Case presentation 2

A 73-year-old woman with diabetes mellitus and community-acquired pneumonia was admitted to hospital and treated with a third generation cephalosporin, intravenous fluids, insulin, and supplemental oxygen. She gradually improved, with defervescence of her fever by day 5 and improvement in her cough and dyspnea. On day 8 she developed watery offensive diarrhea with severe abdominal cramping. She was anorexic and hypoglycemic. Her temperature increased to 38-5 C, her heart rate increased to 135...

Case presentation 1 continued

You treat your patient for a total of 6 months. At 1 and 2 months, his sputum smears and culture are negative, and he is unable to produce sputum thereafter. You see him monthly to assess symptoms and adherence. At 4 weeks, his transaminase levels rise to 3 times baseline. As he is asymptomatic, you continue his therapy and these normalize by week 8. He completes therapy and is asked to present 1 year later for x ray film follow up. Contact tracing reveals no immediate family or fellow workers...

Herpes simplex type

The onset of HSV-1 encephalitis (HSE) is usually abrupt, although a subacute prodrome of frontal headache and malaise may occur less commonly. Fever is present in 90 of cases, headache is prominent early in the course of disease, and the majority of patients have signs suggesting a localized lesion involving one or both temporal lobes.56,71 These findings often include dramatic personality changes, which may be the first clinical manifestation. Following these behavioural changes, patients may...

Sexually transmitted infections

A 17-year-old girl presents to the city sexual health clinic with vaginal discharge. She has a new boyfriend and is 'on the pill' she and her partner do not use condoms as their relationship is monogamous. On examination, she has mild lower abdominal tenderness to palpation, cervicitis, and cervical discharge. There is cervical motion tenderness and left adnexal tenderness on bimanual examination. Her 17-year-old boyfriend has accompanied her to the clinic and is assessed separately he reports...

Case presentation 3

A 74-year-old retired schoolteacher presents with an infection in his left forefoot. He gives a history of type 2 diabetes mellitus of 8 years' duration, which has required insulin for control of blood sugar for the last 4 years. He is a non(never)-smoker, with a daily alcohol intake of 4-5 units. His family doctor reports that his blood sugar control has deteriorated over the last year, and that he had an episode a week previously that may have been a transient ischemic attack. Clinical...

Case presentation

A healthy 45-year-old man hit his forearm while doing some house renovations, causing a minor abrasion, 3 days prior to his presentation to the Emergency Department. He noted some minor swelling, pain, and erythema yesterday, but this morning he noted much more pain. His right forearm was swollen and erythema covered most of the dorsal surface from wrist to elbow. The emergency physician refers him for consideration of parenteral therapy and inpatient treatment with concerns about the area of...

Diabetic foot infections

Due to the triad of vascular insufficiency, peripheral neuropathy, and impaired immune function, foot ulceration and infection are common among diabetics. Foot infections are among the most common cause for hospital admission in diabetics.54,55 Osteomyelitis is present in an estimated 20 of complicated infections56 and diabetic foot infection accounts for 50 of lower extremity amputations.57-59 In 1996, 86 000 lower extremity amputations were performed on diabetic patients in the United...

Severe and complex urinary tract infections

This patient has a severe urinary tract infection requiring hospital admission.4 In addition to fever and flank tenderness, she has signs of possible sepsis with hypotension, rapid heart and respiratory rates, and mental clouding. Furthermore, her diabetes is out of control. Based on her clinical presentation, she has upper urinary tract disease (kidney, renal pelvis, or ureter) otherwise known as pyelonephritis. Because this woman is diabetic, she is by definition presenting with a complicated...

Diagnosis of STI

Sexually transmitted pathogens cause several common syndromes. Infection with Neisseria gonorrhoea or Chlamydia trachomatis frequently results in urethritis, cervicitis, or the constellation of symptoms and signs that suggest the presence of pelvic inflammatory disease. HSV, Treponema pallidum, and Haemophilus ducreyi are common agents of ulcerative genital disease, while vaginal discharge is commonly caused by infection with Trichomonas vaginalis or Candida spp. or by bacterial vaginosis....

References

Foxman B, Barlow R, D'Arcy H, Gillespie B, Sobel JD. Urinary tract infection self-reported incidence and associated costs. Ann Epidemiol 2000 10 509-15. 2. Kunin CM. An overview of urinary infections. In Kunin CM, ed, Urinary Tract Infections Detection, Prevention and Management, 5th edn, Baltimore Williams Wilkins, 1997. 3. Hooton TM, Scholes D, Hughes JP et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med 1996 335 468. 4. Bent S,...

Case presentation 2 continued

The patient's CSF PCR for HSV is positive and she completes a 14-day course of intravenous acyclovir. She has a slow recovery over several weeks with no clinical evidence of relapse and is transferred to a rehabilitation facility. Six months after the encephalitis, she is living independently but functioning at a lower level than previously and has short-term memory impairment and anosmia. 13. Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. A review of 493...

Urinary tract infections in men

A 40-year-old man presented to his physician with a 3-day history of dysuria. The pain was moderately severe but only present during voiding. He had no urethral discharge and he had no pelvic pain. He had not been sexually active for over 1 month prior to his dysuria. On examination, his temperature was 37-4 C and the general physical exam was normal. The rectal examination showed a mildly enlarged but non-tender prostate. Urine analysis showed pyuria and bacteriuria. Urine culture was obtained...