Infectious Disease

ATLANTA, June 23 ? Americans returning after the World Cup in Germany should be wary of measles, according to the CDC, which issued a measles warning today aimed at soccer fans.

ATLANTA - Six unrelated clusters of community-acquired methicillin-resistant Staphylococcus aureus infection involving 44 people in three states have been linked to 13 unlicensed street-corner tattoo artists.

ROCHESTER, Minn. - Heartburn is mainly a phenomenon of western culture, according to a systematic review of gastroesophageal reflux disease (GERD).

SEATTLE - Among newly sexually active women, consistent condom use by their partners reduced the risk of human papilloma virus (HPV) infection, researchers reported.

LONDON - If the fates of former cannibals in New Guinea are an accurate indicator, British citizens may have a half-century to worry about whether they ate beef in the 1990s tainted with prion proteins that will lead one day to variant Creutzfeldt-Jakob disease.

BALTIMORE - Reports of paralyzed rats made to walk come and go, all claiming to be new and different. That said, this one is based on coaxing mouse embryonic stem cells into forming functional motor neuron circuits that extend to skeletal muscle, and it may well be different.

CINCINNATI - When it comes to inducing allergies in young children, not all types of airborne fungal spores are created equal, researchers here said.

UTRECHT, The Netherlands - Oral swabbing with antiseptics may be an inexpensive and effective way to prevent bacterial pneumonia in patients on mechanical ventilators, according to a study here.

OAKLAND, Calif. ? Coffee may help protect the livers of heavy alcohol drinkers. In a cohort study of Kaiser Permanente members, drinking one to three cups of coffee a day was associated with a 40% decrease in the risk of alcoholic cirrhosis versus drinking less than one cup.

ATLANTA ? After 25 years, the AIDS pandemic has killed more than 25 million people round the world. Today, nearly 40 million people live with HIV.

AMSTERDAM, The Netherlands ? A short course of antibiotics is just as effective as seven to 10 days for patients with uncomplicated community-acquired pneumonia who improve substantially, researchers here reported.

ROCKVILLE, Md. - The FDA today approved Gardasil (quadrivalent human papillomavirus [Types 6, 11, 16, 18] recombinant vaccine) for prevention of cervical cancer and for prevention of cervical, vulvar and vaginal pre-cancers caused by HPV types 16 and 18.

ROCKVILLE, Md. - The FDA has cleared the way for Tysabri (natalizumab), the multiple sclerosis drug, to go back on the market but under a special restricted distribution program.

HAMILTON, Ontario ? A more intensive program of treating pneumonia in nursing home residents can keep many of them out the hospital, researchers here said.

STOCKHOLM – A protein produced by urinary tract epithelial cells, which appears within minutes of the onset of a urinary tract infection, seems to have potent antimicrobial effects.

ROCHESTER, Minn. ?Treating obese patients with chronic hepatitis C infection with a diet-and-exercise regimen could improve both their overall health and their response to antiviral therapies, researchers suggest.

TEMPLE, Tex. - Diabetics who develop foot infections have a 55-fold greater risk of being hospitalized than diabetics without foot infections and a 154-fold higher risk of losing the affected foot, found a multicenter study.

Campers and hikers often suffer superficiallacerations far from a sourceof medical care or supplies.

A 22-year-old woman presents with fever and malaise of1 month’s duration. About 3 weeks earlier she went to theemergency department. Erythromycin was prescribed,and the patient was told to seek medical attention if hercondition did not improve. Since that time, her healthhas worsened, the fever has continued, and she has lostweight. She says she has had painful areas on her handsand feet but no rash.

A 43-year-old woman presents to the emergency departmentwith fatigue, dyspnea, and intermittent chest painof 3 days’ duration. Her symptoms have worsened sinceshe arose, and 2 hours ago palpitations developed. She describesthe chest pain as a heavy pressure under her sternumthat does not radiate; she denies fever, nausea, vomiting,and diaphoresis.

A 25-year-old man reports that he has had a swollen eye for thepast several days. He noticed a small amount of yellow discharge the previousevening. He denies systemic complaints, including fever, chills, nausea, vomiting,and recent trauma. He also tells you that he has a drip in my private area.

Match each picture with the phrase below that best describes it. The organisms in these pictures might be microscopicor macroscopic, and they can be recovered from skin lesions or clothing by the patient and/or clinician.Answers and discussion appear on the following page.

Some sexually transmitteddiseases (STDs), such assyphilis and gonorrhea, arecenturies-old scourges; othershave attained clinicalsignificance only in recent years.Despite the availability of effectivetherapy for many of these diseases,they remain an important publichealth problem.

Patients with psychiatric disordersoften present a diagnostic challenge-even for psychiatrists. Their demeanormay not readily reveal the nature orseverity of the problem. Nevertheless,there are clues that can help you sortthrough the differential and arrive atthe correct diagnosis.

A 77-year-old woman who had hadanorexia and weakness for 3 monthswas seen after a syncopal episode. Sheappeared pale but alert. Heart rate was110 beats per minute; respiration rate,22 breaths per minute; and blood pressure,170/70 mm Hg. Her hematologicindices were: hemoglobin level, 4.3 g/dL;mean corpuscular volume (MCV), 60fL; mean corpuscular hemoglobin concentration(MCHC), 29 g/dL; red bloodcell count, 1.6 million/μL; white bloodcell count, 7500/μL; and platelet count,452,000/μL.

Although pertussis is generally considered to be a pediatric illness, it is important to note that approximately 60% of cases of pertussis in the United States occur in adolescents and adults.1 The incidence of pertussis in adults in the United States increased 400% from 1990 to 2001.2-4

abstract: Pulmonary hypertension is an increasingly recognized complication of HIV disease. Echocardiography is the most useful imaging modality for an early diagnosis; the most frequent findings are systolic flattening of the interventricular septum, right atrial and right ventricular enlargement, and tricuspid regurgitation. Other components of the workup include comprehensive laboratory tests (complete blood cell count, measurement of prothombin time and partial thromboplastin time, hepatic profile, etc), chest radiography, pulmonary function tests with arterial blood gas analysis, ventilation-perfusion lung scanning, and spiral CT scanning. The treatment of this condition is complex and controversial, and the drug of choice has not yet been established. The therapies currently used include antiretroviral agents, bosentan, calcium channel blockers, epoprostenol, and sildenafil.

A 47-year-old African American woman presented to the hospital after a 5-day history of cough and shortness of breath. The patient also described worsening cough with yellow sputum production over that same time but denied any fevers, chills, nausea, vomiting, abdominal pain, and urinary symptoms. Her condition began to rapidly deteriorate on arrival to the emergency department (ED).

Pulmonary arterial hypertension (PAH) can be difficult to diagnose because the symptoms are nonspecific and the physical findings are usually subtle (Table). In 2004, the American College of Chest Physicians (ACCP) published clinical practice guidelines for the diagnosis and management of PAH.1 Highlights of the ACCP's recommendations for patient assessment include the following:

The authors describe a woman who presented with severe pulmonary hypertension. A cardiopulmonary cause was initially sought, but thyrotoxicosis was the underlying cause.