ID

Does the Existence of Community Acquired MRSA Change Empiric Therapy for Skin and Soft Tissue Infections?

January 3, 2007
Does the Existence of Community Acquired MRSA Change Empiric Therapy for Skin and Soft Tissue Infections?

A 58 year old man with type 2 diabetes and chronic venous insufficiency/recurrent lower extremity cellulitis presents with fever and a left lower extrmity ulcer with purulent drainage. He's been successfully treated in the past with both Unasyn/Augmentin or Levaquin.  In the face of community acquired methicillin resistant staph aureus (CA-MRSA),  have guidelines for skin and soft tissue infections changed?

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

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Morning Report-A Frequently Overlooked Diagnosis

December 28, 2006
Morning Report-A Frequently Overlooked Diagnosis

A 57 year old female  with a past medical history of hypertension, obesity, remote intravenous drug use and several years of chronic low back pain, with both intermittent radiation to her lower extremities  and decreased sensation in her lower extremities  presented with an acute worsening of the pain in her lower back.  The patient reported that she was awakened from sleep and "had to crawl to the bathroom," because of the pain.  She was febrile on admission with moderate lower spine tenderness.  She was…

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Does Circumcision Decrease the Transmission of HIV?

December 18, 2006
Does Circumcision Decrease the Transmission of HIV?

Recently, two large clinical trials in Kenya and Uganda that examined the role of circumcision in men to prevent the spread of HIV were halted on the grounds that not offering circumcision to men taking part in the trial would be unethical.  The trials involved nearly 3,000 heterosexual men in Kenya and nearly 5,000 men in Uganda, none of whom were infected with HIV prior to starting the trial.  In the Kenayn trial, men who were circumcised had a 53% relative risk reduction…

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Fast Facts-Rheumatology

November 30, 2006
Fast Facts-Rheumatology

Bellevue Morning Report Teaching Points 11/27

CC: Left knee swelling and pain x 1 week

54 yo male without past medical history in his usual state of health until 5 weeks prior when he had painful ejaculation and intermittent dysuria, denies penile discharge. Treated for a urinary tract infection with unknown antibiotic. 3 weeks later develops recurrent symptoms and again treated with another course of unknown abx by outside physician. However he develops left knee pain and swelling and is unable to…

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Diagnostic Dilemma #2 How Should You Approach a Low Titer +RPR?

November 28, 2006
Diagnostic Dilemma #2 How Should You Approach a Low Titer +RPR?

45 year old male with history of Hep B ( Hep B Surf Ag + but Hep E Ab+ and E Ag – and DNA viral load was not sent) and syphilis treated in the past.  He has RPRs in the past that were 1:1 for years and then negative x 2 a year apart, the last being over two years ago.  He had labs drawn last week and had an RPR of 1:4.  He does report high-risk unsafe sexual activity (with female prostitutes)…

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Tamiflu Patients Need Monitoring

November 14, 2006
Tamiflu Patients Need Monitoring

Over 100 cases have been reported to the FDA involving the use of Tamiflu and the development of hallucinations, delerium and other unusual behavior mainly in Japanese children.  From the Chicago Tribune article "Health officials have been sensitive about taking any action that might dissuade people from taking Tamiflu, since the drug could play an important role in an outbreak of bird flu."

Read more about it in the Chicago Tribune and FDA websites…here are the links:

FDA announcement

Chicago Tribune Story

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Headlines: Salmonella Outbreak

November 2, 2006

The CDC and the FDA announced yesterday that they are investigating an outbreak of Salmonella typhimurium illness that has affected at least 171 people in 19 states. Symptoms include fever and nonbloody diarrhea. The outbreak seems to be subsiding and they are still unclear as to the source suspecting tomatoes or letuce. No deaths as of yet, 11 patients hosptialized. Cases have been seen in Arkansas, Connecticut, Georgia, Indiana, Kentucky, Maine, Massachusetts, Michigan, Minnesota, North Carolina, New Hampshire, Ohio, Pennsylvania, Rhode Island, Tennessee, Virginia, Vermont,

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