Infectious Disease

During a routine skin examination,periungual erythema and increasedcurvature of the nail plate are notedin a 78-year-old man. The patient hasemphysema and a smoking historyof more than 50 pack-years. Currently,he requires oxygen support forregular daily activity.

For the past 2 days, an elderly woman has had severe pain in and discharge from the right ear. She has diabetes, which is well controlled with anoral hypoglycemic agent, and eczematous dermatitis.

A 41-year-old woman with a 4-yearhistory of polymyositis with lupus featureshas had constant rectal pain for4 months. She has not noticed any factorsthat either aggravate or relievethe pain. The patient complains of intermittentconstipation (but no dischargeor rectal bleeding), generalizedweakness and malaise for the past 2months, a low-grade fever for the pastmonth, and a 4.1-kg (9-lb) weight lossover the past 6 weeks. She denies nightsweats or chills, anorexia, vision problems,drug allergies, and tobacco oralcohol use.

A 24-year-old woman complains ofa pruritic rash that erupted after shesoaked in a hot tub a few days earlier.The patient is otherwise healthy;her only medication is an oralcontraceptive.

This painful, blistery eruption recentlydeveloped on the hand of ateenage girl. She claims she has hadno other such lesions. What doesthis look like?

A 67-year-old woman who is being treated as an inpatient for head traumacomplains of vague tenderness during an abdominal examination. Othercomplaints are difficult to assess. She had been placed on an oxygen ventilator;however, her cognitive function and pulmonary function are improving, andher cerebral edema is diminished.

A 25-year-old man complains of moderate discomfort, burning, redness, serousdischarge, and slightly impaired vision in his right eye; he also has mild photophobia.His symptoms began suddenly about 36 hours earlier, and the discomforthas increased steadily since that time. The left eye is unaffected.

The parents of a 6-year-old boy are concerned about the asymptomatic bumpsthat have developed on their son’s abdomen during the last few months.

A 22-year-old man presents to theemergency department with a2-week history of a worsening nonproductive,irritating dry cough andexertional dyspnea. The patient hasbeen otherwise healthy. He deniesfever, rigors, night sweats, hemoptysis,chest pain, palpitations, orthopnea,paroxysmal nocturnal dyspnea,ankle edema, and lymphadenopathy.

A 26-year-old man who presentswith acne mentions that he has had“Raynaud’s” for 10 years. His eyelidsare pinkish violet and swollen. Nailfold telangiectases are present,and violaceous papules and scaleoverlie the joints. The patient deniesany other symptoms.

Infections continue to be the leading killer of children worldwide.This text-now in its 11th edition-provides comprehensiveyet concise information on the natural history, diagnosis,treatment, and prevention of the major infections thataffect children. New to this edition are chapters on fungal infections,eye infections, cholera, dengue and dengue hemorrhagicfever, helminthic infections, and malaria. All otherchapters have been extensively revised and updated to coversuch topics as smallpox vaccination, bioterrorism, newer hepatitisviruses, and Pseudomonas infections in patients withcystic fibrosis. Included in the appendices are the indications,contraindications, adverse effects, and drug interactions ofantimicrobials used in children; the recommended childhoodand adolescent immunization schedule; and a discussion ofsevere acute respiratory syndrome. More than 50 color photographs-as well as numerous radiographs, photomicrographs,diagrams, charts, and tables-accompany the text.

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For 3 days, a 42-year-old man has had episodic dullchest pain. The anterior precordial and retrosternalpain intensifies with inspiration and movement. He has nohistory of recent viral infection, hypertension, coronaryartery disease, cardiac surgery, diabetes mellitus, or hyperlipidemia.There is no family history of cardiovasculardisease.

A 76-year-old woman presents with chest pain-which she describes as“muscle tightness”- that began when she awoke in the morning. Thepain is constant, exacerbated by deep inspiration, and accompanied by asubjective sense of slight dyspnea; she rates its severity as 3 on a scale of1 to 10. She denies pain radiation, nausea, diaphoresis, palpitations, andlight-headedness. Her only cardiac risk factors are hypertension and a distanthistory of smoking.

For 1 week, a 35-year-old woman’s left ear has been very painful, erythematous,and swollen. There is no history of insect bite or trauma. Her conditionimproved only slightly after the physician she initially consulted prescribedmethylprednisolone and cephalexin.

MONTREAL -- Early reports about promising investigational compounds and new insights into the effect of diet on the gut were highlights in gastroenterology during the year.

BALTIMORE -- Potentially lethal ICU blood-stream infections were cut by as much as 66% through the use of inexpensive common-sense measures such as hand-washing, removal of unneeded catheters, and the use of safer catheter sites, researchers reported.

TORONTO, Dec. 27 - Researchers and clinicians descended en masse on this city this year for the World AIDS Conference -- the first time in a decade the meeting has been held in North America.

IRVINE, Calif.-- Methamphetamine users may develop carotid artery dissections, leading to a severe stroke, an effect also seen in cocaine users, according to researchers here.

ATLANTA -- Tuberculosis remained at relatively low rates in the U.S., despite more reported cases of multi-drug resistant TB (MDR TB). But a new alarm was sounded in 2006 ? extensively drug resistant TB (XTR TB).

ROCKVILLE, Md. -- Against the background of the growing incidence of type 2 diabetes and obesity in the United States came news this year about the first new insulin delivery system in 80 years, as well as new categories of drugs for type 2 disease.

BALTIMORE -- An investigational approach to sifting infectious prions from donated blood could help quell fears, focused in Britain, about the possible spread by transfusion of variant Creutzfeldt-Jakob disease (vCJD), researchers here reported.

HOUSTON -- After a plaque of scary headlines, the news of a potential pandemic avian flu has dropped off the front pages. But virologists believe the threat is waiting in the wings.

ST. LOUIS -- Bacteria in the gut may be arbiters of weight loss or gain, according to a revolutionary theory proposed by researchers here. They suggested that manipulation of intestinal microbes might be used one day to treat obesity.

KINGSTON, Ontario, Dec. 20 -- For critically ill patients on mechanical ventilation, bronchoalveolar lavage and endotracheal aspiration appear to be equally effective when diagnosing pneumonia, said researchers here.

ANN ARBOR, Mich. -- There may be a causal connection between excess allogeneic transfusions for women during coronary bypass surgery and their higher risk of death after the procedure.

OAKLAND, Calif. -- HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

OAKLAND, Calif. -- HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

ROCKVILLE, Md. -- Two patients treated with the immune modulator Rituxan (rituximab) for systemic lupus erythmatosus have died of progressive multifocal leukoencephalopathy (PML), the FDA warned physicians.

SYDNEY, Australia -- Kidney transplantation is associated with a significant increase in risk of cancer, including a tripling of the risk for cancer at 18 sites, researchers here reported.