Archive for June 30, 2011

A 30-Year-Old Man with Diarrhea after a Trip to the Dominican Republic

N Engl J of Med June 30, 2011

Case 20-2011 —

Edward T. Ryan, M.D., Lawrence C. Madoff, M.D., and Mary Jane Ferraro, Ph.D., M.P.H.

Presentation of Case

Dr. Stephen M. Carpenter (Infectious Diseases): A 30-year-old man was seen in the emergency room at this hospital in January 2011 because of diarrhea.

The patient had been well 5 days earlier, when he traveled to a resort in theDominican Republicfor a social event. On his fourth day in theDominican Republic, 2 days before this presentation, he flew back to theUnited States, arriving at1 a.m. the day before presentation. Four hours later, he was awakened by the urge to defecate, and he had watery diarrhea. He reported having approximately 12 watery bowel movements during the next 35 hours. He consumed chicken broth and took bismuth solution, without improvement. The night before this presentation, relatives informed him that 13 other attendees of the event had diarrhea. On the day of this presentation, he noted that stool frequency and volume were decreasing. He took a combination of ampicillin and sulbactam (375 mg) orally, which he had obtained inSouth America. He called the Massachusetts Department of Public Health and was referred to the emergency department at this hospital….



June 30, 2011 at 6:35 pm Leave a comment

Antitrypanosomal Therapy for Chronic Chagas’ Disease

New Engl J of Med June 30, 2011

Clinical Therapeutics

Caryn Bern, M.D., M.P.H.

A 42-year-old woman presents to her physician with a letter stating that after she made a recent blood donation, a serologic test of her donated blood was positive for Chagas’ disease. The patient was born inEl Salvadorand moved to theUnited Stateswhen she was 18 years of age. Her three children are 8, 13, and 16 years of age. Her medical history is remarkable only for a cholecystectomy 2 years earlier; she reports no cardiac or gastrointestinal symptoms. Her physical examination is unremarkable. Electrocardiography (ECG) shows sinus rhythm at a rate of 72 beats per minute and a complete right bundle-branch block. An echocardiogram shows mild left ventricular segmental wall-motion abnormalities, but a normal ejection fraction and left ventricular diameter. The patient is referred to an infectious-disease consultant, who recommends antitrypanosomal therapy….



June 30, 2011 at 6:33 pm Leave a comment

Lessons from Sickle Cell Disease in the Treatment and Control of Malaria

N Engl J of Med June 30, 2011

Clinical Implications of Basic Research

Philip J. Rosenthal, M.D.

Malaria, especially infection with Plasmodium falciparum, has exerted strong selective pressure on the human genome. In a well-characterized, balanced polymorphism, persons who are homozygous for the sickle hemoglobin mutation (in which valine replaces glutamic acid at position6 inthe β-globin chain of hemoglobin A, producing hemoglobin S) have serious hematologic illness, but those who are heterozygous for the mutation (and have hemoglobin AS) are asymptomatic and relatively protected against severe falciparum malaria as compared with those who have normal hemoglobin.1 A recent study by Ferreira and colleagues2 offers an improved understanding of how hemoglobin AS protects against malaria, thereby providing insight into potential means of treating and controlling this disease…




June 30, 2011 at 6:32 pm Leave a comment


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