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Biomedical subjects

Fred A Lopez

Publications and source records attributed to Fred A Lopez.

At least 19 recordsLinked to original sources
PubMed2006

Skin and soft tissue infections.

Primary skin infections (ie, pyodermas) typically are initiated by some breach in the epidermis, resulting in infection by organisms, such as Streptococcus pyogenes and Staphylococcus aureus, that normally colonize the skin. Host-associated factors, such as immunosuppression, vasculopathy, neuropathy, or decreased lymphatic drainage, may predispose to skin infection. The clinical syndromes associated with skin infections are often characteristic and are defined most simplistically by anatomic distribution. Although often mild and self-limited, skin infections can be more aggressive and involve deeper structures, including fascia and muscle. This article discusses skin and soft tissue infections, including impetigo, hair follicle-associated infections (ie, folliculitis, furuncles, and carbuncles) erysipelas, cellulitis, necrotizing fasciitis, pyomyositis, septic bursitis, and tenosynovitis.

Journal Article↗
PubMed2003

Successful management of disseminated Nocardia transvalensis infection in a heart transplant recipient after development of sulfonamide resistance: case report and review.

Nocardia transvalensis is a rarely reported cause of clinically significant disease, and, to our knowledge, has not been reported previously as a cause of infection in the cardiac transplant population. We report a case of N transvalensis new taxon-2 pulmonary infection that disseminated to the brain and skin in a cardiac transplant recipient despite adequate sulfonamide serum levels. Subsequent isolates were resistant to sulfonamides, and molecular ribotyping of the primary and subsequent isolates confirmed that these were the same N transvalensis new taxon-2 strain. The taxonomic and diagnostic considerations, as well as the clinical significance of anti-microbial-resistant nocardia, are reviewed and discussed herein.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed2002

Broad-range bacterial detection and the analysis of unexplained death and critical illness.

Broad-range rDNA polymerase chain reaction (PCR) provides an alternative, cultivation-independent approach for identifying pathogens. In 1995, the Centers for Disease Control and Prevention initiated population-based surveillance for unexplained life-threatening infections (Unexplained Death and Critical Illness Project [UNEX]). To address the causes of UNEX cases, we examined 59 specimens from 46 cases by using broad-range bacterial 16S rDNA PCR and phylogenetic analysis of amplified sequences. Specimens from eight cases yielded sequences from Neisseria meningitidis (cerebrospinal fluid from two patients with meningitis), Streptococcus pneumoniae (cerebrospinal fluid from one patient with meningitis2 and pleural fluid from two patients with pneumonia), or Stenotrophomonas maltophilia (bone marrow aspirate from one patient with pneumonia). Streptococcus pneumoniae rDNA sequence microheterogeneity was found in one pleural fluid specimen, suggesting the presence of multiple strains. In conclusion, known bacterial pathogens cause some critical illnesses and deaths that fail to be explained with traditional diagnostic methods.

Adolescent↗
PubMedDate not supplied

A fish hook and liver disease: revisiting an old enemy.

Vibrio vulnificus is an uncommon but potentially devastating pathogen. Early recognition with prompt antimicrobial therapy and surgical treatment are key factors for a favorable outcome. Patients with diseases of the liver represent the group at highest risk of infection. However, clinicians are often unaware of underlying liver disease in these patients at the time of presentation. We present a case of fulminant V. vulnificus infection in a patient with previously undiagnosed liver disease.

Adult↗
PubMedDate not supplied

Clinical case of the month. Chest pain, diaphoresis, and dyspnea in a hypertensive 53-year-old man.

Aortic dissection is a life-threatening condition requiring urgent diagnosis and treatment. The initial challenge for the physician lies in distinguishing aortic dissection from more common conditions such as myocardial infarction that also are characterized by chest pain. Subsequent management depends on imaging techniques that define whether just the descending aorta is affected or its more proximal portions as well. Mortality and morbidity are high, especially when the ascending aorta is involved.

Aortic Dissection↗
PubMedDate not supplied

Hereditary angioedema: a rare but potentially lethal disease.

Hereditary angioedema, although uncommon, should be considered in the differential diagnosis of all patients with facial edema. In this article, we present a case of hereditary angioedema and discuss the presentation, diagnosis, and management of the disease.

Adolescent↗
PubMedDate not supplied

Lymphoma or pseudolymphoma?

Anticonvulsant hypersensitivity syndrome is a systemic illness that presents most commonly as a triad of fever, rash, and lymphadenopathy in a patient exposed to one or more of the aromatic antiepileptic drugs (phenytoin, phenobarbital, and carbamazepine). Although generally self-limited, the syndrome may be life-threatening, particularly among patients who develop severe cutaneous eruptions or hepatitis. Early recognition of the syndrome is essential, as immediate discontinuation of the offending antiepileptic agent is the most important step in improving outcome. We present a case of anticonvulsant hypersensitivity syndrome in a patient with a previous history of Hodgkin's lymphoma.

Adult↗
PubMedDate not supplied

Clinical case of the month. Severe progressive weakness in a 58-year-old man. Myasthenia gravis.

Myasthenia gravis historically has been associated with significant morbidity and mortality rates, and most of those afflicted either died of the disease or became greatly disabled. However, modern understanding of the pathogenesis of this disorder has led to several effective treatments which have transformed the prognosis of this disease greatly.

Diagnosis, Differential↗
PubMedDate not supplied

A 19-year-old man presenting with a generalized body rash.

A 19-year-old man presented to the emergency department with a chief complaint of generalized body rash for two weeks. The rash began shortly after he initiated penicillin therapy for a sore throat diagnosed one week previously. He also complained of having dark urine and abdominal discomfort. His urinalysis revealed proteinuria and hematuria, and he was admitted for further evaluation and management. While in the hospital, he had an episode of hemoptysis. A renal biopsy was performed and revealed IgA deposition. In light of his systemic symptoms including rash and abdominal pain, he was diagnosed with Henoch-Schonlein purpura (HSP).

Adult↗
PubMedDate not supplied

A 71-year-old man with hyperglycemia and mental status changes.

Hyperglycemic hyperosmolar syndrome is an extreme but relatively common presentation of uncontrolled or new-onset diabetes mellitus. The diagnosis of the disorder itself is fairly straightforward, but the search for an underlying cause can be challenging. Infections are the usual precipitating factor, but a variety of other stressors can be involved. We report herein a patient presenting with hyperglycemic hyperosmolar coma with three possible precipitating infections: pharyngitis, urinary tract infection, and infective endocarditis.

Aged↗
PubMedDate not supplied

Essential thrombocytosis: diagnostic and treatment dilemmas.

Essential thrombocytosis is one of the chronic myeloproliferative disorders that includes polycythemia vera, chronic myelogenous leukemia, and agnogenic myeloid metaplasia. Despite established diagnostic criteria and greater than a quarter century of study, there are still several diagnostic and management dilemmas that plague researchers and clinicians alike. We present a case of essential thrombocytosis in a patient with multiple sequelae.

Aspirin↗
PubMedDate not supplied

Education does pay off: pneumococcal vaccine screening and administration in hospitalized adult patients with pneumonia.

Streptococcus pneumoniae-associated infections are an important cause of hospitalization and mortality in high-risk and elderly patients. Even in the setting of appropriate therapy, the case fatality rate of invasive pneumococcal disease in the elderly may approach 40%. Since approximately 40,000 people die annually from pneumococcal-associated disease, it represents a substantial target for vaccine-preventable, bacterial fatalities. The 23-valent pneumococcal polysaccharide vaccine has proven consistently effective in preventing invasive pneumococcal disease. Despite its endorsement by numerous specialty societies, the pneumococcal vaccine is underutilized in the inpatient setting. In a recent report of quality indicators for Medicare beneficiaries, the percentage of Medicare beneficiaries in Louisiana admitted with pneumonia who were screened or received the pneumococcal vaccination prior to discharge was only 4%, the lowest percentage in the United States. The Louisiana State University-New Orleans Internal Medicine Department and its house staff embarked upon a retrospective study to determine its baseline pneumococcal vaccination or screening rates for all patients with pneumonia on its inpatient services at the The Medical Center of Louisiana in New Orleans from July 2000 through June 2001. From July 2001 through June 2002 an intensive educational intervention concentrating on the indications and benefits of pneumococcal vaccination was directed toward the Louisiana State University Internal Medicine house staff assigned to the inpatient service. Retrospective analysis for pneumococcal vaccine screening and administration of charts of all patients with pneumonia on the LSU Medicine service from July 2001 through June 2002 was performed in order to determine the effects of the intervention. Data from the pre-educational intervention period revealed a baseline pneumococcal vaccine screening or administration rate of 11% for all patients with pneumonia on the LSU Internal Medicine inpatient service. During the one-year intervention period, the pneumococcal vaccine screening or administration rate increased to 71%, a clinically and statistically significant increase (p-value < 0.0001). Data targeting patients 65 years of age and older revealed a baseline pneumococcal vaccine screening or administration rate of 10% for patients with pneumonia on the LSU Internal Medicine inpatient service which increased to 82% during the one year educational intervention (p-value < 0.0001). House officer scores (possible range 0-100) on a questionnaire assessing their understanding of the indications and benefits of pneumococcal vaccination were significantly higher after the educational intervention compared to before the intervention (means +/- standard deviations, 68 +/- 9 vs. 59 +/- 10, p < 0.0001). The findings from this study highlight the importance of education in increasing compliance with widely-accepted practice guidelines such as pneumococcal vaccine screening or administration in patients hospitalized with pneumonia.

Female↗
PubMedDate not supplied

Clinical case of the month. A young man with a persistent skin eruption. Mycosis fungoides.

There are many types of skin disease that fit into the classification of cutaneous lymphoma, but mycosis fungoides is by far the most common of this group. It is a non-Hodgkin's lymphoma of T-cell origin that presents in the skin. Mycosis fungoides often evolves for years without a specific diagnosis because it can present as an eczematous or psoriasiform eruption. Patients identified in the early stages and treated appropriately have a normal life expectancy.

Adolescent↗