Cutaneous Tuberculosis.

Cutaneous tuberculosis (TB) may present in various clinical manifestations. Skin involvement may occur as a result of exogenous inoculation, contiguous spread from a nearby focus of infection, or by hematogenous spread from a distant focus. Because the clinical presentation of cutaneous TB can vary widely, it is important to have a high index of suspicion in appropriate clinical settings.

Clinical Case of the Month: A 64 Year-Old Woman Presenting With Fever, Confusion, Ophthalmoplegia and Pneumonia.

Legionella pneumophila is a major cause of atypical community-acquired pneumonia, which is commonly severe enough to require hospitalization. Though primarily a respiratory infection, Legionellosis involves the central nervous system (CNS) in up to 50% of patients, and diagnosis can be obscured by the absence of obvious respiratory symptomatology. A reversible diffuse encephalopathy is the most common neurologic complication, but focal CNS involvement can sometimes be the initial presentation.

Clinical Case of the Month. A 44-Year-Old HIV-Infected Man With Righ-Shoulder Swelling.

Immunocompromised patients are susceptible to various joint infections with less-common pathogens, such as mycobacterium. Physicians should have a low threshold to investigate the cause of an arthropathy further. An aspiration of the effusion is usually warranted to identify the possible pathogen and target treatment.

Vasculopathy, hematological, and immune abnormalities associated with levamisole-contaminated cocaine use.

Objectives: To report 4 cases of cocaine-related purpura and to review previously reported cases of levamisole, levamisole-contaminated cocaine, and cocaine-induced vasculopathy.

Methods: We describe 4 patients suspected of vasculopathy associated with levamisole-tainted cocaine use. A retrospective review of the literature was performed using the PubMed, PubJet, MD consult, and Cochrane review databases.

A middle-aged man with newly diagnosed HIV infection and rash.

TEN is a rare cutaneous drug reaction associated with high morbidity and mortality. The underlying pathogenic mechanisms are poorly understood. Development of an effective treatment algorithm has been hampered by the low incidence of this disorder, incomplete knowledge of the mechanisms of epidermal death, and lack of large controlled trials to evaluate therapeutic interventions.

Susceptibility trending of blood isolates of the Bacteroides fragilis group over a 12-year period to clindamycin, ampicillin-sulbactam, cefoxitin, imipenem, and metronidazole.

Numerous reports have described a steady overall increase in resistance among clinical isolates of the Bacteroides fragilis group to several antimicrobial agents, particularly clindamycin. Determination of resistance rates is significantly influenced by the number of isolates of each species within the B. fragilis group tested.

Faculty Evaluations by Medicine Residents Using Known versus Anonymous Systems.

Purpose: This study examined the extent to which faculty evaluation results differed, based on whether residents were required to submit ratings anonymously or not.

Method: We used a retrospective analysis of existing records representing Internal Medicine residents' evaluation of 51 faculty members in an anonymous and known (non-anonymous) rater system on an inpatient medicine service.

Results: Mean scores for 48 of 51 individuals were lower for anonymous than non-anonymous evaluations.

Infections related to the ingestion of seafood. Part II: parasitic infections and food safety.

Parasites are responsible for a substantial number of seafood-associated infections. The factor most commonly associated with infection is consumption of raw or undercooked seafood. People with underlying disorders, particularly liver disease, are more susceptible to infection.

Infections related to the ingestion of seafood Part I: Viral and bacterial infections.

Foodborne diseases cause an estimated 76 million illnesses in the USA each year. Seafood is implicated in 10-19% of these illnesses. A causative agent can be traced in about 44% of seafood-related outbreaks, viruses accounting for around half of these illnesses.

Education does pay off: pneumococcal vaccine screening and administration in hospitalized adult patients with pneumonia.

Streptococcus pneumoniae-associated infections are an important cause of hospitalization and mortality in high-risk and elderly patients. Even in the setting of appropriate therapy, the case fatality rate of invasive pneumococcal disease in the elderly may approach 40%. Since approximately 40,000 people die annually from pneumococcal-associated disease, it represents a substantial target for vaccine-preventable, bacterial fatalities.

Bacteremia due to Bacteroides fragilis group: distribution of species, beta-lactamase production, and antimicrobial susceptibility patterns.

A retrospective analysis of susceptibility data on 542 blood isolates of the Bacteroides fragilis group tested from 1987 to 1999 by the same NCCLS-recommended broth microdilution method throughout is presented. Metronidazole, beta-lactam-beta-lactamase inhibitor combinations, carbapenems, and trovafloxacin were the most active agents (susceptibility of >or=93%). Among the cephalosporin-cephamycins, the order of activity was cefoxitin > ceftizoxime > cefotetan = cefotaxime = cefmetazole > ceftriaxone.

A fish hook and liver disease: revisiting an old enemy.

Vibrio vulnificus is an uncommon but potentially devastating pathogen. Early recognition with prompt antimicrobial therapy and surgical treatment are key factors for a favorable outcome. Patients with diseases of the liver represent the group at highest risk of infection.