bluuebunny/crossref_metadata_2025 huggingface dataset:
The Oncology Care Model and Adherence to Oral Cancer Drugs: A Difference-in-Differences Analysis
Authors: Keating Nancy L , Brooks Gabriel A , Landrum Mary Beth , Liu Pang-Hsiang , Wolf Robert , Riedel Lauren E , Kapadia Nirav S , Jhatakia Shalini , Tripp Amanda , Simon Carol , Hsu Van Doren , Kummet Colleen M , Hassol Andrea
Published: January 2022

Background

Adherence to oral cancer drugs is suboptimal. The Oncology Care Model (OCM) offers oncology practices financial incentives to improve the value of cancer care. We assessed the impact of OCM on adherence to oral cancer therapy for chronic myelogenous leukemia (CML), prostate cancer, and breast cancer.

Methods

Using 2014-2019 Medicare data, we studied chemotherapy episodes for Medicare fee-for-service beneficiaries prescribed tyrosine kinase inhibitors (TKIs) for CML, antiandrogens (ie, enzalutamide, abiraterone) for prostate cancer, or hormonal therapies for breast cancer in OCM-participating and propensity-matched comparison practices. We measured adherence as the proportion of days covered and used difference-in-difference (DID) models to detect changes in adherence over time, adjusting for patient, practice, and market-level characteristics.

Results

There was no overall impact of OCM on improved adherence to TKIs for CML (DID = −0.3%, 90% confidence interval [CI] = −1.2% to 0.6%), antiandrogens for prostate cancer (DID = 0.4%, 90% CI = −0.3% to 1.2%), or hormonal therapy for breast cancer (DID = 0.0%, 90% CI = −0.2% to 0.2%). Among episodes for Black beneficiaries in OCM practices, for whom adherence was lower than for White beneficiaries at baseline, we observed small improvements in adherence to high cost TKIs (DID = 3.0%, 90% CI = 0.2% to 5.8%) and antiandrogens (DID = 2.2%, 90% CI = 0.2% to 4.3%).

Conclusions

OCM did not impact adherence to oral cancer therapies for Medicare beneficiaries with CML, prostate cancer, or breast cancer overall but modestly improved adherence to high-cost TKIs and antiandrogens for Black beneficiaries, who had somewhat lower adherence than White beneficiaries at baseline. Patient navigation and financial counseling are potential mechanisms for improvement among Black beneficiaries.
Rare Case of Accelerated-Phase Chronic Myeloid Leukemia Diagnosed During Treatment for JAK2 V617F–Positive Primary Myelofibrosis
Authors: Ryu Jeayeon , Chu Daehyun , Park Bosung , Kim Miyoung , Cho Young-Uk , Hwang Sang-Hyun , Jang Seongsoo , Seo Eul-Ju , Lee Jung-Hee , Park Chan-Jeoung
Published: January 2022

Myeloproliferative neoplasms (MPNs) are clonal hematopoietic stem cell disorders characterized by the expansion of myeloid lineage cells. Chronic myeloid leukemia (CML) is characterized by a BCR-ABL1 fusion gene that causes constitutive tyrosine kinase activity. Polycythemia vera, essential thrombocythemia, and primary myelofibrosis (PMF) are frequently associated with driver mutations in genes such as JAK2, CALR, and MPL and are mutually exclusive of BCR-ABL1. Herein, we report the first case study of a patient diagnosed with accelerated-phase CML while undergoing treatment for initial JAK2 V617F–positive, BCR-ABL1-negative PMF. This finding emphasizes the importance of BCR-ABL1 testing in patients with an atypical BCR-ABL1-negative MPN disease course.
Pneumonia in a Patient With a Kidney Transplant
Authors: Tan Nicholas Y. , Abu Saleh Omar M. , Beam Elena
Published: January 2022

Rhodococcu equi is a zoonotic organism that is a common pathogen in immunocompromised populations, including transplant recipients and those with HIV. Among transplant recipients, R equi infection is associated with renal transplantation, corticosteroid use, diabetes mellitus, recent opportunistic infection, and male sex. Constitutional symptoms, including fever, weight loss, and fatigue, may accompany respiratory findings and may thereby lead to a misdiagnosis of pulmonary tuberculosis. No specific guidelines have been published to date for treating R equi infections. Generally, a 2- to 3-drug combination of antibiotics with intracellular activity is recommended, with selections guided by antimicrobial susceptibility testing.
Retinal Lesions and Eye Pain
Authors: Vijayvargiya Prakhar , Marcelin Jasmine R.
Published: January 2022

Ocular syphilis is uncommon, but syphilis accounts for 1% to 5% of all uveitis cases at tertiary referral centers in the United States. Syphilis can involve any ocular structure and is not limited to the uvea. An ophthalmologic examination can show conjunctivitis, episcleritis, scleritis, or interstitial scleritis. Establishing the diagnosis of syphilitic uveitis requires serologic tests, in addition to ophthalmologic evaluation. Many experts suggest treating ocular syphilis as neurosyphilis because the eyes are contiguous with the brain. Treatment with intravenous penicillin G for 10 to 14 days is considered first-line therapy.
A Lengthy Leg Problem
Authors: Marcelin Jasmine R. , Baddour Larry M.
Published: January 2022

Nonpurulent lower-extremity cellulitis is a common clinical diagnosis. Potential mechanisms of pathogenesis include easier propagation of bacterial infection through damaged lymph systems, dermal or subcutaneous fluid accumulation reducing local immunity, and further damage after infection. Patients who have had 3 or more episodes of cellulitis per year are ideal candidates for pharmacologic prophylaxis. Oral antibiotic prophylaxis is effective in preventing recurrent episodes of lower-extremity cellulitis. The recommended regimen is oral penicillin V.
A Filamentous Monster
Authors: Rafei Abdelghani El , DeSimone Daniel C. , Sugrue Alan M. , Thompson Rodney L.
Published: January 2022

Nocardia is a gram positive, weakly acid-fast, branching, aerobic bacilli. It most commonly affects the lungs because inhalation is the main route of infection. Symptoms are nonspecific and may include fever, night sweats, anorexia, weight loss, dyspnea, cough, hemoptysis, and pleuritic chest pain. Imaging findings include reticulonodular infiltrates, pleural effusion, and multiple or single nodules. Although Nocardia can spread to almost any organ, extrapulmonary disease most commonly involves the central nervous system. Patients usually present with headache, nausea, seizures, or altered mental status. Empiric antibiotic therapy includes trimethoprim-sulfamethoxazole with parenteral amikacin or imipenem for severe or life-threatening infections.
Constitutional Symptoms in a Patient After Cardiovascular Surgery
Authors: Kang Joana , DeSimone Daniel C.
Published: January 2022

Vascular graft infection (VGI) is an infrequent complication of aortic repair, with an estimated incidence rate of approximately 1.4%. However, mortality rates range from 25% to 75%, and clinician awareness of the syndrome and quick, reliable diagnostic methods are critical for improving clinical outcomes. Diagnosis is made by considering a combination of clinical symptoms, laboratory studies, microbial cultures, and imaging studies. Although a broad array of pathogens can cause VGI, the most common ones are gram-positive bacteria, including staphylococcal and streptococcal species
More Than One Problem
Authors: Challener Douglas W. , Marcelin Jasmine R.
Published: January 2022

Coinfection with HIV and hepatitis C virus (HCV) is common. Chronically coinfected persons have higher rates of cirrhosis, hepatic insufficiency, and hepatocellular carcinoma compared with HIV-negative individuals. Because of the high prevalence of HIV-HCV coinfection, all patients with HIV diagnoses should be screened for HCV infection. The primary therapeutic goal in patients with HIV-HCV coinfection is to eradicate the HCV and limit progression of liver disease and complications.
Fifty-Year-Old Man With Diabetes Mellitus and Sinusitis
Authors: Challener Douglas W. , Marcelin Jasmine R. , Whitaker Jennifer A.
Published: January 2022

Mucormycosis is relatively rare, with about 500 cases occurring in the United States each year. Angioinvasion often results in vessel thrombosis and tissue necrosis. The typical patient with mucormycosis has uncontrolled diabetes mellitus and often is in diabetic ketoacidosis. The most common clinical syndrome, especially for patients with diabetic ketoacidosis, is a rhinocerebral infection, which presents as facial and eye pain and facial numbness. Diagnosis relies on histopathologic identification of the characteristic angioinvasion and fungi with silver stain. Treatment requires surgical resection and antifungal pharmacologic therapy.
HIV Prevention
Authors: Ajmal Saira R. , Kasten Mary J.
Published: January 2022

Preexposure prophylaxis (PrEP) with daily tenofovir disoproxil fumarate/emtricitabine can reduce the risk of HIV infection by more than 90% for patients who are highly adherent. When considering PrEP, the first step is to determine the risk of HIV acquisition based on sexual risk behaviors during the past 6 months. Evaluation should include baseline HIV test, renal function estimate, and hepatitis B screen. Follow-up should be scheduled at 1 month and every 3 months thereafter. The need to continue PrEP should be reassessed on an annual basis, and PrEP should be continued for 1 month after the last high-risk exposure.
Two Problems
Authors: Jagtiani Anil C. , Temesgen Zelalem
Published: January 2022

Solid organ transplantation is increasingly common in the management of end-organ disease for patients with HIV. Patients with HIV and hepatitis C coinfection have a much higher rate of acute cellular rejection. To improve outcomes, donor and recipient selection and aggressive and timely management of posttransplant complications are important. Clinically significant drug interactions must be considered; the most important interactions affect patients receiving a protease inhibitor−based regimen. Although patients with coinfections consistently have poorer outcomes, patients with HIV infection do benefit from organ transplantation.
Bilateral Tinnitus
Authors: O’Connor Christina G.
Published: January 2022

As a drug class, aminoglycosides are highly effective against most gram-negative bacteria and Mycobacterium, but they are associated with a risk of clinically significant adverse effects, including ototoxicity. A sign of aminoglycoside cochlear toxicity is bilateral sensorineural hearing loss, beginning at high frequencies. Vestibular toxicity can present with any combination of vertigo, nausea, vomiting, nystagmus, and ataxia. Aminoglycoside- and macrolide-related ototoxicity is a treatment-related adverse effect that is serious, difficult to detect, and potentially irreversible. Patients must be vigilantly monitored for signs of drug-induced ototoxicity by health care professionals.
Does It Always Have to Be a Burning Sensation?
Authors: Shah Aditya S. , Wilson John W.
Published: January 2022

Gonorrhea is caused by Neisseria gonorrhoeae. For men, classic manifestations of gonorrhea include urethritis and oropharyngeal exudates with lymphadenopathy. In women, classic manifestations are cervicitis, infertility, ectopic pregnancy, chronic pelvic pain, and pelvic inflammatory disease, but women commonly may be asymptomatic. Nucleic acid amplification test is preferred for diagnosing genital and extragenital gonococcal infections. Ceftriaxone cures about 98%-99% of uncomplicated gonorrhea infections, but dual treatment with ceftriaxone and azithromycin is recommended. Retesting is recommended 3 months after treatment because patients with gonorrhea constitute a high-risk group with potential for reinfection.
It Must Be Something in the Water: A Hand Infection After Fishing
Authors: del Valle Kathryn T. , Tande Aaron J.
Published: January 2022

Mycobacterium marinum infections initially can mimic common skin and soft tissue infections. M marinum infections are associated with aquatic creatures and can also occur after injuries from inanimate objects, such as fishhooks. Patients often initially present with papules on the affected area, which can progress to nodular lymphangitis (also termed sporotrichoid spread). Diagnosis is established on the basis of clinical assessment (indolent course, papules that progress to nodular lymphangitis), histopathologic findings (granulomatous inflammation), and culture results. Treatment should typically include a 3- to 4-month course of at least 2 antimicrobial agents, and frequently used agents include clarithromycin, rifampin, and ethambutol.
Negative Pressure
Authors: Castillo Almeida Natalia E. , Kasten Mary J.
Published: January 2022

Tuberculosis transmission has been documented in health care settings where health care providers and patients encounter persons with unsuspected, infectious tuberculosis disease who have not been isolated in a timely manner or have not received appropriate treatment. Initial risk assessment for tuberculosis is crucial for determining administrative, environmental, and respiratory protective measures. Preventing the spread of aerosol-transmissible pathogens requires the use of airborne infection isolation rooms. In addition, respiratory protection with an N95 or higher-level respirator is recommended. Patients with suspected or confirmed respiratory tuberculosis disease should not share rooms.
Relationships with Children and Ensuring Their Voices in Decision-Making
Authors: Ron-Li Liaw Karen , Lois Becky , McBee Julia , Collins Erin
Published: January 2022

The evidence-base for engaging and integrating children’s voices and their families in healthcare decision-making is emerging and of critical need. In this chapter, the authors review best practices in engaging and communicating with children of all ages and their families, foundational ethical principles and decision-making constructs in pediatric care, and the role of the interdisciplinary healthcare team in supporting children and their families in finding their voices in decision-making throughout the illness continuum. The powerful, illuminating perspectives of Faith, a young adult living with cystic fibrosis, and Jen, the mother of a young boy living with a rare, progressive, metabolic condition, as well as Yong and Mateo’s clinical vignettes, interwoven throughout, highlight critical and common decision-making conflicts, challenges, and successes. Children, adolescents, young adults, families, and interdisciplinary healthcare teams must come together to develop the next generation of innovative, effective shared decision-making strategies, frameworks, skills, and tools.
Team Relationships
Authors: Brown Michelle R. , Chrastek Jody , Catrine Kris
Published: January 2022

Palliative care is a team endeavor. Through teamwork, palliative care uniquely tailors care plans to the needs of children impacted by complex illnesses and their families. The creation, growth, and sustainability of highly functional teams are not automatic. Team relationships are influenced by the inherent structure and composition of team members, and optimal team functioning requires attention to team dynamics. In this chapter, core team processes that support team functioning are defined (e.g., cognition, collaboration, coaching, communication) and their bidirectional impact on relational states (e.g., cohesion, trust, and psychological safety) are described. Practical strategies for supporting the health and well-being of the team and its individual members are presented. Common challenges of interdisciplinary teams are discussed.
Practical Aspects of Palliative Care Communication
Authors: Ragsdale Lindsay , October Tessie , Scanlon Caitlin
Published: January 2022

Pediatric palliative care clinicians coordinate communication among clinicians, balance providing information to families with the emotional support they need to feel comforted in those decisions, and adapt their mode of communication to “match” the developmental age and capacity of the child, the dynamics of the family, and their cultural and religious dimensions. This chapter explores the importance of communication and provides useful tools to tackle these conversations empathetically. It also delves into communication about goals of care, prognosis, and managing hope. Clinicians can utilize these practical frameworks to improve communication and establish therapeutic alliances with patients and their families.
Resolving Conflicts in Pediatric Palliative Care
Authors: Macauley Robert , Chrastek Jody , Brandtjen Amie , Cohen Harvey , Pope Thaddeus M.
Published: January 2022

Conflict is a common occurrence in personal and professional relationships, and the field of interdisciplinary pediatric palliative care (IPPC) is no exception. The intense nature of the work as well as the distinct perspectives of members of the IPPC team not only create the possibility of conflict, but also highlight the importance of addressing it in a constructive and collaborative fashion. This chapter explores three specific situations where conflict may arise: between families and the IPPC team, between patients and their parents, and within the team itself. Approaches include nonviolent communication, humble inquiry, and Radford’s recognition/responsibility/restoration framework. This chapter describes these approaches and reviews legal and ethical paradigms.
Psychological Symptoms
Authors: Samsel Chase , Perko Kathleen , Wiener Lori , Pao Maryland
Published: January 2022

Children who have a chronic or life-threatening illness and their families face myriad challenges. Worry and sadness are natural psychological reactions to the experience of living with constant uncertainty. This chapter discusses when clinicians should be concerned that these responses (whether secondary to the illness or treatment or due to other psychosocial factors) are becoming pathologic in and of themselves. Recognition and treatment of clinically relevant anxiety and depression are important as both may exacerbate preexisting physical conditions and affect symptom management, treatment adherence, and the ability of the child to cope with illness. The chapter addresses the use of developmentally appropriate language and specialized questions to assess mood, anxiety, and pain. Psychotherapeutic and pharmacologic interventions that are individualized, flexible, multidisciplinary, and inclusive of family are presented. Such treatments can reduce distress in both children and families while helping children to integrate the illness experience.
Prevention and Treatment of Pain in Children with Serious Illness
Authors: Friedrichsdorf Stefan J. , Heathcote Lauren , Sangster Michael , Eull Donna , Borucki Amber
Published: January 2022

The effective prevention and treatment of pain in pediatric patients requires multimodal analgesia. Safe and efficacious multimodal analgesia may include one, several, or all of the following approaches: pharmacology (e.g., simple analgesia and/or opioids and/or adjuvant analgesia), anesthetic interventions (e.g., neuroaxial analgesia, nerve blocks), rehabilitation (e.g., physical therapy, occupational therapy, sleep hygiene), psychotherapy (e.g., cognitive behavioral therapy), social work/family support, addressing spirituality (e.g., chaplaincy), and age-appropriate integrative (nonpharmacological) therapies, such as positioning, breathing techniques, self-hypnosis, and distraction. It is inappropriate to perform elective procedures (such as wound dressing changes, blood draws, intravenous cannulations, injections, lumbar punctures) in children without evidence-based treatments to avoid or minimize pain. Failure to implement evidence-based pediatric pain management in medical facilities is now considered inadmissible and poor standard of care.
Gastrointestinal Symptoms
Authors: Madden Kevin , Mahon Margaret M.
Published: January 2022

Gastrointestinal symptoms include a broad spectrum of clinical conditions, ranging from mildly irritating (aphthous ulcers) to functionally disabling (constipation and mucositis). Symptoms can originate anywhere along the gastrointestinal tract from the mouth to the rectum. Children may suffer greatly, as many of the medications used to treat their symptoms have only limited efficacy. Furthermore, suffering takes many forms, not just physical, and the intrinsic interdisciplinary nature of pediatric palliative care lends itself to attending to the psychological and sometimes existential and spiritual suffering that can accompany disabling gastrointestinal symptoms. This chapter will provide a comprehensive, evidence-based, and interdisciplinary approach to gastrointestinal symptoms that afflict seriously ill children. The assessment and treatment of these symptoms is always undertaken within the context of the child’s and family’s goals of care.
Substance Abuse and Sexual Offending
Authors: Briken Peer , Yamak Yasemin , Berner Wolfgang
Published: January 2022

This chapter studies the effects of acute and chronic substance use on sexual offending. A significant proportion of sexual offenders suffer from substance use disorders. Most of the studies that have a non–sexual violent offender control group showed that more sex offenders than non–sexual violent offenders abused alcohol. For drug abuse, mixed results were found. Substance use seems to be more prevalent in rapists than in child molesters and more frequent in nonparaphilic than in paraphilic sexual offenders. Ultimately, the nature of the relationship between substance use and sexual offending is complex and confounded with several factors. Acute and long-term effects of alcohol probably play a contributive but not a primary causal role in sexual offending. Substance abuse also plays a significant role in risk assessment and relapse prevention and should be considered in treatment options more specifically.
Professionals Who Are Accused of Sexual Boundary Violations
Authors: Levine Stephen B. , Risen Candace B.
Published: January 2022

This chapter highlights professionals who are accused of sexual boundary violations. A person can earn the label “sex offender” by engaging in a broad swath of socially unacceptable behaviors. When that person is a professional—a physician, mental health professional, lawyer, business executive, teacher, or clergy person—these behaviors are looked at with particular shock, disbelief, and disappointment. When professionals’ sex offenses are brought to the attention of officials, serious consequences ensue. Within their profession, the offenders may be punished by loss of license and job, public notoriety, and ostracization. The professional may or may not be given an opportunity for rehabilitation. If the professional’s victim presses criminal charges, incarceration becomes a possibility. If the victim presses civil charges, the professional may be compelled to pay a monetary damage award. Ultimately, recognition of professional sexual misconduct is always a life-changing matter for professionals and their families.
Child Pornography and the Internet
Authors: Bradford John M. , Malesky L. Alvin , Ennis Liam , Gress Carmen L. Z. , Brodsky Daniel J. , Alqahtani Abdullah H. , Safdar Hira
Published: January 2022

This chapter discusses the distribution of child pornography on the Internet. Before child pornography on the Internet was a concern, pornography itself had been a concern in the United States for some time. The actual impact of pornography on sexual behavior is debatable and has been going on for a lengthy time. The main question is the possible association between pornography and sexual violence and the development of paraphilia or deviant sexual interest. Although child pornography on the Internet has grown substantially, research into child pornography offenders and other online offenders is still developing. The chapter provides an extensive review of the legal and legislative issues about child pornography and the Internet in the United States, Canada, and Europe. It also looks at the assessment and treatment of individuals convicted for possession of child pornography.
Sex Offender Registries and Public Notification in the United States and Canada
Authors: Murphy Lisa , Smith Justin , Gottfried Emily D. , Brodsky Daniel J.
Published: January 2022

This chapter explores sex offender registries (SORs) and public notification (PN) in the United States and Canada. The process of maintaining a balance between protection of the public and an individual’s right to privacy becomes increasingly difficult when the offender is considered to be dangerous or “morally tainted.” Mechanisms, such as SORs and PN, have been implemented as a political response to highly publicized cases of sexual victimization. Supporters of these interventions claim that such supervisory methods will deter sexual offenders from reoffending while providing information on which the public may act to protect its children and others who may be vulnerable and at the same time giving an investigative tool with which police can more efficiently “solve” sexual offenses. In contrast, opponents of SORs and community notification stress concerns about a discriminatory aspect to the regulations that specifically targets sex offenders when there is an absence of evidence that sex offenders, as a general category, are at a greater risk to reoffend than other categories of offenders. Additionally, critics have raised concerns about the ethics and legality of infringing on the rights of a segment of the population who have already served their sentence and paid the penalty for their misconduct.
Ethical Issues in the Treatment of Sex Offenders
Authors: Bryant Paul , Buchanan Alec , Zonana Howard
Published: January 2022

Sex offenders as a group illicit a variety of strong affective responses, some of which have led to the creation of legislation and other efforts to distinguish this group from typical offenders. With the creation of sexually violent predator (SVP) commitment statues, psychiatrists have been increasingly asked to opine on future dangerousness of individuals who have committed crimes of a sexual nature. Since being tasked with a gatekeeping role, increased focus has been placed on the ethical issues involved in these types of evaluations and treatment. This chapter highlights a number of these ethical issues that have arisen and discusses some of the challenges that psychiatrists continue to encounter.
Pharyngotonsillitis
Authors: Brook Itzhak
Published: January 2022

This chapter evaluates pharyngotonsillitis (PT), an inflammation of the pharynx and tonsils characterized by the presence of increased pharyngeal and tonsillar redness and finding of an exudate, ulceration, or a membrane covering the tonsils. Because the pharynx is served by lymphoid tissues of the Waldeyer ring, an infection can spread to include various parts of the ring such as the nasopharynx, uvula, soft palate, tonsils, adenoids, and the cervical lymph glands. Based on the extent of the infection, it can be described as pharyngitis, tonsillitis, tonsillopharyngitis, or nasopharyngitis. The duration of any of these illnesses can be acute, subacute, chronic, or recurrent. The diagnosis of PT generally requires the consideration of group A β‎-hemolytic streptococci (GABHS) infection. However, other bacteria, viruses, and other infections and noninfectious causes should be considered. Determining if GABHS is the cause of the PT is very important because early antimicrobial therapy shortens the illness, prevents suppurative and nonsuppurative complications, reduces transmission of the pathogen, and prevents misuse of antimicrobials.
Sinusitis
Authors: Kominsky Rachel , Otteson Todd D.
Published: January 2022

This chapter assesses sinusitis. Sinusitis is commonly diagnosed yet criteria for its diagnosis vary and a standard treatment protocol is nonexistent. The majority of patients with acute sinusitis improved without any therapy or with over-the-counter remedies. The temptation to treat an upper respiratory infection with antimicrobials should be avoided, especially in light of increasing bacterial resistance profiles. Ultimately, an understanding of the anatomy, pathophysiology with predisposing factors, and common microbiology helps drive therapeutic decision-making. Any anatomic anomaly, environmental exposure, or disease process, acute or chronic, which prevents the normal mucociliary clearance either by functional obstruction or by thickening of nasal secretions may result in pathogen overgrowth and sinusitis. Typically, these processes or exposures affect not only the paranasal sinus mucosa but also the intranasal mucosa, prompting use of the term “rhinosinusitis.”
Conjunctivitis
Authors: Tu Elmer Y.
Published: January 2022

This chapter studies conjunctivitis. Conjunctivitis is a nonspecific term used to describe inflammation of the ocular surface and conjunctiva from either infectious or noninfectious causes. Infectious conjunctivitis is most commonly due to exogenous inoculation of the mucous membranes lining the surface of the eye and eyelid, resulting in an activation of a local inflammatory response. The vast majority of cases are acute, but it may also present as chronic or recurrent. Although most cases of acute infectious conjunctivitis are self-limited and result in few long-term sequelae, appropriate evaluation and therapy are indicated with specific presentations. When indicated, diagnostic workup consists of conjunctival swabs for Gram and other histologic stains as well as culture.
Iritis
Authors: Lorch Alice , Lobo Ann-Marie
Published: January 2022

This chapter discusses anterior uveitis, or iritis. Anterior uveitis is most commonly idiopathic but can be diagnosed as either inflammatory or infectious in etiology. Anterior uveitis can also be due to reactive inflammation from mild trauma or corneal disease. Neoplasias such as retinoblastoma or lymphoma can present as anterior uveitis, with tumor cells in the anterior chamber. Finally, iritis can be drug-related: cidofovir, diethylcarbamazepine, pamidronic acid, interleukin-3 and interleukin-6, oral contraceptives, quinidine, rifabutin, streptokinase, and sulfonamides are among medications that have been implicated in the past. Infectious causes are generally either bacterial or viral but can be related to protozoa or worms. Many of these diseases present with anterior segment findings but also have posterior involvement on further examination. Emerging diagnostic techniques might enable more rapid diagnosis of known infectious causes or the discovery of novel infectious etiologies of uveitis in the future.
Toxic shock syndrome and Kawasaki disease
Authors: Assimacopoulos Evangelia M. , Assimacopoulos Aristides P. , Salgado-Pabón Wilmara , Schlievert Patrick M.
Published: January 2022

This chapter assesses toxic shock syndrome (TSS) and Kawasaki disease. Staphylococcal and streptococcal TSS are acute-onset multiorgan illnesses. Staphylococcal TSS is caused by Staphylococcus aureus strains that produce pyrogenic toxin superantigens (SAgs), while streptococcal TSS is caused primarily by Streptococcus pyogenes (group A) strains but occasionally by groups B, C, and G strains. Several subsets of staphylococcal TSS exist, with two major categories being menstrual and nonmenstrual. Major risk factors for development of streptococcal TSS include chickenpox in children, penetrating and nonpenetrating wounds, use of nonsteroidal anti-inflammatory agents, and pregnancy. Meanwhile, Kawasaki syndrome (KS) is an acute multisystem vasculitis that occurs primarily in children younger than 4 years of age. KS shares many features with streptococcal scarlet fever and TSS except that hypotension is absent. This chapter reviews the treatment of both TSS and KS.
Viral exanthems
Authors: Bromberg Romina , Thompson Michael , Chirch Lisa M. , Grant-Kels Jane M.
Published: January 2022

This chapter addresses viral exanthems. During the early 1900s, six common childhood exanthematous infections were identified and defined by the use of numbers 1 through 6. The microbiologic agents of these infections were unknown. Over the next century, the etiologies of these exanthems were defined, and four of the six were demonstrated to be caused by viruses. The first exanthem was caused by the measles virus, the third by the rubella virus, the second and fourth by bacterial toxins, the fifth by parvovirus, and the sixth by human herpesvirus 6 (HHV-6). The chapter explores the epidemiology, clinical manifestations, and diagnosis of the classic childhood viral exanthems: measles (rubeola), German measles (rubella), and exanthem subitum (roseola), and parvovirus B19. It also considers viral exanthems seen more often in adults, such as Epstein–Barr virus (EBV) and HIV, as well as emerging viruses with viral exanthems.
Acute pericarditis
Authors: Martinello Richard A. , Cappello Michael
Published: January 2022

This chapter investigates acute pericarditis. The pericardium serves to protect the heart from physiologic changes in intracardiac pressure related to respiration and postural change, and it may also augment the mechanical function of the cardiac chambers. The pericardium is composed of a visceral layer that directly adheres to the epicardium and an outer parietal layer. These two layers are separated by 10 to 35 mL of serous fluid. Pericarditis refers to the inflammation of these tissues. It may be acute, recurrent, or chronic, and can be due to a wide array of etiologies. Both infectious and noninfectious processes have been identified as causes of pericarditis. Most cases are caused by viruses, are self-limited, and the specific pathogen is often unidentified. Urgent drainage of pericardial fluid should be considered in any patient with a possible diagnosis of purulent pericarditis or if hemodynamic compromise is identified. The outcome in these patients is generally poor without drainage, even when appropriate antibiotics are administered.
Epididymo-orchitis
Authors: Fallis Rebecca , Mueller Daniel
Published: January 2022

This chapter examines epididymo-orchitis. Infectious and inflammatory processes involving the contents of the scrotum can range from those that require acute surgical intervention to findings that are benign in nature. Epididymitis and orchitis are conditions that refer to inflammation of the epididymis and testicles, respectively. Since they are relatively uncommon, clinicians who are not urologists may be unfamiliar with these problems. The exact pathogenesis of epididymo-orchitis has not been clearly elucidated, but it most often occurs as a result of bacterial infection. Risk factors for epididymo-orchitis include a history of urinary tract infections, high-risk sexual activity, genitourinary anatomic abnormalities, urinary tract surgery or instrumentation, strenuous activity, cycling, and prolonged periods of sitting. Treatment includes antimicrobial therapy in combination with analgesics, bed rest, and scrotal elevation.
Genital ulcer adenopathy syndrome
Authors: Ronald Allan
Published: January 2022

This chapter investigates genital ulcer adenopathy syndrome. The control and prevention of genital ulcer disease (GUD) is an important public health priority. Ulcerative lesions may produce local genital pain, some pathogens are transmitted from mothers to their infants, and genital lesions increase the risk of human immunodeficiency virus (HIV) acquisition and transmission following sexual intercourse. The most commonly transmitted GUD diagnosis and etiologies are syphilis, herpes simplex, chancroid, lymphogranuloma venereum, and granuloma inguinale or donovanosis. Trauma, erosive balanitis, and fixed drug eruptions are common nontransmissible causes of GUD. Treatment traditionally has been initiated only once a laboratory diagnosis has been established; however, the delay inherent in obtaining laboratory results makes it necessary to initiate empiric syndromic therapy at the time of the initial visit. The selected syndromic therapy should be effective for syphilis.
Polyarthritis
Authors: Dao Kathryn H. , Cush John J.
Published: January 2022

This chapter highlights polyarthritis. The co-occurrence of fever and arthritis educes a broad set of diagnostic considerations, especially infection. Yet, most forms of infectious arthritis typically involve one to three joints (monarthritis to oligoarthritis). The presence of a greater number of joints involved (polyarthritis) with fever evokes a more unusual and challenging range of diagnostic possibilities. Knowledge of prevalent forms of polyarthritis capable of fever can facilitate an early, accurate diagnosis and appropriate therapy. Polyarthritis is defined as inflammatory pain with swelling affecting four or more joints. The distribution, chronology of joint inflammation, and host factors help refine the diagnostic possibilities. The presence of fever is unique as most polyarticular conditions do not manifest substantial or sustained fever. Nevertheless, fever or pyrexia is further evidence of an inflammatory, infectious, or autoimmune disorder.
Infections associated with urinary catheters
Authors: Nicolle Lindsay E.
Published: January 2022

This chapter discusses urinary tract infections (UTIs) as a common and clinically important outcome of the use of urinary catheters. UTI with a catheter in place is usually asymptomatic and referred to as catheter-associated asymptomatic bacteriuria (CA-ASB), while the symptomatic infection is referred to as catheter-acquired urinary infection (CA-UTI). The chapter also describes different types of catheter that are indicated for different populations and have different risks for the occurrence of infection. Also discussed is how the acquisition of urinary infection with catheter use is virtually always through ascending infection, and includes a discussion of indwelling urethral catheters, in which bacteria usually ascend into the bladder on the biofilm and form on the external and internal surfaces of the catheter tubing.
Infected implants
Authors: Dickinson Gordon
Published: January 2022

This chapter addresses infections associated with artificial devices of a specialized nature. It points out that the rate of infection with artificial devices is generally low, but, collectively, there are millions of these devices implanted yearly. It also discusses optimal treatment that requires the participation of surgical specialists experienced in the management of difficult infections, especially for pseudophakic endophthalmitis, in which the mainstay of therapy is intraocular injections. The chapter explains how pseudophakic endophthalmitis is thought to occur as a consequence of contamination with flora of conjunctival sac or lid margin at the time of surgery. The chapter discusses the differential diagnosis of endophthalmitis following cataract extraction that includes sterile inflammation and bacterial and fungal infection.
Recreational water exposure
Authors: Wilson Mary E. , Boggild Andrea K.
Published: January 2022

This chapter describes the types of pathogens, geographic distribution, sources and routes of transmission, clinical presentations, and management of water-associated infections. It analyzes the pathogens in water that infect susceptible humans through skin and mucous membranes via inhalation of aerosols, aspiration, and ingestion. Clinical manifestations of water-associated infections range from superficial skin lesions to fatal, systemic infections. The chapter analyzes the survival of many water-associated pathogens that is influenced by climate, season, other environmental conditions, and the level of sanitation. The risk of infection by waterborne pathogens depends on the duration and type of exposure, concentration density of organisms in water, and host immunity.
Cat scratch disease and other Bartonella infections
Authors: Schwartzman William A.
Published: January 2022

This chapter investigates the cat scratch disease (CSD), which was first described in 1950 by Rene Debré as “La Maladie de Griff de Chat.” It points out how CSD cause remained a mystery until the late twentieth century, when amplification and sequencing of 16S rRNA genes was introduced as a method of identifying organisms that had not been successfully cultured. It also mentions David Relman, who identified the agent of CSD as a small gram-negative coccobacillus that is closely related to the agents causing trench fever, brucellosis, and crown gall disease in plants. The chapter talks about Rochalimaea henselae, Bartonella bacilliformis, and Bartonella rochalimae that share the ability to invade vascular endothelial cells, bone marrow erythroblasts, and mature erythrocytes. It highlights the manifestations of CSD and the expanding roster of Bartonella species that populate mammalian reservoirs.
Enterobacteriaceae
Authors: Stratton Charles
Published: January 2022

This chapter discusses Enterobacteriaceae, which consist of a large, heterogeneous group of aerobic gram-negative bacilli whose natural habitat is the gastrointestinal tract of animals and humans. It highlights three members of the Enterobacteriaceae that are considered pathogens whenever they are isolated from humans: namely Salmonella, Shigella, and Yersinia. It describes the unique clinical features of the pathogens, which cause significant community- and hospital-acquired infections. Escherichia coli is the most frequently isolated pathogen, and it has been noted to have a unique pathogenesis in terms of its ability to cause urinary tract infections. This pathogenesis involves adherent fimbriae and production of glycocalyx, which allow E. coli to adhere to normal bladder epithelium and invade bladder cells, where it is able to survive in biofilm colonies.
Legionellosis
Authors: Marrie Thomas J. , McNeil Shelly , Robbins Mark
Published: January 2022

This chapter describes the family Legionellaceae, which includes the genera Legionella, Berkiella, Occultobacter, and Nucleophilum. Of these, members of the genus Legionella are predominant human pathogens. The chapter also analyzes the genus name, which was derived from the fact that the first recognized outbreak of infection due to these microorganisms affected members of the American Legion in 1976. This chapter also discusses pneumophila, which was the species designation for the first isolate given its predilection for pulmonary infection. L. pneumophila serogroup is a predominant pathogen in the family Legionellaceae, which accounts for 80% to 90% of cases of Legionnaires' disease (LD) worldwide.
Leprosy
Authors: Chamseddin Bahir H. , Vandergriff Travis
Published: January 2022

This chapter focuses on leprosy, an ancient disease that has been the cause of great morbidity and mortality for centuries. A 4,000-year-old skeleton with evidence of lepromatous leprosy was found in India, and DNA from the causative agent, Mycobacterium leprae, has been isolated from a Byzantine skeleton from Israel dated to 300–600 ad. More recent evidence has demonstrated cases of leprosy in England dating to approximately 400–500 ad. M. leprae is an unculturable, obligate intracellular, gram-positive, acid-fast bacillus. It multiplies very slowly in the host and grows best at 33°C to 91°F, which accounts for its predilection for cooler parts of the body such as the skin, testis, anterior segment of the eye, mucous membranes of nasal passages, ear lobes, and extremities.
Pasteurella multocida
Authors: Webster Andrew S. , Rebolledo Paulina A. , Talati Naasha J. , Stephens David S.
Published: January 2022

This chapter focuses on Pasteurella multocida, which translates to “killer of many species” and is a nonmotile, gram-negative, facultative coccobacillus best known for its association with soft-tissue infections after animal bites. It examines P. multocida as an opportunistic pathogen that is capable of causing invasive and life-threatening infections. It also mentions Louis Pasteur, who first isolated P. multocida as the causative agent of fowl cholera in 1880. The chapter highlights how P. multocida commonly colonizes the upper respiratory tract of cats at 70 to 90 percent and dogs at 50 to 66 percent, as well as how it has been isolated from numerous other domestic pets and wild animals. It analyzes the human infection of P. multocida that is usually associated with animal exposure.
Leptospirosis
Authors: DiMarco Daniela E.
Published: January 2022

Leptospirosis is a zoonotic disease caused by spirochetes from the genus Leptospira, at least 10 species (and over 200 serovars) of which are considered pathogenic in humans. Leptospirosis typically occurs after exposure to a contaminated environmental source or an infected animal; Leptospira penetrate intact mucous membranes and abraded skin and disseminate widely via the bloodstream, thus resulting in a myriad of systemic clinical manifestations. Leptospirosis is a biphasic illness in which many patients experience only mild disease. Patients with severe leptospirosis have progressive multi-organ system involvement which manifests as hepatic injury with jaundice, vasculitis, renal failure, hemorrhage, and neurologic complications among others.
Candidiasis
Authors: Carpenter Christopher F. , Gilpin Nicholas
Published: January 2022

This chapter examines Candida spp., small, unicellular yeasts that are found in a number of environments, including soil, hospital surroundings, food, and other inanimate objects. Candida may live as commensal organisms, colonizing the skin, gastrointestinal tract, and vagina; they become opportunistic pathogens when the host has compromised immunologic or mechanical defenses. Candida are common causes of disease ranging from superficial cutaneous and mucocutaneous infections to invasive infections such as candidemia and disseminated candidiasis. The chapter reviews more than 150 species of Candida, with C. albicans being the most frequently implicated in human disease processes. It traces the noticeable increase in disease due to non-albicans species over the past two decades.
Intestinal roundworms
Authors: Suh Kathryn N. , McCarthy Anne E. , Keystone Jay S.
Published: January 2022

This chapter covers nematodes or roundworms, which are the most common parasites infecting humans worldwide. Ascaris lumbricoides, Trichuris trichiura, and hookworms are collectively referred to as geohelminths and infect approximately 1.5 billion people. Also discussed are other important nematodes of humans, such as Strongyloides stercoralis, that completes its entire life cycle within the human host, and Enterobius vermicularis, that is transmitted from person to person. The prevalence and intensity of helminthic infections that are primarily related to poverty, educational and agricultural standards, population density, and sanitary or public health conditions. The majority of geohelminthic infections is asymptomatic and associated with low worm burdens.
Toxoplasma
Authors: Go Roderick , Luft Benjamin J.
Published: January 2022

This chapter analyzes toxoplasmosis, which is caused by the obligate intracellular parasite Toxoplasma gondii and is responsible for significant morbidity and mortality throughout the world. T. gondii has long been recognized as a serious congenital disease, but it was only with the advent of AIDS and the increased use of immunosuppressive therapy that toxoplasmosis has reached epidemic proportions. Humans are incidental hosts in the life cycle of T. gondii. The chapter describes acute infection by toxoplasmosis that occurs via ingestion of meats or water contaminated with tissue cysts or tachyzoites or through handling cats. Toxoplasmosis can be particularly devastating in individuals with immunosuppressive disease or who are undergoing immunosuppressive therapies. The chapter details the testing, evaluation, and treatment of patients presenting with toxoplasmosis.
Extraintestinal amebic infection
Authors: Andrade Rosa
Published: January 2022

This chapter reviews the clinical presentation, diagnosis, and treatment of the extraintestinal manifestations of the invasive amebic disease. They are less common than amebic colitis, where amebic liver abscesses (ALA) are the most common extraintestinal manifestation. ALA arises from the hematogenous dissemination of intestinal amebic trophozoites through the portal circulation, which may present months to years after an episode of amebic colitis. Other extra-abdominal manifestations, such as thoracic and brain amebiasis, commonly result from the direct dissemination of trophozoites from an ALA. Extraintestinal amebiasis is a clinical diagnosis that is supported by relevant epidemiologic risks and serologic, antigen-based, or molecular testing. Untreated extraintestinal amebiasis is fatal, although outcomes have improved since the introduction of nitroimidazoles.