Infectious Disease

A 62-year-old man presents with a violaceous, nonpruritic eruption that arose 2 weeks earlier on the hands and feet, including the palms and soles, and spread to the arms and legs (Figure 1). Over the past 3 to 4 weeks, he has had malaise, nonproductive cough, and a decline in mental status but no fever, headache, nausea, light-headedness, hemoptysis, or melena.

For as long as he could remember, a 27-year-old man had had a recurrent eruption on the palms and sides of the fingers. The rash was characterized by intense pruritus followed by the formation of small water blisters and increased perspiration that resolved with peeling of the skin. The dorsa of the hands were unaffected. Results of a potassium-hydroxide preparation and fungal culture of skin scrapings were negative for hyphae. The thyrotropin level was normal.

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman who is employed as a secretary. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

A 62-year-old man presents with a violaceous, nonpruritic eruption that arose 2 weeks earlier on the hands and feet, including the palms and soles, and spread to the arms and legs.

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

Thanks to antibiotics, infectious diseases that were fatal less than 50 years ago are now eminently curable. But at what cost? Clostridium difficile colitis is one alarming side effect that is occuring more often--and with more severity--than you might think.

Pruritic eruptions on both arms of a 12-year-old who has played outdoors all summer; a rash on the hand of a teenage baseball player . . . might sports be responsible for these lesions?

A 38-year-old man sought treatment for the intensely pruritic swellings that had arisen on his upper lip 2 weeks earlier. These sharply demarcated, tender, boggy, granulomatous pustular tumefactions are kerions.

For as long as he could remember, a 27-year-old man had had a recurrent eruption on the palms and sides of the fingers. The rash was characterized by intense pruritus followed by the formation of small water blisters and increased perspiration that resolved with peeling of the skin. The dorsa of the hands were unaffected. Results of a potassium-hydroxide preparation and fungal culture of skin scrapings were negative for hyphae. The thyrotropin level was normal.

To what do you attribute symptoms of rash and fever in: a man with type 2 diabetes; a woman with systemic lupus erythematosus; a previously healthy girl.

Three case studies of patients with fever and rash challenge you to distinguish infectious from other causes and serious from non-threatening.

PARIS -- Women who opt for an elective cesarean have a threefold higher risk of mortality than those who choose vaginal delivery, according to investigators here.

NEW ORLEANS -- For some physicians and nurses the decision to depart this city permanently is due to post-Katrina losses of practices, homes, and patients, but others cite discouragement and defeat at the failure of leadership that permeates the community.

CAMBRIDGE, Mass. -- Patients and third-party payers are getting a fair amount of bang for their health-care bucks, calculated a Harvard economist, and colleagues.

NEW ORLEANS -- As the waters from Hurricane Katrina receded a year ago, they left a once-thriving medical-research establishment in shambles, much of it irretrievably lost.

WASHINGTON -- An empirical therapy used to battle the Spanish flu early in the 20th century may be a valuable addition if the 21st century avian flu turns into a pandemic, researchers here suggested.

WINNIPEG, Manitoba -- Canadians from coast to coast are remarkably prone to inflammatory bowel disease, possibly the result of a climate that discourages bacterial activity and promotes sterile conditions in childhood.

LUDWIGSHAFEN, Germany -- Antibacterial chewing gum to fight cavities? Go spit in the ocean, say skeptical dentists.

ROCHESTER, Minn. -- Most so-called post-polio syndrome may be the effect of muscle weakness that comes with age rather than an exacerbation of the disease decades later, according to researchers here.

GRAND FORKS, N.D. -- Long-term effects of West Nile virus infection may emerge irrespective of the severity of initial acute symptoms, according to investigators here.

TORONTO -- Human growth hormone appears to reverse some elements of HIV-treatment related lipodystrophy, researchers reported here.

TORONTO -- HIV therapy introduced in Third World countries should focus on antiretroviral regimens designed for long-term success, investigators emphasized here.

TORONTO -- The bleak early days of the AIDS crisis, when clinicians were grabbing at straws, provided lessons for today, said researchers who reviewed the history of the epidemic -- now in its 25th year -- at the 16th International AIDS Conference here.

NANTES, France --The seventh trial of adjuvant Navelbine (vinorelbine)-Platinol (cisplatin) tips the balance toward improved survival in patients with stage IB to IIIA non-small-cell lung cancer (NSCLC).

TORONTO -- The target of most HIV therapy is the virus itself, but researchers said here that another approach -- blocking cells' entry points and locking the virus out -- is also starting to show promise.

TORONTO -- An extensively drug-resistant virulent strain of tuberculosis (XDR-TB) killed 52 of 53 patients who were co-infected with HIV during an outbreak in a rural South African hospital, researchers reported here.

TORONTO -- An intravaginal ring, similar to those used to deliver contraceptives and hormonal agents, is a promising way to deliver anti-HIV microbicides, investigators reported here.

TORONTO -- An investigational pediatric version of a recently approved HIV drug is safe and well-tolerated at two different doses and appears to be effective, researchers said here.

BOSTON -- Serious side effects and the cost of chemotherapy for younger breast cancer patients are greater than previously estimated, researchers reported.

SYLMAR, Calif. -- Methicillin-resistant bacteria are taking emergency room doctors back a half-century to the pre-penicillin days, when skin infections were lanced and drained.