New Cases

Methicillin-Resistant Staphylococcus aureus (MRSA) Skin and Soft Tissue Infections
In the past decade, MRSA has emerged as a prominent cause of community-acquired skin and soft tissue infections. This case discussed the mechanisms of antimicrobial resistance, clinical manifestations and approach to different types of skin and soft tissue infections in which MRSA may be involved. New IDSA guidelines for the management and decontamination of MRSA are reviewed.

Cryptosporidiosis in a Patient with AIDS
Cryptosporidium infection in HIV-infected persons with advanced immunuosuppression can cause debilitating diarrhea. This case provides an overview of the clinical manifestations, appropriate diagnostic tests, and management of HIV-infected patients with cryptosporidiosis.

Discordant CD4 Cell Count and Viral Load Responses to Antiretroviral Therapy
Some patients unfortunately have persistently low CD4 cell counts despite achieving sustained HIV RNA suppression. This case reviews the normal immunologic recovery with different antiretroviral regimens, the potential causes of poor immunologic recovery, and data from the recently published ESPRIT and SILCAAT trials.  

Unusual Changes in Physical Appearance in a Patient with AIDS
Body shape changes in HIV-infected patients can result from different causes. This case describes a 44-year-old man on multiple medications who developed a multitude of body shape changes. The cause for these body shape changes was discovered.

Cyanosis in a Patient with AIDS
A 37-year-old man with advanced HIV disease and a history of pulmonary Kaposi’s sarcoma presented with shortness of breath and cyanosis. Clues to the diagnosis of this uncommon problem are given in the clinical history and by examining the result of the arterial blood gas.

A 43-Year-Old with a Persistent Skin Rash
Evaluation of skin rashes can prove very difficult in HIV-infected persons with advanced immunosuppression. In this case, the diagnosis of these hyperkeratotic, scaling lesions was made on a skin scraping when viewed under a microscope. Test your skills in diagnosis and management in this challenging unknown.

Efavirenz-Associated Central Nervous System Adverse Effects
Efavirenz (Sustiva) is one of the most frequently used antiretroviral medications. The concern for neuropsychiatric adverse effects often plays a role in the decision of whether to include efavirenz as part of an antiretroviral regimen. This case includes a discussion of available data related to efavirenz-related neuropsychiatric manifestations. In addition, this case provides practical recommendations for the prevention and management of these symptoms.

A 27-Year-Old with Disseminated Histoplasmosis
Disseminated histoplasmosis in HIV-infected persons is a potentially life-threatening infection. Clinical manifestations are often non-specific. Diagnostic testing often involves using a combination of tests, including antigen tests and culture. Preferred initial treatment of progressive disseminated infection consists of liposomal amphotericin B (AmBisome), followed by maintenance therapy with oral itraconazole (Sporanox).

A 43-Year-Old with New Visual Symptoms
Cytomegalovirus retinitis remains an important clinical problem with patients with advance immunosuppression. Symptoms of cytomegalovirus retinitis usually include one or more of the four “F’s”: floaters, flashes, field deficits, or failing vision. Oral valganciclovir (Valcyte), with or without a ganciclovir intraocular implant, is generally recommended for initial therapy.

African Americans with HIV: Epidemiology and Risk Factors
The HIV epidemic has disproportionately affected African Americans and in recent years more new diagnoses of HIV (with or without AIDS) involve African Americans than any other racial/ethnic population. This case includes a review of the epidemiology and factors related to the explosion of the HIV epidemic in African Americans.