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‘Urinary Tract Infection’ and the Microbiome

The current paradigm for managing uncomplicated “urinary tract infection” (“UTI”) is deeply flawed. “UTI” is ambiguously defined, and coupled with a belief that “bacteria are not normal inhabitants of the urinary tract,”1 the diagnosis often leads to unnecessary, harmful antibiotic treatment. Although bacteriuria identified by standard clinical cultures (which we will call standard bacteriuria) is central […]

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Stubborn Creatures: Dormant Staphylococcus aureus

A healthy 70-year-old woman was admitted with a 3-day history of a pus-emitting wound on her left shin, in the absence of trauma. She was afebrile, and examination was normal excepting a warm, erythematous and tender area over her left distal tibia with a central swollen area discharging pus. Hemoglobin was 11.7 g/dL, white blood […]

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A Red Herring in the Green Grass: Syphilitic Membranous Glomerulonephritis

Physical discomfort attributed to a routine chore was actually an unusual presentation of an insidious infection. A 51-year-old man presented to the emergency department and reported 1 week of persistent, localized lower back pain that began after he had spent the day mowing his lawn. He denied any trauma, rash, dysuria, discoloration of urine, or […]

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Capillary Fragility in Zika Virus Infection

  A 42-year-old Hispanic woman with no known medical history presented to the hospital with subjective fevers, rash, and arthralgias 5 days after returning to the US from Honduras. She reported multiple mosquito bites while abroad and noted that many relatives had similar symptoms over the preceding weeks. On arrival to the Emergency Department, her […]

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Herpes Zoster Ophthalmicus: A Review for the Internist

Herpes zoster ophthalmicus occurs due to reactivation of the varicella zoster virus in the ophthalmic branch of the fifth cranial nerve. This disease primarily affects the elderly as well as the immunocompromised and can result in a wide range of ophthalmic morbidity. Systemic antiviral therapy is the mainstay of treatment; however, consultation with an ophthalmologist […]

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