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Clinical Problem-Solving
Skin Deep
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 56-year-old woman with symptoms…
- April 5, 2012
- Safdar N., Abad C.L., Kaul D.R., Saint S.
- N Engl J Med 2012; 366:1336-1340
- CME
A 56-year-old woman with symptoms of carpal tunnel syndrome for 6 months presented to a referral clinic with nodular lesions on her right forearm and hand and an increase in numbness and tingling in her right hand.
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Case Records of the Massachusetts General Hospital
Case 5-2012 — A 39-Year-Old Man with a Recent Diagnosis of HIV Infection and Acute Psychosis
Presentation of Case. Dr. Carlos Fernandez-Robles: A 39-year-old man with a recent diagnosis of human immunodeficiency virus (HIV) infection was transferred to this hospital from another hospital because of fever, sweats, and psychosis. The patient had been well until 4 months before admission,…
- February 16, 2012
- Freudenreich O., Basgoz N., Fernandez-Robles C., Larvie M., Misdraji J.
- N Engl J Med 2012; 366:648-657
- CME
A 39-year-old man with a recent diagnosis of HIV infection was admitted to this hospital with fever and bizarre, nihilistic delusions, including statements that he had died. A diagnostic procedure was performed.
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Editorial
Practical Preventive Therapy for Tuberculosis?
Every new episode of tuberculosis — there were 9 million in 2010 — follows a period of asymptomatic infection lasting from weeks to decades. These subclinical infections, which are detectable with a tuberculin skin test or interferon-γ release assay, offer a target for prophylactic treatment…
- December 8, 2011
- Dye C.
- N Engl J Med 2011; 365:2230-2231
Every new episode of tuberculosis — there were 9 million in 2010¹ — follows a period of asymptomatic infection lasting from weeks to decades. These subclinical infections, which are detectable with a tuberculin skin test or interferon-γ release assay, ...
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Original Article
Three Months of Rifapentine and Isoniazid for Latent Tuberculosis Infection
Tuberculosis results in nearly 2 million deaths annually worldwide. More than 2 billion persons are infected with Mycobacterium tuberculosis, and from this reservoir active tuberculosis will develop in millions of persons in coming decades. Treatment of latent M. tuberculosis infection among the…
- December 8, 2011
- Sterling T.R., Villarino M.E., Borisov A.S., et al.
- N Engl J Med 2011; 365:2155-2166
- CME
Treatment of latent TB is an important public-health strategy, but 9 months of daily isoniazid (270 doses) poses challenges for compliance. In this study, 3 months of weekly isoniazid plus rifapentine (12 doses) was found to be noninferior to 9 months of isoniazid alone.
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Correspondence
Acute Leprosy in Ohio during Treatment of HIV–AIDS
To the Editor: Borderline tuberculoid leprosy with type 1 reaction can have an acute presentation in persons infected with HIV. This reaction may develop as part of the immune reconstitution inflammatory syndrome after the initiation of effective antiretroviral therapy.– Despite advances in…
- October 20, 2011
- N Engl J Med 2011; 365:1549-1551
- Free Full Text
A case of probable zoonotic leprosy acquired in the United States is described in a patient infected with HIV. The immune reconstitution inflammatory syndrome developed when antiretroviral therapy was initiated.
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Original Article
Timing of Antiretroviral Therapy for HIV-1 Infection and Tuberculosis
The treatment of patients with tuberculosis and newly identified infection with human immunodeficiency virus type 1 (HIV-1) is one of the most challenging aspects of HIV medicine. Antiretroviral therapy (ART) must be started during treatment for tuberculosis,, yet starting ART very early in the…
- October 20, 2011
- Havlir D.V., Kendall M.A., Ive P., et al.
- N Engl J Med 2011; 365:1482-1491
- Free Full Text
In this international study involving 809 patients with HIV and TB coinfection, earlier therapy for both infections, versus waiting 8 to 12 weeks to initiate antiretrovirals after anti-TB therapy, was beneficial in patients with a low CD4+ T-cell count (<50 per cubic millimeter).
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Editorial
When to Start Antiretroviral Therapy in HIV-Associated Tuberculosis
Tuberculosis is the most common infectious cause of death in persons infected with the human immunodeficiency virus (HIV). However, many of the basic questions have remained unanswered, such as when to start antiretroviral therapy (ART) in HIV-infected patients who present with tuberculosis. The…
- October 20, 2011
- Török M.E. and Farrar J.J.
- N Engl J Med 2011; 365:1538-1540
- Free Full Text
Tuberculosis is the most common infectious cause of death in persons infected with the human immunodeficiency virus (HIV). However, many of the basic questions have remained unanswered, such as when to start antiretroviral therapy (ART) in HIV-infected ...
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Original Article
Earlier versus Later Start of Antiretroviral Therapy in HIV-Infected Adults with Tuberculosis
Tuberculosis is a major cause of death in persons infected with the human immunodeficiency virus (HIV), especially in resource-limited settings. Despite effective tuberculosis therapy, mortality is particularly high among patients with severe immunosuppression. Although mortality among HIV-infected…
- October 20, 2011
- Blanc F.-X., Sok T., Laureillard D., et al.
- N Engl J Med 2011; 365:1471-1481
- Free Full Text
- CME
When to initiate antiretroviral therapy in patients with newly diagnosed HIV infection and TB has been debated. In this study from Cambodia, giving antiretrovirals 2 weeks after the start of TB therapy was superior to therapy begun at 8 weeks, with a decrease in mortality.
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Original Article
Integration of Antiretroviral Therapy with Tuberculosis Treatment
In patients who have infection with the human immunodeficiency virus (HIV) and tuberculosis, antiretroviral therapy (ART) may be initiated at the same time as or soon after the initiation of tuberculosis treatment. However, antiretroviral agents are often deferred until after the intensive phase of…
- October 20, 2011
- Abdool Karim S.S., Naidoo K., Grobler A., et al.
- N Engl J Med 2011; 365:1492-1501
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In this study from South Africa, earlier initiation of antiretroviral therapy in patients with newly diagnosed HIV infection and TB was associated with higher rates of the immune reconstitution inflammatory syndrome and adverse events but increased AIDS-free survival.
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Images in Clinical Medicine
Multiple Intracranial Tuberculomas
Figure 1.
- October 20, 2011
- Akhaddar A. and Boucetta M.
- N Engl J Med 2011; 365:1527
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A previously healthy 17-year-old girl presented with a 2-month history of intermittent fevers, progressive headaches, generalized weakness, and weight loss. Physical examination was notable for mild stiffness in the neck and cervical lymphadenopathy.
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Images in Clinical Medicine
Renal Tuberculosis
Figure 1.
- September 22, 2011
- Teo E.Y. and Wee T.C.
- N Engl J Med 2011; 365:e26
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A 70-year-old man was admitted with a right cerebellar ischemic stroke. Routine plain anteroposterior radiography of the chest unexpectedly revealed a cavitary lesion in the upper left lung and a large calcification in the left abdomen.
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Case Records of the Massachusetts General Hospital
Case 27-2011 — A 17-Year-Old Boy with Abdominal Pain and Weight Loss
Presentation of Case. Dr. Nina Mayer (Medicine–Pediatrics): A 17-year-old boy was seen in the pediatric gastroenterology clinic of this hospital because of abdominal pain and weight loss. The patient had been well until approximately 6 weeks earlier, when intermittent crampy abdominal pain…
- September 8, 2011
- Winter H.S., Gervais D.A., Branda J.A.
- N Engl J Med 2011; 365:940-950
- CME
A 17-year-old boy was admitted to the hospital because of a 6-week history of abdominal pain, constipation, and weight loss. Gastrointestinal radiographs showed narrowing of the cecum. CT scans showed peritoneal implants and a mediastinal mass.
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Original Article
New Regimens to Prevent Tuberculosis in Adults with HIV Infection
Tuberculosis is the most common opportunistic infection and the leading cause of death in adults infected with the human immunodeficiency virus (HIV), especially in Africa, where tuberculosis rates have increased sharply in the past two decades. Previous trials have shown that preventive treatment…
- July 7, 2011
- Martinson N.A., Barnes G.L., Moulton L.H., et al.
- N Engl J Med 2011; 365:11-20
- Free Full Text
- CME
In this study in South Africa, 1148 HIV-infected adults with TB were assigned to rifapentine–isoniazid weekly for 12 weeks, rifampin–isoniazid twice weekly for 12 weeks, isoniazid daily for up to 6 years, or isoniazid daily for 6 months. No regimen was identified as superior.
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Original Article
Primary Isoniazid Prophylaxis against Tuberculosis in HIV-Exposed Children
Tuberculosis is highly endemic in sub-Saharan Africa, a situation aggravated by the ongoing epidemic of human immunodeficiency virus type 1 (HIV-1). The increased burden of tuberculosis among adults in areas with a high prevalence of HIV infection is also associated with high rates of transmission…
- July 7, 2011
- Madhi S.A., Nachman S., Violari A., et al.
- N Engl J Med 2011; 365:21-31
- Free Full Text
In this study from South Africa, more than 1300 BCG-immunized infants with or without HIV coinfection received isoniazid or placebo for 96 weeks, starting at about 14 weeks of life. The burden of TB remained high, and primary isoniazid prophylaxis was not efficacious.
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Editorial
What Is Thwarting Tuberculosis Prevention in High-Burden Settings?
The promise of chemoprophylaxis for tuberculosis has yet to be fully realized. Until recently, testing for and treating latent tuberculosis infection have been limited largely to low-burden settings, where active tuberculosis has been under good control. In the United States and several other low…
- July 7, 2011
- Nardell E. and Churchyard G.
- N Engl J Med 2011; 365:79-81
- Free Full Text
The promise of chemoprophylaxis for tuberculosis has yet to be fully realized. Until recently, testing for and treating latent tuberculosis infection have been limited largely to low-burden settings, where active tuberculosis has been under good control. ...
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Clinical Practice
Latent Tuberculosis Infection in the United States
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A healthy 43…
- April 14, 2011
- Horsburgh C.R. and Rubin E.J.
- N Engl J Med 2011; 364:1441-1448
- CME
- Full Text Audio
This article reviews recommended strategies for screening and treatment of latent tuberculosis in the United States, with attention to the role of interferon-γ–release assays in screening and of shorter treatment regimens (as compared with a 9-month course of isoniazid).
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Original Article
Whole-Genome Sequencing and Social-Network Analysis of a Tuberculosis Outbreak
Mycobacterium tuberculosis is an important infectious disease even in developed countries with extensive control programs. This is the case in British Columbia, Canada, where the 2007 incidence rate of 6.4 cases per 100,000 population exceeded the national average of 4.7 cases per 100,000…
- February 24, 2011
- Gardy J.L., Johnston J.C., Sui S.J.H., et al.
- N Engl J Med 2011; 364:730-739
- Free Full Text
- CME
An outbreak of tuberculosis occurred over a 3-year period in a medium-size community in British Columbia, Canada. The results of mycobacterial interspersed repetitive unitâ€“variable-number tandem-repeat (MIRU-VNTR) genotyping suggested the outbreak was clonal. Traditional contact tracing did not identify a source. We used whole-genome sequencing and social-network analysis in an effort to describe the outbreak dynamics at a higher resolution.
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Images in Clinical Medicine
Chorioretinal Granuloma in Tuberculosis
Figure 1.
- December 2, 2010
- Ezra D.G. and Pavesio C.E.
- N Engl J Med 2010; 363:2248
- Free Full Text
A 17-year-old boy presented to the emergency room with a 48-hour history of deterioration in the vision of his right eye. Visual acuity was measured at 6/24 in the right eye and 6/6 in the left eye. In the right eye, a small subhyaloid hemorrhage and an ...
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Perspective
Global Health: Picking Up the Pace — Scale-Up of MDR Tuberculosis Treatment Programs
Multidrug-resistant (MDR) tuberculosis is a treatable, airborne infectious disease that killed an estimated 1.5 million people between 2000 and 2009 — an annual rate 10 times that of the H1N1 influenza virus. During this period, barely 0.5% of the estimated 5 million people who became ill with…
- November 4, 2010
- Keshavjee S. and Farmer P.E.
- N Engl J Med 2010; 363:1781-1784
- Free Full Text
Multidrug-resistant (MDR) tuberculosis is a treatable, airborne infectious disease that killed an estimated 1.5 million people between 2000 and 2009 — an annual rate 10 times that of the H1N1 influenza virus.¹,² During this period, barely 0.5% of the ...
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Review Article
Current Concepts: MDR Tuberculosis — Critical Steps for Prevention and Control
Multidrug-resistant (MDR) tuberculosis is defined as disease caused by strains of Mycobacterium tuberculosis that are at least resistant to treatment with isoniazid and rifampicin; extensively drug-resistant (XDR) tuberculosis refers to disease caused by multidrug-resistant strains that are also…
- September 9, 2010
- Nathanson E., Nunn P., Uplekar M., et al.
- N Engl J Med 2010; 363:1050-1058
- Free Full Text
- CME
In 2008, there were an estimated 440,000 new cases of MDR-TB globally. This review describes critical challenges to be addressed and policy changes to be made for progress worldwide in preventing and controlling MDR-TB.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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