Infectious Disease Consultation Archive

Pertussis vaccine efficacy

Pertussis vaccine efficacy


Whole cell pertussis vaccines are more effective than newer, acellular versions.

Trimethoprim/sulfamethoxazole-
induced aseptic meningitis

Trimethoprim/sulfamethoxazole-
induced aseptic meningitis


A young woman presented with symptoms consistent with aseptic meningitis after taking a dose of trimethoprim/sulfamethoxazole.

Recommitting to universal precautions in the Ebola era

Recommitting to universal precautions in the Ebola era


Reviewing precautions for blood and body fluids will help protect both healthcare workers and the public.

Pain in a person with hepatitis C and a fatty pancreas

Pain in a person with hepatitis C and a fatty pancreas


An obese patient with chronic hepatitis C, diabetes, advanced cirrhosis, and fatty pancreas presents with chronic right-to-middle upper-abdomen pain.

Treating antifungal-resistant ear infection
s

Treating antifungal-resistant ear infection
s

What is the best way to handle ear fungus that is resistant to ketoconazole?

Hepatitis C and eczema

Hepatitis C and eczema


Several dermatologic manifestations of hepatitis C infection have been described.

Testing for multiple STDs

Testing for multiple STDs

How do you explain to a patient when a positive test results is likely, but inconclusive due to insufficient specimen quality?

When to refer hepatitis C patients for specialist treatment

When to refer hepatitis C patients for specialist treatment

How can clinicians determine which patients will benefit most from specialist referral in resource-limited settings?

Acute pharyngitis in an adult

Acute pharyngitis in an adult

Were antibiotics the right decision in this clinical scenario?

HPV recurrence risk in monogamous relationships

HPV recurrence risk in monogamous relationships

What is the likelihood of HPV-caused cervical cancer recurrence after loop electrosurgical excision procedure?

Antifungal therapy in the elderly

Antifungal therapy in the elderly

What is the best treatment option for an elderly man with a two-year history of onychomycosis?

Standard of care for patients with elevated liver enzymes

Standard of care for patients with elevated liver enzymes

What is the standard of care for a patient with elevated liver function tests?

Diagnosing neutropenia

Diagnosing neutropenia

What constitutes a reasonable workup for neutropenia in an otherwise healthy young person?

Cephalosporins in patients allergic to penicillin

Are there any guidelines for alternatives to cephalosporins in patients allergic to penicillin?

Determining the cause of a refractory lip blister

Determining the cause of a refractory lip blister

A patient returns after acyclovir fails to resolve a fever blister on the lip. What's the next step?

Antibiotic overuse must be avoided

Antibiotic overuse must be avoided

How can I avoid unnecessary antibiotic use while still satisfying my patients?

Should fatty liver be considered in spontaneous bleeding?

Should fatty liver be considered in spontaneous bleeding?

A who takes acetaminophen for chronic neck and back pain awakens to a bloody nose and blood-soaked pillow. Could liver disease be to blame?

Onychomycosis diagnosis

Onychomycosis diagnosis

What is the most sensitive test to use when trying to diagnose toenail fungus?

Group B strep treatment during pregnancy

Group B strep treatment during pregnancy

What treatment regimen would have the least adverse effect on the fetus?

Options for onychomycosis

Options for onychomycosis

What is an effective alternative to oral medications or topical ciclopirox (Penlac) for onychomycosis?

Acute renal failure related to topical acyclovir

Acute renal failure related to topical acyclovir

Is it common to see renal failure triggered by high doses of topical acyclovir?

Gynecomastia in a patient on dialysis

A 69-year-old man with multiple health conditions develops gynecomastia after hemodialysis. Are the two related?

How to treat lymphedema

What are the most effective therapies available to treat lymphedema?

Choosing the best inflammation marker

Which serologic measure of inflammation is the most cost-effective and reliable when monitoring inflammatory disease?

Diagnosing nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is rapidly emerging as one of the most common "incidental findings" identified with radiographic testing. One in four adults is found to have the condition when undergoing abdominal ultrasound.

Mysterious stomach pain when coughing

Could a liver infarct be the cause of a patient's dull, intermittent pain in the right-upper-quadrant? Or is something else to blame?

Is this rash related to terbinafine?

A patient taking terbinafine for onychogryphosis developed a fine pruritic rash over sun exposed body areas while on vacation. Could the drug be to blame?

Puzzling GI upset in a teenager

Esophagogastroduodenoscopy, colonoscopy, complement fixation, celiac, sonogram, gynecologic workup and routine labs have all been negative in a teen with a three-year history of recurrent chronic abdominal pain and diarrhea. What steps should be taken next?

When to give the zoster vaccine

An elderly patient presented with an acute reaction of shingles. How soon after treatment is it advisable to administer the zoster vaccine (Zostavax)?

Tonsillopharyngitis vs. peritonsillar abscess

What is the best way to differentiate tonsillopharyngitis from a peritonsillar abscess?

Can a gluten-free diet tame inflammation?

Is there a connection between celiac disease (CD) and inflammation?

Confirming suspicions of hepatic encephalopathy

A patient is suspected of having hepatic encephalopathy (HE) attributable to liver failure from alcoholism.

Managing post-herpetic neuralgia

A 55-year-old woman who had herpes zoster and takes morphine for post-herpetic neuralgia pain, no longer wants to be on heavy-duty pain medication. What are her alternatives?

Efficacy of cephalexin after raising dosage

Is there any evidence that changing a patient's cephalexin dose from 500 q.i.d. to 1,000 b.i.d. has decreased efficacy in terms of infection control?

Antibiotics have no effect on oral contraceptives

While it is true that lower serum ethinyl estradiol and progestin levels have been found in women using combination OCs and antibiotics, these women remain well within the therapeutic window.

Differentiating between types of intertriginious warts

Which type of human papillomavirus (HPV) is associated with nonmucosal, condyloma acuminatum-appearing warts found under the pannus in intertriginous areas?

New-onset alopecia in women

What is the appropriate workup in an otherwise healthy woman aged 75 years with new-onset hair loss?

Is simultaneous vaccination always necessary?

In adolescents aged 11 to 14 years, must the human papillomavirus; meningococcal (MCV4); tetanus, diphtheria, and pertussis (Tdap); and, if needed, varicella vaccines be given simultaneously?

What causes delirium?

Is it possible to have a geriatric patient in serious delirium while all labs and urinalysis are within normal limits?

Latent tuberculosis in a patient vaccinated with BCG?

Are health care providers performing proper follow-up for patients who where previously diagnosed with BCG vaccine who have positive skin tests for tuberculosis?

Are iodine preparations safe for treating pressure sore eschar formations?

The use of povidine-iodine in wound care is controversial. Several experimental studies have demonstrated concerns regarding its safety and effect on wound healing.

Tips for tracking Tdap vaccination status

Current FDA indications for tetanus, diptheria and pertussis vaccine call for only one dose between ages 11 and 64 years. What strategies or processes have been employed to communicate to the patient whether he or she has received the one-time-only tetanus shot?

Chemoprophylaxis for traveler's diarrhea

Travel medicine clinicians may consider advising patients to pack a medical kit with antibiotics to self-treat traveler's diarrhea.

Treatments for recurrent UTI in elderly patients

Treatments for recurrent UTI in elderly patients

Is there a role for suppressive antibiotic therapy in geriatric patients with recurrent urinary tract infections?

Post-splenectomy vaccination recommendations

What vaccines and vaccination schedule are recommended for splenectomy patients?

Extended therapy for hepatitis C

Is it reasonable to extend interferon and ribavirin therapy to 72 weeks to increase a patient's chance of achieving sustained viral response to hepatitis C?

Sertraline for constipation

Is sertraline effective as an off-label treatment for irritable bowel syndrome?

MMR vaccination for health-care workers

Clinicians asks advice for appropriate vaccine procedure for health care workers who received childhood vaccines, but cannot supply documentation and no longer have immunity to measles, mumps or rubella.

Phenazopyridine as a treatment for UTI

If a woman has taken OTC phenazopyridine, and urine dipstick results are skewed, is it appropriate to treat empirically with antibiotics based on history and exam findings?

Bacterial biofilms explained

What are bacterial biofilms, and is there a link between these communities and chronic infections? What treatment strategies are recommended?

Treatments for granuloma annulare

A clinician contemplates dapsone for granuloma annulare. Should other treatments be considered?

Does herpes indicate child abuse?

How can I determine if HSV-1 in a 2-year-old girl is the result of abuse or exposure from a vaginal birth of an HSV-positive mother?

When to swab for pertussis

When should an adult with a spasmodic upper-respiratory infection be swabbed for pertussis?

Infectious vs. noninfectious perioral dermatitis

How does one differentiate between infectious and noninfectious perioral dermatitis in the absence of systemic symptoms?

Natural food supplement to prevent malaria

Is the low-toxicity natural agent artemisinin beneficial in malaria prophylaxis?

When is it OK for a clinician to return to work after MRSA?

What treatment and/or confirmatory testing are required before a health-care professional who has been diagnosed with MRSA infection can resume working with patients?

Multiple STDs in a teenager

What is the most effective way to deal with teenagers with repeated sexually transmitted diseases?

Flu-test effectiveness

Has anyone had success with the QuickVue influenza test kits? Should patients with flulike symptoms be treated with antibiotics regardless of test results?

Safety of herbal vaginal products

Some of my patients with abnormal Pap smears attributable to the high-risk HPV virus claim to have "healed" their cervixes with herbal vaginal suppositories. Are these products safe and/or effective?

A young girl's painful rash

A six-year-old girl has been suffering from rashes on the face, chest, and trunk that occur for a week or two, then clear only to recur the next month.

Stubborn onychomycosis

My patient's onychomycosis is responding poorly despite treatment with terbinafine and itraconazole. What do you suggest I do next?

How effective is BCG vaccine against TB?

Given the number of immigrants from Third World countries, why are medical providers still teaching that BCG vaccine provides lifelong protection against TB?

The life span of mononucleosis

Can a person have mononucleosis more than once?

Overly aggressive response to cryotherapy accident

Could this case have been handled in a less invasive manner?

Best treatment for burn blisters

Is it best to remove intact blisters on new second-degree burns or leave them alone?

Immunity to day-care infections

PA questions whether a child would have better immunity to diseases if introduced to day care earlier.

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