1/7. A look-back investigation of patients of an hiv-infected physician. public health implications.BACKGROUND. Transmission of the human immunodeficiency virus (hiv) to five patients receiving care from an hiv-infected dentist in florida has recently been reported. Current data indicate that the risk of hiv transmission from health care workers to patients is low. Despite this low risk, programs to notify patients of past exposure to an hiv-infected health care worker are being conducted with increasing frequency. methods. We recently conducted an investigation of all the patients cared for by an hiv-infected family physician during a period when he had severe dermatitis caused by mycobacterium marinum on his hands and forearms. After reviewing the patients' records, we notified 336 patients who had undergone one or more procedures (digital examination of a body cavity or vaginal delivery) placing them at potentially increased risk of hiv infection. The patients were offered tests for hiv infection and counseling. RESULTS. Of the 336 patients, 325 (97 percent) had negative tests for hiv antibody, 3 (1 percent) refused testing, 1 (less than 1 percent) died of a cause unrelated to hiv infection before notification, and the hiv-antibody status of 7 (2 percent) remained unknown. The direct and indirect public health costs of this investigation were approximately $130,000. CONCLUSIONS. The results of this investigation raise important questions about the risk of hiv transmission from health care workers to patients and the usefulness of hiv look-back programs, particularly in the light of recently published recommendations from the Centers for disease Control. We propose that before a look-back investigation is undertaken, there should be a clearly identifiable risk of transmission of the infection, substantially higher than the risk requiring limitation of an hiv-infected health care worker's practice prospectively.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Pitted keratolysis: a manifestation of human dermatophilosis.A case of pitted keratolysis caused by Dermatophilus congolensis is reported. The organism was isolated from the lesion and identified by its morphological, cultural, and biochemical characteristics. A survey of the literature revealed that it rarely causes human infections, but is a common causative agent of disease in domesticated and wild animals. Human infections reported previously were traced to contact with infected animals or contaminated soil. We report pitted keratolysis in a 44-year-old physician with no known history of such a contact.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
3/7. pseudomonas infections associated with hot tubs and other environments.Infections due to pseudomonas aeruginosa are not confined to the hospital intensive care unit. This paper examines the association of P. aeruginosa and several community-acquired infections. Hot tub folliculitis is a recently described disorder occurring in outbreaks among persons who unknowingly immerse themselves in contaminated whirlpools, spas, or swimming pools. The green nail syndrome and other dermatoses are also reviewed. Infective endocarditis, invasive external otitis, and puncture would osteomyelitis are serious infections that carry high risks for the patient and challenge the physician's most potent therapies.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
4/7. mycobacterium marinum infection in a 4-year-old child.Infections with mycobacterium marinum are uncommon in children but should be considered by a physician confronted with chronic, poorly healing skin lesions. A case of such an infection in a 4-year-old child is presented. Presenting signs and symptoms, differential diagnosis, and treatment of these infections are discussed.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
5/7. vibrio vulnificus infection. Case report and update since 1970.vibrio vulnificus infections is being reported with increasing frequency in coastal regions of the united states. Raw seafood consumption, particularly raw oysters, and wounds acquired in a marine environment predispose to infection. patients with advanced liver disease are at increased risk of developing septicemia. V. vulnificus is a virulent pathogen producing significant morbidity and mortality; its virulence relates in part to the production of exotoxin. skin lesions occur early in the clinical course of infection and provide means of specific diagnosis. The patient and the consulting physician are well served by the dermatologist capable of recognizing this infectious disease.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
6/7. Varicella gangrenosa due to group A beta-hemolytic streptococcus.Varicella is usually a well-tolerated disease in normal children. Pyogenic infections involving the skin are the commonest complications and their potential severity is emphasized by our recent experience with two children who suffered from gangrene as a result of cutaneous superinfection with group A beta-hemolytic streptococci. We present the recognition and management of these patients in an effort to reacquaint physicians with this potentially fatal infection.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
7/7. staphylococcal infections in patients with atopic dermatitis.Cutaneous staphylococcal infections appear to be relatively infrequent in atopic dermatitis even though patients have broken skin heavily colonized with staphylococcal organsism. We found superficial staphylococcal pustules on the skin of 22 patients with atopic dermatitis. Such lesions were more commonly found with severe exacerbations of atopic dermatitis. They appeared on unbroken skin independent of hair follicles and were associated with considerable pruritis. Such lesions were rapidly removed by excoriation and frequently were overlooked by patients and physicians. Most lesions appeared when polymorphonuclear leukocyte chemotaxis was depressed. Ineffective chemotaxis combined with high-colonization density and inadequate stratum corneum barrier during exacerbations of atopic dermatitis may lead to mild staphylococcal infections. These infections appear to have no systemic effects but possibly the considerable associated pruritis could worsen the atopic dermatitis. Occasional patients may require intermittent or continuous antibiotic therapy.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |