The American journal of medicine
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PRESENTING FEATURES: A 53-year-old man who had human immunodeficiency virus (HIV) presented to the Johns Hopkins Hospital with a 3-month history of increasing dysphagia, cough, dyspnea, chest pain, and an episode of syncope. His past medical history was notable for oral and presumptive esophageal candidiasis that was treated with fluconazole 6 months prior to presentation. Three months prior to presentation, he discontinued his medications, and his symptoms of dysphagia recurred. ⋯ Induced sputum was negative for Pneumocystis carinii, fungi, or acid-fast bacilli. A bronchoalveolar lavage was performed. What is the diagnosis?
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Comparative Study
Value of initial chest radiographs for predicting clinical outcomes in patients with severe acute respiratory syndrome.
To determine whether the initial chest radiograph is helpful in predicting the clinical outcome of patients with severe acute respiratory syndrome (SARS). ⋯ Frontal chest radiographs on presentation may have prognostic value in patients with SARS.
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Community-acquired pneumonia (CAP) is the sixth most common cause of death in the United States and the leading cause of death from infectious diseases. It is associated with significant morbidity and mortality, and poses a major economic burden to the healthcare system. Streptococcus pneumoniae is the leading cause of CAP. ⋯ Increasing resistance to a variety of antimicrobial agents has been documented in S. pneumoniae and is common in H. influenzae as well. Successful empiric therapy is paramount to the management of CAP to avoid treatment failure and subsequent associated costs. Given that resistance is increasing among respiratory pathogens, and S. pneumoniae is the most common etiologic agent identified in CAP, strategies for antimicrobial therapy should be based on the likely causative pathogen, the presence of risk factors for infection with resistant bacteria, and local resistance patterns.