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Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

January 22, 2009

Commentary by Melanie Maslow, MD, FACP, Associate Professor of Medicine, NYUSOM, Chief, Infectious Diseases, New York Harbor Healthcare System, NY

Faculty Peer Reviewed

Cellulitis is an acute spreading infection of the skin extending to the deep subcutaneous tissue characterized by pain, swelling, erythema and warmth. Cellulitis in the non-neutropenic patient, in the absence of bite wounds, salt or fresh water exposure, and coexisting ulcers is usually caused by Gram-positive pathogens, the most common being the beta-hemolytic streptococci and S .aureus, including methicillin-sensitive…

Grand Rounds: “Bacterial Meningitis”

September 11, 2008

Commentary by Stephen Carpenter MD, PGY-2

Dr. Vincent Quagliarello, Professor of Medicine at Yale University, delivered his Medicine Grand Rounds lecture entitled “Bacterial Meningitis in Adults: Principles and Practice in 2008” on Wednesday, September 3rd, 2008. He began with some of the history of the disease and noted that despite all the medical advances, bacterial meningitis still has a mortality rate of 27% and an even higher rate of 54% in poorer nations where high rates of HIV infection confound the problem.…

Case Presentation: Acute Rheumatic Fever

August 29, 2008

Commentary by Bani Chander MD, PGY-3. and Ben Bergman MD, PGY-3

Please also see last week’s Class Act Post on the pathogenesis of Rheumatic Heart Disease

A 34-year-old Hispanic male presents with the chief complaint of chest pain. The patient had been well until 10 days prior to admission, when he developed a severe sore throat accompanied by fever, rigors, and diffuse myalgias. There was no associated cough. Three days later, he visited his primary care physician at an outside facility and was prescribed…

Class Act: Pathogenesis of Rheumatic Heart Disease

August 14, 2008

Class act is a feature of Clinical Correlations written by NYU 3rd and 4th year medical students. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member.

Commentary by Matt Stein MS-4; Reviewed by Harold Horowitz MD, Professor, NYU Division of Infectious Diseases and Immunology

In general, acute rheumatic fever (ARF) is a delayed sequela of a group A streptococcus (GAS) pharyngeal infection. Following an initial throat infection, which is often either untreated or incompletely treated, there exists a latent…

Breaking news: FDA issues new Boxed Warning for Fluoroquinolones

July 10, 2008

Commentary by Marilena S. Antonopoulos, PharmD, Pharmacology Editor

On July 8th, the FDA notified the manufacturers of fluoroquinolone antimicrobial drugs that a Boxed Warning in the product labeling and a Medication Guide for patients concerning the increased risk of tendinitis and tendon rupture is necessary. The FDA conducted a new analysis of the available literature and post-marketing adverse event reports which reconfirms that the use of fluoroquinolones is associated with an increased risk of tendon rupture.

The risk of developing fluoroquinolone-associated tendinitis and tendon…

Admission screening cultures for MRSA: Is it time?

July 9, 2008

Commentary by Howard Leaf, M.D. Assistant Professor, Division of Infectious Diseases and Immunology

Pressure continues to build for healthcare facilities to act to decrease hospital-acquired infections, particularly those associated with MRSA. This is partly data-driven, with one study reporting that 25% of patients acquiring MRSA colonization during a hospitalization subsequently become infected . The call to act is also partly a political response to concerns in the lay press about “superbugs” wreaking havoc both in hospitals and in the community. Seven states have…

Neutropenic Precautions Demystified

June 13, 2008

Commentary by Rachana Jani MD, PGY-1 and Neal Steigbigel MD, Professor of Medicine (Infectious Diseases/Immunology)

Rachana Jani MD: Walking onto an oncology floor, one cannot help but notice the precautionary signs that segregate these patients from the rest of the hospital. “No fresh fruits or flowers.” “Neutropenic isolation, please see nurse before entering.” The idea of neutropenic precautions first emerged in the 1960s when myelosuppressive therapy came to the forefront of cancer treatment. It only made sense that patients with an impaired immune…

Should H. pylori Eradication Be Confirmed?

June 12, 2008

Commentary by Fritz Francois, MD, MS, NYU Division of Gastroenterology

Humans are essentially the only reservoir for Helicobacter pylori, which is estimated to colonize the stomach of about half the world’s population (1). Although the bacteria generally do not invade the mucosa, attachment to the epithelium leads to an inflammatory reaction with neutrophils, lymphocytes, plasma cells, and macrophages. Over time, the persistent inflammation leads to changes in the gastric mucosa that may predispose to the development of dysplasia(2).

Some say tomato, some say nationwide outbreak of Samonellosis

June 10, 2008

Commentary by Chirayu Gor, MD

The CDC has issued an alert regarding the outbreak of a rare type of Salmonella, termed Salmonella Saintpaul. Since mid-April, over 140 persons have been identified in 16 states with this uncommon serotype of Salmonella. Preliminary investigation has implicated tomatoes.

The Rational Clinical Examination: Does This Patient with Diabetes Have Osteomyelitis of the Lower Extremity?

March 28, 2008

Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

The most recent installment in JAMA’s Rational Clinical Exam Series seeks to determine the accuracy of the history, physical exam, radiology and laboratory in making the diagnosis of osteomyelitis in diabetics. This is relevant given its frequency of occurrence and its cost and since the gold standard for diagnosis, namely a bone biopsy and culture, is less than optimal for a variety of reasons.

Less than 10% of the…

HotSpots: Promed

March 7, 2008

Welcome to HotSpots, a new feature of Clinical Correlations. In this series, we intend to highlight unique websites of interest to the medical profession. Feel free to make suggestions for sites that should be featured in this series by clicking the comment field or sending us an email.

Commentary by Shrujal Baxi MD, NYU Chief Resident

http://www.healthmap.org/promed

If you don’t know what the Chikungunya virus is or you want to know where the Plague is killing people in the world today, then this…

Measles Alert!

February 20, 2008

Commentary by Rosemary Adamson MD, PGY-2

Be on the look-out for measles! New York City’s Department of Health and Mental Hygiene (DOHMH) issued a measles alert at the end of last November because there were 5 confirmed cases of measles being imported from abroad in 2007 to NYC. The DOHMH wished to raise healthcare provider awareness of measles, especially in travelers. Coming from the UK, this alert is close to my heart, as Britain has been battling with reduced uptake of the MMR vaccine…

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