Items in AFP with MESH term: Immunocompromised Host
Molluscum Contagiosum and Warts - Article
ABSTRACT: Molluscum contagiosum and warts are benign epidermal eruptions resulting from viral infections of the skin. Molluscum contagiosum eruptions are usually self-limited and without sequelae, although they can be more extensive in immunocompromised persons. Spontaneous disappearance of lesions is the norm, but treatment by local destruction (curettage, cryotherapy, or trichloroacetic acid) or immunologic modulation can shorten the disease course, possibly reducing autoinoculation and transmission. Warts result from a hyperkeratotic reaction to human papillomavirus infection; nongenital warts are classified as common, periungual, flat, filiform, or plantar, based on location and shape. Warts are treated by local destruction (acids, cryotherapy, electrodesiccation-curettage), chemotherapy, or immunotherapy. The choice of treatment varies with the age and wishes of the patient, the potential side effects of the treatment, and the location of the lesions.
Necrotizing (Malignant) External Otitis - Article
ABSTRACT: Necrotizing (malignant) external otitis, an infection involving the temporal and adjacent bones, is a relatively rare complication of external otitis. It occurs primarily in immunocompromised persons, especially older persons with diabetes mellitus, and is often initiated by self-inflicted or iatrogenic trauma to the external auditory canal. The most frequent pathogen is Pseudomonas aeruginosa. Patients with necrotizing external otitis complain of severe otalgia that worsens at night, and otorrhea. Clinical findings include granulation tissue in the external auditory canal, especially at the bone-cartilage junction. Facial and other cranial nerve palsies indicate a poor prognosis; intracranial complications are the most frequent cause of death. Diagnosis requires culture of ear secretions and pathologic examination of granulation tissue from the infection site. Imaging studies may include computed tomographic scanning, technetium Tc 99m medronate bone scanning, and gallium citrate Ga 67 scintigraphy. Treatment includes correction of immunosuppression (when possible), local treatment of the auditory canal, long-term systemic antibiotic therapy and, in selected patients, surgery. Family physicians and others who provide medical care for immunocompromised patients should be alert to the possibility of necrotizing external otitis in patients who complain of otalgia, particularly if they have diabetes mellitus and external otitis that has been refractory to standard therapy. Susceptible patients should be educated to avoid manipulation of the ear canal (i.e., they should not use cotton swabs to clean their ears) and to minimize exposure of the ear canal to water with a high chloride concentration. Appropriate patients should be referred to an otolaryngologist.
ABSTRACT: Vibrio vulnificus infection is the leading cause of death related to seafood consumption in the United States. This virulent, gram-negative bacterium causes two distinct syndromes. The first is an overwhelming primary septicemia caused by consuming raw or undercooked seafood, particularly raw oysters. The second is a necrotizing wound infection acquired when an open wound is exposed to warm seawater with high concentrations of V. vulnificus. Most patients, including those with primary infection, develop sepsis and severe cellulitis with rapid development to ecchymoses and bullae. In severe cases, necrotizing fasciitis can develop. Case-fatality rates are greater than 50 percent for primary septicemia and about 15 percent for wound infections. Treatment of V vulnificus infection includes antibiotics, aggressive wound therapy, and supportive care. Most patients who acquire the infection have at least one predisposing immunocompromising condition. Physician awareness of risk factors for V. vulnificus infection combined with prompt diagnosis and treatment can significantly improve patient outcomes. (Am Fam Physic
Yellow-White Retinal Lesion in a 48-year-old Woman - Photo Quiz
Eleven National Medical Associations Join to Prevent Pneumonia - Special Medical Reports