Cutaneous disseminated histoplasmosis in AIDS patients in south Florida

Background Histoplasma capsulatum is a dimorphic pathogenic fungus endemic to the Mississippi and Ohio river valleys. In the immunocompetent it causes a self‐limited disease, but in the immunocompromised may lead to disseminated disease (disseminated histoplasmosis (DH)). It is one of the opportunistic infections which defines the acquired immunodeficiency syndrome (AIDS) and is rarely encountered outside endemic regions. Methods Clinical, laboratory, and histologic information concerning seven patients with DH and AIDS in South Florida was recorded. Results We report seven cases of DH with mucocutaneous lesions in patients infected with the human immunodeficiency virus (HIV). All patients had markedly depressed CD4 counts of less than 40 cells/mm3, and only two had traveled to endemic areas. Two out of the seven patients were diagnosed with HIV/AIDS at the time DH was identified. All of our patients had mucocutaneous lesions at the time of diagnosis, which clinically presented as a generalized papular eruption, ulcers, and erythematous scaly plaques. Conclusions Even in non‐endemic regions, HIV‐positive patients presenting with fever, chills, weight loss, hepatosplenomegaly, anemia, cough, lymphadenopathy, and mucocutaneous lesions should have an early skin biopsy specimen taken for mycologic tissue culture and histopathologic evaluation for disseminated fungal infections

The Role Of Communication Technology In Adolescent Relationships And Identity Development

Background: The popularity of communication technologies such as text messaging, e-mail, instant messaging, and social networking sites has grown exponentially, especially among adolescents. At the scale of growth along with the pressures and normative use of communication technology, psychological effects of these technologies need to be further assessed. Objective: The purpose of this study was to determine if technology usage and preference for using communication technology in social situations are related to adolescent development in regard to peer relationships, identity development, and psychological adjustment. Methods: Participants (N = 268; 69 % female; 81.9 % White) from three public high schools were surveyed in their classroom. Results: Time spent using communication technology was associated with less relationship avoidance, but greater internalizing symptom severity, identity distress, existential anxiety, and peer aggression. Preference for using technology for interpersonal communication was associated with greater peer aggression, relationship anxiety, and existential anxiety. Those with a preoccupied attachment style (high in relationship anxiety, but low in relationship avoidance) reported the most time using communication technology. Communication technology usage was not related to identity exploration, commitment, or status, but it did predict psychological symptom severity over and above the identity and relationship variables. Conclusions: Communication technology usage was found to be related to identity and relationship problems, and was linked to greater maladjustment, even after controlling for identity and relationship difficulties

Case 48-1992: An 82-Year-Old Man with Pulmonary Densities and a Mass in the Left Upper Abdominal Quadrant

Presentation of Case An 82-year-old man was admitted to the hospital because of abdominal pain, nausea, and vomiting. There was a history of a right pulmonary parahilar radiologic density interpreted as atelectasis in the superior segment of the right lower lobe and discovered 3 1/2 years earlier (Fig. 1), when the patient was admitted for treatment of pneumonia. A test for human immunodeficiency virus antibodies was negative. One year before admission the patient was readmitted to the hospital because of pneumonia and recovered. Seven months before entry the patient returned to the hospital because of a dry cough and dyspnea… © 1992, Massachusetts Medical Society. All rights reserved