Infectious Disease

Abstract: Inhalation of Aspergillus is responsible for a variety of lung infections and diseases; Aspergillus fumigatus is the most common causative agent. Allergic bronchopulmonary aspergillosis (ABPA), caused by sensitivity to A fumigatus, is diagnosed primarily in persons with asthma or cystic fibrosis. Differentiating ABPA from other Aspergillus-related lung infections and diseases is often challenging. A patient's symptoms, underlying risk factors, and any prior pulmonary disease contribute to the diagnosis. Findings include pulmonary infiltrates, total serum IgE levels greater than 1000 IU/mL, IgE and IgA anti-A fumigatus antibodies, peripheral blood and pulmonary eosinophilia, and central bronchiectasis. Untreated ABPA often results in chronic bronchiectasis, pulmonary fibrosis, and dependence on corticosteroids; an accurate diagnosis of ABPA is critical to avoiding irreparable disease. (J Respir Dis. 2006;27(3):123-134)

This is a difficult question, because most "sinus headaches" are migraines.1-3 In fact, there is no such thing as a sinus headache. The International Headache Society (IHS) defines a headache attributable to rhinosinusitis according to the criteria listed in Table 1.4 This requires a diagnosis of acute rhinosinusitis and a headache that occurs at the same time.

Nongenital cutaneous warts--that is, common, plantar, filiform, and flat warts--are manifestations of the human papillomavirus (HPV). These warts are among the most common dermatologic complaints seen in primary care practices and are among the most common lesions treated by dermatologists.

A 39-year-old woman who had a fever and episodes of nonbloody vomiting for 5 days presented to the emergency department after the sudden onset of severe, left-sided flank pain (10/10 severity) that was sharp, constant, and radiated to the front. She had no associated urinary symptoms, vaginal discharge, or bowel disturbances. Her last menses, 10 days earlier, was regular. Aside from a urinary tract infection 2 years earlier, her medical history was insignificant.

For some time, diarrhea caused by Clostridium difficile has been a serious problem in hospitals. Recently, more virulent strains of this pathogen have started to show up in hospitals.

Breast Infection in a Woman With Diabetes

New recommendations for the treatment of coughs caused by colds and for the vaccination of adults against pertussis are among the changes in the revised guidelines on the mangement of coughs.

A 56-year-old man presents with diffuse erythema. He has not changed his routine or eaten anything unusual. The rash initially appeared the previous night as asymptomatic erythema on the face and body. On awakening in the morning, the patient noticed that the erythema had spread over most of his body and had become pruritic. Over-the-counter diphenhydramine did not relieve the symptoms.

During a basketball game, a 23-year-old soldier had been hit in the right eye with the ball. The eye was slightly red with copious lacrimation; vision was normal. Using a Wood lamp and fluorescein dye, MAJ Kenneth S. Brooks, APA-C, of Camp As Sayliyah, Doha, Qatar, examined the patient's eye for corneal abrasions and saw these results. Note the almost complete halo of dye, with gaps at the 6 o'clock and 11 o'clock positions on the iris. This curious phenomenon was baffling until the soldier was asked about recent eye surgeries; he answered that he had undergone photorefractive keratectomy (PRK) several months earlier.

Monday morning your nurse hands you charts for 4 new patients. Each patient is a woman with widespread body pain, stiffness, and fatigue. All have already been evaluated by another physician and were advised that they should reduce stress and practice distraction techniques. They are in your office today seeking a second opinion.

A 45-year-old man comes to see you for a routine physical.He has no complaints and no significant medical history.However, while questioning him you discover that he usedintravenous heroin until about 10 years ago-and sometimesshared needles. He also drank 6 or more beers a day for about 20 years, a practicehe stopped at the same time that he quit using illicit drugs. He has multiple tattoos,which were done at commercial parlors. He is married but has no children. His wife hasno history of hepatitis. Physical examination is unremarkable.

A nonhealing ulcer recently developedin a painful facial rash that hadworsened over several months. The44-year-old patient is a heavy drinkerwith a history of elevated liver functionlevels. She has had numerousunprotected sexual contacts over theyears.

A 64-year-old man has experienced melena 4 or 5 times in the previous24 hours. He has had no emesis but complains of moderate epigastric pain.He has had similar-although milder-pain in recent weeks.

A 43-year-old fireman comes to your office after a routine blood test revealedthat his serum alanine transferase (ALT) level was elevated to approximatelytwice the normal value. The level was confirmed by repeated testing.

The last naturally occurringcase of smallpox was reportedin Somalia in October 1977.Despite the eradication ofsmallpox, the causative agent,variola virus, remains in existence.1,2

Although widely regarded as a raredisorder, hereditary hemochromatosisis the most common genetic disease inCaucasians. In certain populations ofnorthern European descent, 1 of every200 persons is homozygous for thecausative mutation.1

Abstract: In the assessment of community-acquired pneumonia, an effort should be made to identify the causal pathogen, since this may permit more focused treatment. However, diagnostic testing should not delay appropriate empiric therapy. The selection of empiric therapy can be guided by a patient stratification system that is based on the severity of illness and underlying risk factors for specific pathogens. For example, outpatients who do not have underlying cardiopulmonary disease or other risk factors can be given azithromycin, clarithromycin, or doxycycline. Higher-risk outpatients should be given a ß-lactam antibiotic plus azithromycin, clarithromycin, or doxycycline, or monotherapy with a fluoroquinolone. If the patient fails to respond to therapy, it may be necessary to do bronchoscopy; CT of the chest; or serologic testing for Legionella species, Mycoplasma pneumoniae, viruses, or other pathogens. (J Respir Dis. 2006;27(2):54-67)

Physicians around the country are being bombarded with questions about avian flu. This brief review of the current status of the avian flu outbreak and its treatment and prevention provides the information you will need to answer the most pressing patient questions.

A 52-year-old man with hypertension and hyperlipidemia presents to the emergency department with a 5-month history of cough and dyspnea.

22-year-old man is hospitalized because of severe hypertension. In addition, he reports exertional retrosternal pressurelike pain, with a severity of 5/10, that lasts for 2 to 3 minutes.

Most primary care practitioners approach the patient who complains of dizziness with some trepidation. This is chiefly because the differential diagnosis involves multiple organ systems and a wide variety of disorders. In this article, I offer a rational, straightforward, and cost-effective approach that uses only minimal, selective diagnostic testing.

A 21-month-old previously healthy child is brought to the pediatrician's office because of increasingly labored breathing that began the night before. The father reports that the child has had fever, congestion, nonproductive cough, and irritability for 2 days and that she is slightly hoarse.

A 22-year-old woman presents with progressive fatigue and dyspnea on exertion that develops after she walks about 30 feet. She also reports orthopnea, lower extremity swelling, weight gain, dry cough, and paroxysmal nocturnal dyspnea.

A pruritic facial eruption; asymptomatic, erythematous lesions;a persistent papule--can you identify the disorders pictured here?

A 5-year-old boy, who lives on a farm and routinely plays with his pet dogs, presented with these scaly, inflamed macules with a central clearingon the abdomen and forehead.

My patient has been hospitalized for pneumonia several times by different physicians. He has never received the pneumococcal vaccine. Can this vaccine begiven during the patient’s hospital stay?

A 51-year-old man who has been hospitalized for 7 days for acute pancreatitis has a predischarge platelet count of 812,000/µL.

There's a curse frequently attributed to the Chinese, "May you live in interesting times." It seems that we find ourselves living in interesting times right now. The Department of Homeland Security recently heightened our threat levelfrom code yellow to code orange. Duct tape, plastic wrap, and flashlights are in short supply at local hardware stores. There’s been more talk about smallpox and the smallpox vaccine, and parents and colleagues are eager for more information.

Practical Pointers: Discover Shortcuts Devised by Colleagues

A 7-year-old girl isbrought to your office by her parents,who state that she has had rednessaround her left eye for the past 2 to 3days. During the last 24 hours, therehas been a marked increase in rednessand soft tissue swelling that hasimpeded the child’s vision. There isno history of trauma or eye infection.