fort Collins,Colo. The team, led by Nordin Zeidner,DVM, PhD, senior research microbiologistin the division of vectorborneinfectious diseases at the CDC,compared the efficacy of oral doxycyclinewith that of injectable sustained-release doxycycline in miceexposed to nymphal ticks infectedwith either Borrelia burgdorferi orAnaplasma phagocytophilum.

Recognition of a simultaneous viral and bacterial skin infectioncan be challenging. In the case presented here, an immunocompromisedpatient presented with a painful rash on the arm,pustules and papules on the chest, and crusted lesions onthe nares. Culture and immunofluorescent staining revealedStreptococcus and varicella-zoster virus, respectively. Afterappropriate treatment, the rash completely resolved. [InfectMed. 2008;25:240-241]

The effective management of HIV-1 infection has evolveddramatically over the past decade. As treatments have becomemore effective, better tolerated, and easier to take, treatmentsuccess as defined by surrogate markers has becomeincreasingly common. Nevertheless, responses to therapyare not uniform, and even in the ideal setting of clinical trialswith a select patient population treated with a compact andwell-tolerated regimen, sustained antiviral response will not beachieved in up to 20% of patients. Major factors that influencetreatment response include adherence, stage of disease at whichtherapy is initiated, therapeutic potency, patient demographics,and treatment history. In the first part of this 2-part series, stageof disease and therapeutic potency are addressed. [Infect Med.2008;25:222-226]

More than 22,000 persons in the United States are affected bycatscratch disease (CSD) annually. Despite the discovery of thecausative organism more than a decade ago, much is still unknownabout this illness. Recent data suggest that ticks, as wellas cats, may transmit the disease to humans. Immunofluorescenceassay is proving to be the most efficient and noninvasivetechnique for diagnosing CSD. Among available antimicrobials,azithromycin has proved to be especially useful, although randomized,double-blind, placebo-controlled trials are warrantedto define the best treatment method for patients with CSD.[Infect Med. 2008;25:242-246, 250]

It is now known that one of the most importantand largest reservoirs of HIV-1 is gut-associated lymphoidtissue (GALT). This fact will no doubt lead tonew directions in research in HIV pathophysiology andpharmacotherapy.