Infectious Disease

A 19-day-old infant was brought to the emergency department (ED) after a day of fever, coughing, and difficulty in breathing. He had been born at full term via vaginal delivery. There was no history of prolonged rupture of membranes. The mother was group B streptococcus-positive and had been treated appropriately before the delivery. The infant received 48 hours of empiric antibiotic therapy after his birth; blood cultures were negative at the birth hospital. The infant had been doing well before the ED visit.

A 62-year-old previously healthy man is admitted for right upper quadrant pain; a workup reveals acute cholecystitis as the cause. During evaluation for surgery, his creatinine level is found to be 6.0 mg/dL; 1 year earlier it was 1.0 mg/dL. A trial of fluids does not lower the creatinine level. Renal ultrasonography shows no obstruction but reveals increased kidney size (left, 11.4 3 4.4 3 5.0 cm; right, 10.1 3 4.6 3 4.5 cm) with increased diffuse echogenicity.

A 6-year-old boy has a rash on his hands and feet that erupted shortly after he started first grade. His parents are concerned that he may be allergic to something at school, such as chalk. He is otherwise healthy.

This 18-year-old girl had been taking divalproex for seizure disorder for 2 years. Because she had gained weight while taking this medication, the patient asked for another drug. Her neurologist prescribed lamotrigine. Ten days after starting the new agent, a generalized, painful, pruritic, ery- thematous dermatitis; fever; and sore throat developed.

Staphylococcal pneumonia can be classified as either primary or secondary. In primary disease, the infection is caused by direct inoculation of the respiratory tract. Secondary disease occurs by hematogenous spread (eg, as in endocarditis).

A 62-year-old previously healthy man is admitted for right upper quadrant pain; a workup reveals acute cholecystitis as the cause. During evaluation for surgery, his creatinine level is found to be 6.0 mg/dL; 1 year earlier it was 1.0 mg/dL.

This 18 year old girl had been taking divalporex for seizure disorder for 2 years. After requesting a new drug because of weight gain, a generalized, painful, pruritic, erythematous dermatitis; fever; and sore throat developed after ten days.

A 4-year-old girl presents with a highly pruritic rash. The day before, she had been playing outdoors at her grandmother's house. No pets were present, and the patient does not recall being stung or bitten by insects. There are bushes on the grandmother's property.

When sewing lacerations in children, think ahead to the removal stage.

When sewing lacerations in children place sutures far enough from the wound edges that their eventual removal will be easy.

A Photo Quiz to Hone Dermatologic Skills

Two children, one with a history of infection, the other with a history of an allergic reaction were noted to have postinflammatory hyperpigmentation.

SAN DIEGO -- The pain of a prostate biopsy may not be fully numbed by local anesthesia, according to Mayo Clinic researchers who determined that the procedure may never be free of all discomfort.

SAN DIEGO -- The pain of a prostate biopsy may not be fully numbed by local anesthesia, according to Mayo Clinic researchers who determined that the procedure may never be free of all discomfort.

LONDON -- A pathway to early diagnosis of tuberculosis could be so-called proteomic fingerprinting of serum, a technique that employs mass spectroscopy to identify a pattern of proteins specific to the disease.

LONDON -- A pathway to early diagnosis of tuberculosis could be so-called proteomic fingerprinting of serum, a technique that employs mass spectroscopy to identify a pattern of proteins specific to the disease.

NEW HAVEN, Conn. -- The use of antibiotics has been substantially reduced for children with acute otitis media, with little effect on outcomes, by contingency prescriptions that recommend a delay in filling.

NEW HAVEN, Conn. -- The use of antibiotics has been substantially reduced for children with acute otitis media, with little effect on outcomes, by contingency prescriptions that recommend a delay in filling.

BOSTON -- The sharp drop in air travel after the 9/11 attacks in 2001 slowed the spread of the 2001-2002 seasonal flu and delayed its peak by almost two weeks, according to researchers here. The finding showed that air travel contributes to influenza's spread.

EAST HANOVER, N.J. -- Investigators looking to see whether an Alzheimer's drug could help the memory of patients after a traumatic brain injury had to mine the data hard for a faint light at the end of the tunnel.

EAST HANOVER, N.J. -- Investigators looking to see whether an Alzheimer's drug could help the memory of patients after a traumatic brain injury had to mine the data hard for a faint light at the end of the tunnel.

ATLANTA -- As the severe acute respiratory syndrome (SARS) epidemic moved round the world in 2002-03, clinicians tried a range of interventions against the coronavirus. Now it seems that they may have been futile, at best.

SPRINGFIELD, Ill. -- Americans' risk of dying from cancer continues to decrease, but the rate of new cancers for both sexes and for all races combined has not changed from 1992 to 2003, according to a report by the nation's leading cancer organizations.

SAN DIEGO -- Fatal encounters with stingrays like the one that killed "Crocodile Hunter" Steve Irwin this week are extremely rare, but minor injuries from the creatures are common.

ROCKVILLE, Md. -- The FDA has approved a fully implantable mechanical heart, but has limited the use to a subset of heart failure patients unlikely to live for more than a month without the device.

BEIJING -- A potentially dose-sparing avian influenza vaccine containing inactivated whole particles of the virulent H5N1 strain evoked good immune responses at low doses in early clinical trials, researchers here and in England reported.

CHICAGO -- Lactose-intolerant children should not avoid dairy products but consume as much as they can tolerate, according to a report issued today by the American Academy of Pediatrics.

Abstract: Rhinosinusitis affects millions of persons annually and has a marked impact on quality of life and work productivity. Chronic rhinosinusitis (CRS) is characterized by symptoms that last at least 12 weeks. The history and physical examination should include a search for underlying conditions, such as allergic or nonallergic rhinitis and nasal polyposis. An evaluation of underlying immunodeficiency is warranted in certain patients, particularly those with severe or difficult-to-treat disease or other recurrent infections. When radiologic evaluation is indicated, coronal sinus CT scanning is the procedure of choice. While antibiotics are indicated for bacte- rial rhinosinusitis, intranasal corticosteroids represent the mainstay of treatment for CRS and are particularly useful when polyp disease is present. Nasal irrigation with a saline solution can be a very beneficial adjunctive therapy. Depending on coexisting conditions, additional treatments may include antihistamines, leukotriene modifiers, and immunotherapy. (J Respir Dis. 2006;27(9):372-379)

Acute infection has been known to increase the risk of arterial cardiovascular events, but the effects of acute infections on venous thromboembolic disease have not been well established. Using the self- controlled case-series method, British researchers studied data obtained from general practitioners between 1987 and 2004 to investigate whether acute respiratory and urinary tract infections transiently increased the risk of initial incidents of deep venous thrombosis (DVT) in 7278 persons and pulmonary embolism (PE) in 3755.

Previous receipt of the pneumococcal vaccine is associated with improved survival, reduced risk of respiratory failure, and decreased length of stay among patients hospitalized with community-acquired pneumonia (CAP). This finding was reported by Fisman and associates, who evaluated data from 109 community and teaching hospitals.