Infectious Disease

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.

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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

A recent study suggests a causal relationship between oral pathology-that is, gingivitis and periodontitis-and stroke. Periodontitis is the leading cause of tooth loss in the United States; the disease may affect nearly 50% of Americans older than 65 years. The pockets of infection that surround the teeth and penetrate into surrounding tissues function as chronic abscesses. The ongoing infection may seed the bloodstream with bacteria during flossing, toothbrushing, or professional cleaning.

The Advisory Committee on Immunization Practices recommendsthe zoster vaccine for persons aged 60 years and older, whether ornot they have had a previous episode of herpes zoster.

Urge incontinence, also referred to as overactive bladder (OAB)-wet, is the involuntary loss of urine accompanied by or immediately preceded by a sensation of urgency. It has a reported overall prevalence of 16.0% in men and 16.9% in women. Currently, the mainstay of management for symptomatic urgency and OAB-wet is medical therapy.

It is sometimes difficult for women with genital warts to visualize their lesions. Offer patients a hand-held mirror so that they can see what the lesions look like, and recommend that they use a similar mirror at home to monitor the lesions' size and number.

DURBAN. South Africa -- When women with HIV exclusively breastfeed their infants for the first six months, the chance of passing on the virus is only about 4%, researchers here said.

ANDOVER, Mass. -- Some radiofrequency (RF) denervation probes distributed from here by Smith & Nephew have been recalled because they were mistakenly labeled as sterile, the company announced.

NEW ORLEANS -- Tilarginine offers no benefit for heart attack patients suffering cardiogenic shock, researchers reported here. The finding rang the death knell for the agent.

NEW ORLEANS -- Artificially boosting high-density lipoprotein (HDL) levels does not reverse atherosclerosis, though it may have some vascular benefit, researchers said here.

NEW ORLEANS -- A burst of high-dose statins just before angioplasty and stenting for stable acute coronary syndrome appears to reduce cardiac complications, found an Italian trial.

MEMPHIS, Tenn. -- Clinicians may one day give children a nasal spray of viral enzymes to prevent acute otitis media, researchers said here.

LOS ANGELES -- Like a Pap smear, detection of abnormal anal cytology is clinically useful in HIV-positive gay men to predict the presence of anal dysplasia, according to researchers here.

LONDON -- The effects of bacterial meningitis in infancy persist as learning disabilities through young adulthood, suggested investigators here.

TAIPEI, Taiwan -- Enterovirus 71 infection in children associated with central nervous system involvement, and especially cardiopulmonary failure, may stall neurodevelopment and cognitive function, researchers here reported.

ROCKVILLE, Md. -- The FDA has issued a safety alert for linezolid (Zyvox) after clinical trial data suggested excess mortality when the drug was used to treat Gram-negative septicemia.

ROCKVILLE, Md. -- The FDA has approved eculizumab (Soliris), tbe first of a new class of natural immune system blockers, for paroxysmal nocturnal hemoglobinuria, a rare blood disorder that can lead to disability and death.

OMAHA, Neb. -- Antibiotics are prescribed for 70% to 80% of sinus infections even though most are caused by viruses, researchers here reported.

ROCKVILLE, Md. -- The FDA has approved a rapid test that will allow the diagnosis of viral meningitis within hours of symptoms rather than days.

LEIDEN, The Netherlands -- One fifth of temporary stomas created after surgery for rectal cancer became permanent, according to a Dutch study.

ATLANTA -- The Advisory Committee on Immunization Practices of the CDC, as expected, has recommended wide use of the vaccine against four major strains of human papillomavirus that cause cervical cancer.

HONG KONG -- Crowded hospital units were a key factor that led to "super-spreading" outbreaks of severe acute respiratory syndrome (SARS) in China, according to researchers here.

STONY BROOK, N.Y. -- The polio virus has been put to work at killing neuroblastoma cells in mice.

SEATTLE -- The metal gallium -- approved as a drug by the FDA to treat symptomatic hypercalcemia of malignancy -- may also be useful as an antimicrobial, according to researchers here.

UTRECHT, The Netherlands -- Tuberculosis tests based on interferon-gamma response, measured by a blood test, picked up exposure to a TB-infected store employee here, but a positive result on the standard tuberculin skin test was not associated with exposure to the infected employee.

MANCHESTER, England -- Failures of total hip replacements are significantly more likely to occur when patients carry variants in genes encoding for collagen breakdown and the vitamin D receptor, according to investigators here.