February 28th 2025
A medical director of antimicrobial stewardship at a large metropolitan health system highlights the dangers of AMR and how she believes the pharmaceutical industry could help.
February 14th 2025
Orbital Cellulitis in a 13-year-old Boy
September 2nd 2002A 13-year-old boy presents with swelling of the left eyelidsthat started 12 hours earlier; the eyelashes are mattedwith yellow discharge. He does not wear contact lenses oreyeglasses and denies ocular trauma or foreign bodies. Hehas been nauseated and has vomited once; his motherattributes these symptoms to an antibiotic that was prescribed5 days earlier for a sinus infection. Medical historyis noncontributory; there is no family history of ocularproblems.
Young Man With Acquired Ptosis
September 1st 2002A swollen, painful eyelid prompted a 39-year-old man to seek medical attention.The patient had noticed swelling, redness, and irritation in his left lateral eyebrowarea 2 days earlier. Upon awakening on the morning of his appointment,the left upper eyelid also felt full and tender and was drooping. A pointed drainingarea of purulent material had formed in the lateral brow region (not visiblehere). The patient was afebrile and denied any recent periorbital trauma. Hewas otherwise healthy; his only medication was a daily multivitamin.
Herpes Simplex Virus Type 2 Infection and Acute Urticaria
September 1st 2002A 37-year-old woman complains of “itchy bumps” that erupted just above herwaist 2 or 3 days earlier. She denies having had this condition in the past.The patient is otherwise healthy and takes no medications. An avid gardener,she claims to be able to identify and avoid poisonous plants.
Visceral Leishmaniasis in a Young Man
September 1st 2002After 5 weeks of undulating fever, weight loss, and night sweats, a 22-year-old man presented to the emergency department. He reported no significant medical history. The patient had recently completed a course of tetracycline followed by another of azithromycin for a presumed upper respiratory tract infection.
Young Boy With Acute Foot Pain
September 1st 2002The most appropriate choice is B. The history andphysical findings suggest that the patient may have afracture or contusion of the foot from trauma. There areno systemic signs that suggest an underlying infectious,chronic inflammatory, or oncologic process. A plain x-rayfilm of the foot is necessary to seewhether a fracture is present andwhether immobilization will be necessary.In the absence of fever and localerythema, infection appears unlikely,and a CBC count is unwarranted.
Diabetes: Management of Diabetic Foot
August 2nd 2002Foot ulcerations and infections are the leading cause of hospitalizationamong patients with diabetes; they occur in about15% of these patients. Given the rapidly increasing incidenceof diabetes, physicians can expect to see a growing numberof diabetic foot problems. Here, a group of experts, many ofwhom practice at the renowned Joslin-Beth Israel DeaconessFoot Center in Boston, offer guidance on all aspects of diabeticfoot care. The topics covered range from proven preventivestrategies to cutting-edge wound care techniques that drawon such new developments as growth factors and living skinequivalents. A detailed review of the pathophysiology of thediabetic foot is also included. The emphasis throughout is ona multidisciplinary approach that incorporates the servicesof diabetologists, podiatrists, orthopedic surgeons, orthotists,diabetic nurse educators, and others. Numerous black-and-whiteand color photographs, drawings, algorithms, and charts illustratethe text.
When You Can't Wash Your Hands, Try This
August 1st 2002Frequent hand washing is extremely important to help prevent nosocomial infections; however, compliance can be a problem. Encourage all staff members who have contact with patients to carry a bottle of quick-drying gel hand disinfectant with them.
Latest CDC Guidelines on Treating STDs: Ectoparasitic, Protozoan, and Fungal Infections
August 1st 2002Which treatment approaches are effective in a woman who has persistent or refractory vaginal trichomoniasis? Should the male sex partner of a patient who has recurrent vulvovaginal candidiasis be treated? Answers to these and other questions can be found in the recently updated CDC guidelines on managing sexually transmitted diseases
Can You Identify These Pathogenic Organisms That Creep, Float, or Fly?
July 1st 2002Match each picture with the phrase below that best describes it. The organisms in these pictures might be microscopicor macroscopic, and they can be recovered from skin lesions or clothing by the patient and/or clinician.Answers and discussion appear on the following page
Asymptomatic Lyme Disease: A Ticking Time Bomb?
July 1st 2002Is there a meaningful percentage of patients who contract Lyme disease but havenone of the early symptoms-neither the rash nor the flu-like symptoms (eg, fever,myalgia, headache, and stiff neck)-and in whom the disease only becomes clinicallyevident in a later stage when it is much harder to treat?
Toddler With Henoch-Schönlein Purpura
July 1st 2002An otherwise healthy 18-month-old boy presented with palpable purpura over the legs, arms, and buttocks; his face, neck, and trunk were spared. The patient was otherwise asymptomatic, alert, and playful. His mother reported that the child had a “stuffy nose and cough” 1 month earlier.