– Dermatophyte Infections
– Infection and Targeted Agents Used to Treat Hematologic Malignancy
– Pregnancy Planning and Counseling
The classic annular lesion of tinea corporis shows a raised a vesicular margin with central clearing.
Jan V Hirschmann, MD
University of Washington School of Medicine, Puget Sound VA Medical Center, Seattle, WA
Dermatophytes are fungi that infect the skin, hair, and nails. Clinicians should suspect dermatophyte infection in patients with any scaling, patients with erythematous eruption, and patients whose nails exhibit the characteristics of tinea unguium. The diagnosis can be confirmed by microscopy or culture of appropriate samples. The optimal method of obtaining specimens from the skin is by scraping the scaly lesions; the best sources from nails are fragments of subungual debris. With vesicles or pustules, the best sample is the roof of the lesion.
Micrograph of a plasmacytoma, a hematological malignancy
Sarah P Hammond, MD
Harvard Medical School, Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
Gowri Satyanarayana, MD
Division of Infectious Diseases, Department of Medicine, Vanderbilt University, Nashville, TN
Infection and Targeted Agents Used to Treat Hematologic Malignancy
Notably, in the last few years, at least two new oral targeted therapies have been approved by the Food and Drug Administration to treat chronic lymphocytic leukemia and certain types of non-Hodgkin lymphoma, including ibrutinib and idelalisib. Based on the B cell immunosuppressive mechanism of these drugs, infectious complications might be expected with clinical use. However, there has been limited clinical experience to date, with no specific infectious complications identified with ibrutinib. In contrast, idelalisib, when combined with other cancer treatments, has been linked to an increased risk of death and serious adverse events in clinical trials, most of which have been attributed to opportunistic infections.
Ellen W Seely, MD
Clinical Research, Endocrinology, Diabetes and Hypertension Division, Department of Medicine, Brigham and Women’s Hospital, Professor of Medicine, Harvard Medical School, Boston, MA
Jeffrey L Ecker, MD
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Pregnancy Planning and Counseling
Two emerging concepts are likely to change pregnancy planning and preconception genetic counseling. The first is the availability of rapid and affordable testing to identify those who are carriers of a wide variety of genetic conditions, so-called “expanded carrier screening.” Careful pretest and posttest education will be needed so that patients and couples can make informed decisions and anticipate potential issues prior to pregnancy. The second concept, linked to the first, is a move from race-based targeted screening to pan-ethnic testing. This shift recognizes the difficulties of selecting appropriate conditions for genetic carrier testing based on appearance or self-identification.
As seen in Scientific AmericanTM Medicine, teaching principles and practice in Internal Medicine.