Infectious Disease

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.

A 60-year-old man was hospitalized with fever and hypotension secondary to recurrent cellulitis of the left leg. He had a history of polysubstance abuse and hepatitis C. Elephantiasis nostras verrucosa was diagnosed based on bilateral nonpitting edema and hyperkeratotic verrucous lesions in the pretibial area. The patient's erythrocyte sedimentation rate and white blood cell count showed evidence of infection; osteomyelitis of the left fifth metatarsal head was suspected.

A 29-year-old sailor presented with a painless, enlarging, reddish, mobile lump under his left nipple. Four months earlier, while on deployment in the South Pacific, he had his nipples pierced on a whim.

A 63-year-old man with myelodysplasia presented with oral thrush, intranasal dryness, and congestion that developed 2 months earlier. Intranasal saline rinse and sleeping with the head elevated temporarily relieved the nasal symptoms.

ROCKVILLE, Md. -- The FDA has given a thumbs up to a topical antibiotic treatment for impetigo in children who are nine months or older.

BIRMINGHAM, England -- A cluster of six matching cases of tuberculosis here in 2005 originated from one person's exposure to bovine TB, strongly suggesting human-to-human spread, British researchers reported.

ATLANTA -- The rate of fluoroquinolone-resistant gonorrhea has become so high in the U.S. that physicians have been urged to switch to the last line of defense, the cephalosporins.

RIO DE JANEIRO -- The novel investigational drug raltegravir was highly effective at reducing the level of virus in their blood of extremely sick HIV patients, many of them with AIDS, according to researchers here.

BARCELONA, Spain -- Patients with hepatitis C virus infection who achieve a sustained virologic response to therapy should be considered cured, said investigators today.

ROCHESTER, Minn. -- The source of Staphylococcus aureus bloodstream infections that develop after cardiac devices are implanted may be the devices themselves, researchers reported.

ROCKVILLE, Md. -- The FDA said two reports of glass fragments in a liquid antifungal triggered a nationwide recall of griseofulvin (Grifulvin V), microsize 125 mg/5mL.

ROCHESTER, N.Y. -- A genetically engineered seasonal flu vaccine incubated in insect cells, rather than chicken eggs, is safe and produces a robust immune response, researchers here have found.

ALBUQUERQUE, N.M. -- Moderate use of statins is associated with a sharply reduced risk of death from chronic obstructive pulmonary disease, researchers here found.

DURHAM, N.C. -- A common herbal extract may alleviate the pain of a recurrent bladder infection, suggest experiments on mice.

ROCHESTER, N.Y. -- Filtering WBCs from donated blood may reduce postoperative infections by 10% among transfused surgical patients, according to a meta-analysis.

LOS ANGELES -- The Chinese art of tai chi appears to protect against shingles as efficiently as a vaccine against varicella zoster and even augment the immunity conferred by the vaccine.

BOSTON -- Co-infection with HIV and either hepatitis B or C remains a clinical challenge, but new therapies appear to have increased the opportunities for effective treatment.

NASHVILLE, Tenn. -- Evidence continues to mount that the use of the new pneumococcal conjugate vaccine is dramatically reducing the rate of pneumonia in young children - and even in adults who have never been vaccinated.

NORWICH, England -- Routine screening of newborns for cystic fibrosis is cost effective, found researchers here.

BARCELONA, Spain -- The third-generation protease inhibitor darunavir (Prezista) is highly effective in combating highly resistant HIV, according to researchers here.

SOUTHAMPTON, England -- The research focus in asthma should shift back to conventional T-cells and away from the newly discovered invariant natural killer cells, according to investigators here.

TOKYO -- There are signs that influenza B can develop resistance to two of the main antiviral drugs, according to scientists here.

WINSTON-SALEM, N.C. -- Children prone to frequent ear infections are the major beneficiaries of the new pneumococcal conjugate vaccine, researchers here say.

abstract: Hemoptysis has many causes, including bronchiectasis, lung cancer, and bronchitis. The initial goals of the history and physical examination are to differentiate hemoptysis from epistaxis and hematemesis and then to establish its severity. A variety of signs and symptoms may suggest the underlying cause. For example, hematuria suggests vasculitis or an immunologically mediated disease, such as Wegener granulomatosis or systemic lupus erythematosus. The workup includes chest radiography and measurement of hemoglobin and hematocrit levels, platelet count, international normalized ratio, activated partial thromboplastin time, and creatinine level. Chest CT scanning often identifies sources of bleeding that are not apparent on radiographs and sometimes can be used in conjunction with bronchoscopy. Patients with massive hemoptysis should be hospitalized for rapid evaluation and intervention; treatment may include interventional bronchoscopy, angiography, or embolization. (J Respir Dis. 2007;28(4):139-148)

Structured treatment interruption (STI) before initiating a new antiretroviral regimen is one strategy for improving virological response in patients with multidrug-resistant HIV-1 infection. However, there are conflicting data concerning the effectiveness of STI, and its role has not been established. The results of several recent studies, described below, are noteworthy (Table).

Invasive fungal infections continue to be a major cause of morbidity and mortality in immunosuppressed patients. Two studies recently addressed the effectiveness of the newer antifungal posaconazole in the prevention of these infections. The first study compared posaconazole with fluconazole in patients with graft versus host disease. The second compared it with fluconazole or itraconazole in patients with prolonged neutropenia.

WHAT’S YOUR DIAGNOSIS?

Oral Contraceptives: Five Vignettes Illustrate Dx and Rx Problems-- and Solutions

A 65-year-old woman seeks evaluation of a tender, pruritic patchy rash on the trunk and extremities, as well as tender lips. Her symptoms began after she started taking a new NSAID for osteoarthritis. She has no known drug allergies and has not changed any other medications. The photographs were taken 2 days apart.

A 57-year-old woman presents with swelling of the hands that began several weeks earlier and is now worsening. She denies joint pain, and she has no history of trauma or significant vascular disease. She has had pneumonia several times; each episode was successfully treated with antibiotics. She has smoked 2 packs of cigarettes a day for the past 20 years