Infectious Disease

Methicillin-resistant Staphylococcus aureus (MRSA) became a "bug" to be reckoned with nearly 50 years ago. At that time, however, it targeted only patients who were exposed to infection in the hospital.In recent years, the epidemiology of MRSA has significantly changed. The pathogen is now a major culprit in community-acquired infections.

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever (temperature, up to 38.8°C [102°F]) of 9 days' duration. Physical findings included subcutaneous crepitus, erythema, and swelling of the left arm, chest, and neck. White blood cell count was 27,000/µL with 91% neutrophils. Chest radiographs showed gas in the subcutaneous and soft tissue of the neck, arm, and chest . Necrotizing fasciitis was suspected.

I read with interest the case of lymphogranuloma venereum (LGV) featured in Dr Henry Schneiderman's recent "What's Your Diagnosis?" column (CONSULTANT, February 2007, page 187). As one who has had a career-long interest in sexually transmitted disease, I feel compelled to make a few remarks regarding this case.

A 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever.

For 4 days, a 58-year-old woman with type 1 diabetes mellitus had had increasing right vulval pain that spread to the suprapubic area and abdomen. She reported that swelling and a "heavy feeling" in the lower abdomen had developed during the last 24 hours; these symptoms were associated with fever and chills.

Yesterday, my laboratory reported to me that a pharyngeal swab tested positive for chlamydial infection (detected by DNA testing). This was not the first time I diagnosed sexually transmitted pharyngeal chlamydial infection in a patient. Readers beware: it does happen.

A 45-year-old man sought medical advice after suffering for 6 months with recurrent pain and a purulent discharge at the sacrococcygeal region. Two weeks before this consultation, an abscess on the patient's right buttock had been drained by another physician. The patient had type 1 diabetes mellitus for 5 years; his medical history was otherwise unremarkable.

This lesion had erupted on the back of an elderly man with diabetes mellitus. The inflammatory process involved contiguous follicles with pus evident at several openings.

or several years, a 71-year-old man has had a pruritic eruption on both legs that occurs every winter and resolves in the spring. He is scheduled to undergo knee surgery, but the surgeon will not perform the operation until the rash has cleared. The patient has not used a new soap or changed his bathing habits recently.

Frightened but lucid man who appears stated age. Vital signs are normal. No mass palpable in abdomen, though there is a faint suggestion of upper-abdominal distension. No supraclavicular lymphadenopathy, umbilical nodules, or upper-abdominal vascular bruit.

Phytobezoars commonly develop in the distal small bowel, where the lumen is narrow. Prevalence is higher after partial gastric resection.

ALAMEDA, Calif. -- In patients with chronic hepatitis C, a seven-gene test may outdo usual clinical risk factors in predicting the likelihood of advance to cirrhosis.

SILVER SPRING, Md. -- An FDA advisory panel has unanimously recommended accelerated approval of a novel antiretroviral drug as an add-on treatment for adult infected with CCR5-tropic HIV-1.

COPENHAGEN -- The use of protease inhibitors to treat HIV is associated with an increased risk of a heart attack, according to a large observational study.

COLOGNE, Germany -- For treating candidemia and invasive candidosis, micafungin (Mycamine) is as effective as liposomal amphotericin B, with fewer side effects, according to researchers here.

BOSTON -- Girls perinatally infected with HIV early in the AIDS epidemic have reached adolescence and a mixed picture is emerging on their reproductive health, researchers here reported.

NEW YORK -- Children with Helicobacter pylori infection have reduced risks of asthma and allergy, researchers here reported.

BRADFORD, England -- Well-meaning physicians may unwittingly induce delirium in older patients when they prescribe medications such as antihistamines or sleep aids, according to a literature review.

HOUSTON -- A large percentage of influenza deaths are the result of disease-triggered acute myocardial infarctions, researchers here reported.

ATLANTA -- A rabies-therapy protocol that saved an unvaccinated Wisconsin teenager from death in 2004 has not rescued two other youngsters, the CDC reported.

LONDON -- It's not easy to find clean studies on how to improve hand hygiene, reported investigators here after a literature search.

BALTIMORE -- Projections notwithstanding, easy access to so-called morning-after pills does not reduce population-level pregnancy rates, according to a meta-analysis.

LOS ANGELES -- Cervarix, an investigational cervical cancer vaccine, prevented all precancerous lesions because of human papillomavirus types 16 and 18 for 5.5 years, researchers reported here.

ROCKVILLE, Md. -- A vaccine against the H5N1 avian flu has been approved by the FDA.

HOUSTON -- Rotavirus infection, the most common cause of severe pediatric diarrhea, spreads beyond the intestines into the bloodstream, researchers here reported.

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

LOS ANGELES -- Darbepoetin alfa (Aranesp) should not be used for treatment of anemia caused by cancer, researchers here reported. Compared with placebo, darbepoetin hastened death despite significantly reducing the need for transfusion.

BARCELONA, SPAIN -- The ability of the investigative protease inhibitor telaprevir to rapidly reduce levels of hepatitis C virus hints that shorter treatment regimens may be possible, researchers reported here.

How long does immunity against polio last in a person vaccinated with oral poliovirus vaccine (OPV)? With inactivated poliovirus vaccine (IPV)?

Topical corticosteroids remain the mainstay of treatment, especially in patients with erythematous, acutely inflamed psoriatic plaques. The topical immunomodulators tacrolimus and pimecrolimus are used to treat psoriasis, although neither has FDA approval for this indication. Unlike corticosteroids, immunomodulators do not cause skin atrophy, irreversible striae, acne, or tachyphylaxis. Newer topical vehicles of delivery (eg, foam clobetasol propionate) and newer drug combinations (eg, once-daily calcipotriene/betamethasone dipropionate ointment) may improve efficacy and reduce side effects. Reserve systemic therapy for patients with moderate to severe psoriasis. Until more long-term safety data become available, be cautious about prescribing biologic agents for patients at risk for infection (particularly tuberculosis) and malignancy.