Infectious Disease

The diagnosis of many serious infectious diseases relies heavily on clinical suspicion, particularly in the early stages of the illness. In this 3-part series, we provide useful clues to the triage and diagnosis of these diseases. Here we discuss staphylococcal toxic shock syndrome (TSS) and streptococcal TSS.

Ulcerative colitis affects about 500,000 persons in the United States and accounts for more than 30,000 hospitalizations and 1 million workdays lost each year. The exacerbations and remissions that characterize the clinical course of the disease can make its management particularly challenging. What is the optimal approach to treatment? And which agents are most effective for maintenance therapy?

The gold standard for diagnosis is joint aspiration and synovial fluid analysis; however, compensated polarized light microscopy is not available in most primary care practices. In part 2 of his 3-part podcast, Dr Lieberman discusses the diagnosis of gout in real-world practice.

Will you recognize these potentially life-threatening infections when you see them? Inside: clues to early diagnosis.

For 3 days, a 28-year-old woman with a history of polymyositis and possible dermatomyositis had fever, chills, and nonproductive cough. She complained of rash, joint pain, and progressive immobility because of severe muscle weakness. For the past 6 years, she had been taking prednisone (60 mg/d), hydroxychloroquine (200 mg bid), and tramadol (100 mg q6h prn for pain).

For 5 days, a 68-year-old woman has been bothered by a painful swelling on her left cheek. There is no history of trauma or bite. She takes a diuretic for mild hypertension. Amoxicillin/clavulanate was started 2 days earlier pending the results of a bacterial culture.What is the likely diagnosis?

Every year thousands of physicians must take-and pass-an examination to become board certified in internal or family medicine. Thousands more must pass a board recertification examination to maintain their license to practice medicine- and similar exams are required of physician assistants and nurse practitioners. To pass a certification or recertification examination requires up-to-date and in-depth knowledge in at least a dozen areas of clinical medicine.

Patients who followed a written action plan for exacerbations of chronic obstructive pulmonary disease (COPD) had shorter recovery times, reported Canadian researchers.

Turmeric, a spice used in curry, may help prevent Clostridium difficile infection. Rattan Patel, MD, of Cedars Sinai Medical Center in Los Angeles, and his colleagues found that curcumin (the active ingredient in turmeric) inhibited the growth of various strains of C difficile in vitro.

In this engaging session, 5 patients with complex and difficult cases of ulcerative colitis were presented to an expert panel, which consisted of Maria Abreu, MD, Edward Loftus, MD, and David Rubin, MD. The panel moderator was Jean-Paul Achkar, MD.

In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: "The future of the general practice of medicine, if any." The year was 1969.

A 69-year-old man with stage II chronic kidney disease due to hypertension fell from his bicycle and presented to the emergency department (ED) with abrasions, ecchymoses, and a 3-cm laceration on his right leg. The patient was an avid cyclist. His wounds were cleaned and the laceration sutured. There were no fractures, and the patient was discharged home.

What are the most significant health risks associated with tattoos?

A 48-year-old woman sought medical attention after an episode of gross hematuria associated with mild right-sided loin discomfort. She did not have urinary frequency, urgency, or dysuria. Her history included 3 urinary tract infections; a Proteus species was cultured on each occasion. The family history was unremarkable. Other than mild loin tenderness, physical findings were normal.

A step-by-step review of various wound closure techniques, illustrated with a wealth of instructive clinical photographs.

This year's influenza season is approaching fast. Although the World Health Organization officially declared an end to the 2009 H1N1 influenza pandemic in August, the H1N1 virus is still circulating and is likely to continue to cause serious disease in infants, young children, pregnant women, and other high-risk groups.

Many patients with a viral upper respiratory tract infection still expect an antibiotic prescription when they come to the office.

For a few weeks, a 36-year-old woman has had this pruritic labial rash.

My patient is a woman in her late 30s who has several episodes a month of confluent facial erythema that is very warm to the touch and highly pruritic.

This year’s influenza season is approaching fast. Although the World Health Organization officially declared an end to the 2009 H1N1 influenza pandemic in August, the H1N1 virus is still circulating and is likely to continue to cause serious disease in infants, young children, pregnant women, and other high-risk groups.

A51-year-old man who was an active injection drug user was admitted to the ICU with septic shock and severe respiratory distress. Notable findings were fever, multiple opacities on a chest radiograph, and an elevated white blood cell count.

This 40-year-old man presented with fever and a generalized, painful, nonpruritic rash of 2 days’ duration. The rash first appeared on his face then spread to his hands, buttocks, and lower extremities. Two weeks earlier, he had an episode of severe rhinitis followed by high fevers, chills, muscle aches, and ankle pain.

Dr Rosen invites you to match the clinical characteristics in the checklist with the disorders pictured in the photos. This month’s challenge: 2 leg lesions.

Inside: a photo guide to the various manifestations of stasis dermatitis, irritant contact dermatitis, and allergic contact dermatitis-including diagnostic clues and treatment options.

A previously healthy 19-year-old woman presents with a sore throat that has become progressively more painful over the course of 1 week. She also has left-sided neck swelling, light-headedness, and intermittent headaches. She denies recent sexual activity.

A 32-year-old woman presents for evaluation of itching in the pubic area.

A linear, severely pruritic rash erupted on the lateral and plantar aspects of the left foot of a 72-year-old woman who had recently been camping on a Caribbean beach. Antihistamines and locally applied antifungal agents offered no relief.

An 18-year-old woman from Mexico was hospitalized because of severe headache with nausea and vomiting. Her headaches had started 4 years earlier and had progressively worsened. They occurred mainly in the occipital region and were pulsating, worse on bending down, and unrelieved by any medication. They were often accompanied by dizziness and presyncope.

A 29-year-old Ukrainian man presents with a mildly pruritic generalized rash, which started 4 days earlier as a widespread eruption. The patient has no contacts who have a similar rash.

During a routine checkup, a 14-year-old girl inquires about a large red spot on her right ankle. The asymptomatic, erythematous area overlying the malleolus has been present for several months.