NEJM â Collection Updates for Viral Diseases

ORIGINAL ARTICLE: Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2

Thu, 04Â FebÂ 2010 00:00:00 -05:00

Background: Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and is associated...

CORRESPONDENCE: Responses to 2009 H1N1 Vaccine in Children 3 to 17 Years of Age

Adriano Arguedas, M.D., Carolina Soley, M.D., and Kelly Lindert, M.D. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

To the Editor: The current 2009 pandemic influenza A (H1N1) virus is associated with substantial morbidity in children, with 45% of hospitalizations occurring in patients under 18 years of age.1...

EDITORIAL: Rotavirus Vaccine â A Powerful Tool to Combat Deaths from Diarrhea

Mathuram Santosham, M.D., M.P.H. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

Rotavirus infection, the leading cause of severe childhood diarrhea in both developed and developing countries, results in over half a million deaths each year.1 Currently, two rotavirus vaccines (Rotarix [GlaxoSmithKline...

ORIGINAL ARTICLE: Vaccine-Acquired Rotavirus in Infants with Severe Combined Immunodeficiency

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Live pentavalent humanâbovine reassortant rotavirus vaccine is recommended in the United States for routine immunization of infants. We describe three infants, two with failure to thrive, who had dehydration and...

ORIGINAL ARTICLE: Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: A phased introduction of a monovalent rotavirus vaccine occurred in Mexico from February 2006 through May 2007. We assessed the effect of vaccination on deaths from diarrhea in Mexican...

ORIGINAL ARTICLE: Effect of Human Rotavirus Vaccine on Severe Diarrhea in African Infants

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: Rotavirus is the most common cause of severe gastroenteritis among young children worldwide. Data are needed to assess the efficacy of the rotavirus vaccine in African children.

Methods: We conducted...

CORRESPONDENCE: Intravenous Zanamivir for Oseltamivir-Resistant 2009 H1N1 Influenza

Thu, 07Â JanÂ 2010 00:00:00 -05:00

To the Editor: A 10-year-old girl with acute lymphoblastic leukemia was transferred to our hospital on August 31. The patient required mechanical ventilation for worsening lobar pneumonia, despite the administration...

CORRESPONDENCE: A Community Cluster of Oseltamivir-Resistant Cases of 2009 H1N1 Influenza

Thu, 07Â JanÂ 2010 00:00:00 -05:00

To the Editor: Oseltamivir-resistant infection with the 2009 pandemic influenza A (H1N1) virus has so far been described only rarely and is conferred by the H275Y substitution in the neuraminidase...

ORIGINAL ARTICLE: Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Background: While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information...

ORIGINAL ARTICLE: Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Background: Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women.

Methods: Statewide surveillance for patients who were hospitalized...

ORIGINAL ARTICLE: Outbreak of 2009 Pandemic Influenza A (H1N1) at a New York City School

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Background: In April 2009, an outbreak of novel swine-origin influenza A (2009 H1N1 influenza) occurred at a high school in Queens, New York. We describe the outbreak and characterize the...

ORIGINAL ARTICLE: Household Transmission of 2009 Pandemic Influenza A (H1N1) Virus in the United States

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Background: As of June 11, 2009, a total of 17,855 probable or confirmed cases of 2009 pandemic influenza A (H1N1) had been reported in the United States. Risk factors for...

PERSPECTIVE: The Emotional Epidemiology of H1N1 Influenza Vaccination

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Last spring, when 2009 H1N1 influenza first came to our attention, my patients were in a panic. Our clinic was flooded with calls and walk-in patients, all with the same...

PERSPECTIVE: Australia's Winter with the 2009 Pandemic Influenza A (H1N1) Virus

Thu, 31Â DecÂ 2009 00:00:00 -05:00

When the World Health Organization declared a âpublic health emergency of international concernâ on April 25, 2009, after the emergence in Mexico of pandemic influenza A (H1N1) virus, Australia activated...

CORRESPONDENCE: Bacterial Pathogens and Death during the 1918 Influenza Pandemic

Thu, 24Â DecÂ 2009 00:00:00 -05:00

To the Editor: A review of recut lung-tissue specimens and published autopsy series from the 1918 influenza pandemic suggests that secondary bacterial pneumonia1 was an important cause of death, consistent...

EDITORIAL: The Need for Science in the Practice of Public Health

Nicole Lurie, M.D., M.S.P.H. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

When H5N1 avian influenza emerged in 1997, much of the world began planning for an eventual pandemic. Most planners expected the pandemic to begin in Asia and believed the virus...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 40-2009 â A 29-Year-Old Man with Fever and Respiratory Failure

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Dr. Wilson Tak-Yu Kwong (Medicine): A 29-year-old man was admitted in July 2009 to the critical care unit of this hospital because of fever and respiratory failure.

The patient had been...

ORIGINAL ARTICLE: Clinical Features of the Initial Cases of 2009 Pandemic Influenza A (H1N1) Virus Infection in China

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Background: The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those...

EDITORIAL: Pandemic Influenza Vaccine Policy â Considering the Early Evidence

Kathleen M. Neuzil, M.D., M.P.H. — Thu, 17Â DecÂ 2009 00:00:00 -05:00

âPolicy decisions regarding influenza rest on judgments about the behavior of the virus, the impact of the disease and our ability to interdict its course. But the virus is capricious,...

OTHER POINTS OF VIEW: Diagnostic Testing for 2009 Pandemic Influenza A (H1N1) Virus Infection in Hospitalized Patients

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Establishing a diagnosis of 2009 pandemic influenza A (H1N1) virus infection in hospitalized patients can be challenging, especially in patients presenting late in their clinical course. Although real-time reverse-transcriptase polymerase...

CORRESPONDENCE: Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Thu, 17Â DecÂ 2009 00:00:00 -05:00

To the Editor: Faix et al. (Aug. 13 issue)1 highlight the moderate sensitivity of rapid antigen tests as compared with reverse-transcriptaseâpolymerase-chain-reaction (RT-PCR) assays in detecting the 2009 pandemic influenza A...

ORIGINAL ARTICLE: Trial of 2009 Influenza A (H1N1) Monovalent MF59-Adjuvanted Vaccine

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Background: The 2009 pandemic influenza A (H1N1) virus has emerged to cause the first pandemic of the 21st century. Development of effective vaccines is a public health priority.

Methods: We conducted...

ORIGINAL ARTICLE: A Novel Influenza A (H1N1) Vaccine in Various Age Groups

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Background: There is an urgent need for a vaccine that is effective against the 2009 pandemic influenza A (H1N1) virus.

Methods: A split-virus, inactivated candidate vaccine against the 2009 H1N1 virus...

ORIGINAL ARTICLE: Response to a Monovalent 2009 Influenza A (H1N1) Vaccine

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Background: A novel 2009 influenza A (H1N1) virus is responsible for the first influenza pandemic in 41 years. A safe and effective vaccine is needed. A randomized, observer-blind, parallel-group trial...

OTHER POINTS OF VIEW: When to Consider the Use of Antibiotics in the Treatment of 2009 H1N1 InfluenzaâAssociated Pneumonia

Thu, 10Â DecÂ 2009 00:00:00 -05:00

We are now facing a pandemic caused by an epidemiologically distinct, novel virus, the 2009 pandemic influenza A (H1N1) virus (swine flu), against which few persons born since 1970 have...

OTHER POINTS OF VIEW: Antiviral Treatment for Patients Hospitalized with 2009 Pandemic Influenza A (H1N1)

Thu, 03Â DecÂ 2009 00:00:00 -05:00

With the 2009 H1N1 pandemic well under way, many clinicians are providing care to patients with influenza. Previously, although antiviral treatment was recommended,12 clinicians may not always have prescribed it...

CORRESPONDENCE: Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis

Thu, 03Â DecÂ 2009 00:00:00 -05:00

To the Editor: Neuraminidase inhibitors (oseltamivir and zanamivir) are recommended for treatment of severe illness caused by the 2009 pandemic influenza A (H1N1) virus, and their use has also been...

ORIGINAL ARTICLE: AbacavirâLamivudine versus TenofovirâEmtricitabine for Initial HIV-1 Therapy

Thu, 03Â DecÂ 2009 00:00:00 -05:00

Background: The use of fixed-dose combination nucleoside reverse-transcriptase inhibitors (NRTIs) with a nonnucleoside reverse-transcriptase inhibitor or a ritonavir-boosted protease inhibitor is recommended as initial therapy in patients with human immunodeficiency...

PERSPECTIVE: The Emergency Use Authorization of Peramivir for Treatment of 2009 H1N1 Influenza

Thu, 03Â DecÂ 2009 00:00:00 -05:00

On October 23, 2009, Food and Drug Administration (FDA) Commissioner Margaret Hamburg issued an Emergency Use Authorization (EUA) for peramivir for intravenous injection (BioCryst Pharmaceuticals). Peramivir is an unapproved investigational...

PERSPECTIVE: Mandatory Vaccination of Health Care Workers

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Mandatory vaccination of health care workers raises important questions about the limits of a state's power to compel individuals to engage in particular activities in order to protect the public....

CORRESPONDENCE: Pathological Changes Associated with the 2009 H1N1 Virus

Thu, 12Â NovÂ 2009 00:00:00 -05:00

To the Editor: Between April 23, 2009, and May 15, 2009, we performed 15 autopsies on deceased patients in whom probable influenza had been diagnosed either clinically or macroscopically. Small...

CORRESPONDENCE: Older Age and a Reduced Likelihood of 2009 H1N1 Virus Infection

Thu, 12Â NovÂ 2009 00:00:00 -05:00

To the Editor: Early epidemiologic reports regarding the 2009 pandemic influenza A (H1N1) virus suggest that cases of infection and deaths are concentrated in adults between the ages of 20...

EDITORIAL: Preparing for 2009 H1N1 Influenza

Richard P. Wenzel, M.D., and Michael B. Edmond, M.D., M.P.H. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

In 1743, when disease was presumed to be astral in origin, European newspapers reported on a contagious influence (influenza in Italian) that was being visited on the citizens of Rome....

ORIGINAL ARTICLE: Cross-Reactive Antibody Responses to the 2009 Pandemic H1N1 Influenza Virus

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: A new pandemic influenza A (H1N1) virus has emerged, causing illness globally, primarily in younger age groups. To assess the level of preexisting immunity in humans and to evaluate...

ORIGINAL ARTICLE: Hospitalized Patients with 2009 H1N1 Influenza in the United States, AprilâJune 2009

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of patients who were hospitalized with 2009 H1N1 influenza...

ORIGINAL ARTICLE: Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand

The ANZIC Influenza Investigators — Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: Planning for the treatment of infection with the 2009 pandemic influenza A (H1N1) virus through health care systems in developed countries during winter in the Northern Hemisphere is hampered...

PERSPECTIVE: Defeating Rotavirus? The Global Recommendation for Rotavirus Vaccination

Thu, 12Â NovÂ 2009 00:00:00 -05:00

This past April, the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization announced a global recommendation that rotavirus vaccines be included in national immunization programs. The...

CORRESPONDENCE: Risk of Confusion in Dosing Tamiflu Oral Suspension in Children

Thu, 05Â NovÂ 2009 00:00:00 -05:00

To the Editor: The medical community should be made aware of the serious potential for dosing errors in children prescribed Tamiflu (oseltamivir) oral suspension, as illustrated in the case described...

EDITORIAL: Human Papillomavirus Vaccine for Cancer Prevention

Olivera J. Finn, Ph.D., and Robert P. Edwards, M.D. — Thu, 05Â NovÂ 2009 00:00:00 -05:00

Cancer immunoprevention has become synonymous with the vaccines that have been approved for the prevention of infection with highly transmissible strains of human papillomavirus (HPV) that establish chronic infection and...

ORIGINAL ARTICLE: Vaccination against HPV-16 Oncoproteins for Vulvar Intraepithelial Neoplasia

Thu, 05Â NovÂ 2009 00:00:00 -05:00

Background: Vulvar intraepithelial neoplasia is a chronic disorder caused by high-risk types of human papillomavirus (HPV), most commonly HPV type 16 (HPV-16). Spontaneous regression occurs in less than 1.5% of...

PERSPECTIVE: Novel H1N1 Influenza and Respiratory Protection for Health Care Workers

Thu, 05Â NovÂ 2009 00:00:00 -05:00

Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have...

REVIEW ARTICLE: Norovirus Gastroenteritis

Thu, 29Â OctÂ 2009 00:00:00 -05:00

The Norwalk agent was the first virus that was identified as causing gastroenteritis in humans, but recognition of its importance as a pathogen has been limited because of the lack...

CORRESPONDENCE: Use of Ribavirin to Treat Influenza

Thu, 22Â OctÂ 2009 00:00:00 -05:00

To the Editor: Ribavirin, an antiviral drug with in vitro activity against both DNA and RNA viruses, is approved in the United States for the treatment of hepatitis C and...

REVIEW ARTICLE: Maternal and Neonatal Herpes Simplex Virus Infections

Lawrence Corey, M.D., and Anna Wald, M.D., M.P.H. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

An estimated 25 to 65% of pregnant women in the United States have genital infection with herpes simplex virus type 1 (HSV-1) or HSV type 2 (HSV-2).1 Neonatal HSV infection,...

ORIGINAL ARTICLE: Comparative Efficacy of Inactivated and Live Attenuated Influenza Vaccines

Thu, 24Â SepÂ 2009 00:00:00 -05:00

Background: The efficacy of influenza vaccines may vary from year to year, depending on a variety of factors, and may differ for inactivated and live attenuated vaccines.

Methods: We carried out...

PERSPECTIVE: Poverty, Wealth, and Access to Pandemic Influenza Vaccines

Thu, 17Â SepÂ 2009 00:00:00 -05:00

On June 11, 2009, Margaret Chan, director general of the World Health Organization (WHO), declared that the status of the influenza A (H1N1) pandemic had reached phase 6 â active...

ORIGINAL ARTICLE: Progressive Multifocal Leukoencephalopathy after Natalizumab Monotherapy

Thu, 10Â SepÂ 2009 00:00:00 -05:00

We describe progressive multifocal leukoencephalopathy (PML) caused by infection with human polyomavirus JC virus in a patient with multiple sclerosis who was treated with natalizumab. The first PML symptoms appeared...

ORIGINAL ARTICLE: Treatment of Progressive Multifocal Leukoencephalopathy Associated with Natalizumab

Thu, 10Â SepÂ 2009 00:00:00 -05:00

We describe the clinical and therapeutic course of a 52-year-old patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy (PML) developed after 12 months of therapy with natalizumab. The patient...

ORIGINAL ARTICLE: Asymptomatic Reactivation of JC Virus in Patients Treated with Natalizumab

Thu, 10Â SepÂ 2009 00:00:00 -05:00

Background: Progressive multifocal leukoencephalopathy (PML) occurs in a fraction of patients with multiple sclerosis who were treated with natalizumab. Most adults who are infected with the JC virus, the etiologic...

PERSPECTIVE: Reemergence of PML in Natalizumab-Treated Patients â New Cases, Same Concerns

Thu, 10Â SepÂ 2009 00:00:00 -05:00

When progressive multifocal leukoencephalopathy (PML), a rare demyelinating disease induced by JC virus, appeared in 2004 as a complication of natalizumab treatment for multiple sclerosis, a more common demyelinating disease,...

CORRESPONDENCE: Persistent Carriage of Hepatitis E Virus in Patients with HIV Infection

Thu, 03Â SepÂ 2009 00:00:00 -05:00

To the Editor: Hepatitis E virus is an emerging infection in developed countries, with many clinical manifestations.1 We describe a 48-year-old bisexual white male who was infected with human immunodeficiency...

PERSPECTIVE: H1N1 Influenza, Public Health Preparedness, and Health Care Reform

Thu, 27Â AugÂ 2009 00:00:00 -05:00

In December 2009, the Department of Health and Human Services will present to Congress its first-ever national health security strategy, outlining high-priority activities and areas of investment for strengthening the...

CORRESPONDENCE: Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Thu, 13Â AugÂ 2009 00:00:00 -05:00

To the Editor: The Naval Health Research Center serves as the Navy hub for the Department of Defense's Global Emerging Infections Surveillance and Response System (GEIS), in which it monitors...

ORIGINAL ARTICLE: Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico

Thu, 13Â AugÂ 2009 00:00:00 -05:00

Background: In late March 2009, an outbreak of a respiratory illness later proved to be caused by novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Mexico. We describe...

ORIGINAL ARTICLE: Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza

Thu, 13Â AugÂ 2009 00:00:00 -05:00

Background: In the spring of 2009, an outbreak of severe pneumonia was reported in conjunction with the concurrent isolation of a novel swine-origin influenza A (H1N1) virus (S-OIV), widely known...

ORIGINAL ARTICLE: Peginterferon Alfa-2b or Alfa-2a with Ribavirin for Treatment of Hepatitis C Infection

Thu, 06Â AugÂ 2009 00:00:00 -05:00

Background: Treatment guidelines recommend the use of peginterferon alfa-2b or peginterferon alfa-2a in combination with ribavirin for chronic hepatitis C virus (HCV) infection. However, these regimens have not been adequately...

REVIEW ARTICLE: Historical Perspective â Emergence of Influenza A (H1N1) Viruses

Shanta M. Zimmer, M.D., and Donald S. Burke, M.D. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

On April 17, 2009, officials at the Centers for Disease Control and Prevention (CDC) confirmed two cases of swine influenza in children living in neighboring counties in California.1 Here we...

CLINICAL THERAPEUTICS: HPV Vaccination for the Prevention of Cervical Intraepithelial Neoplasia

Jessica A. Kahn, M.D., M.P.H. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

A sexually active 18-year-old woman presents to her internist for an annual examination. During the review of her family history, she notes that her mother recently received a diagnosis of...

PERSPECTIVE: The Persistent Legacy of the 1918 Influenza Virus

Thu, 16Â JulÂ 2009 00:00:00 -05:00

It is not generally appreciated that descendents of the H1N1 influenza A virus that caused the catastrophic and historic pandemic of 1918â1919 have persisted in humans for more than 90...

CORRESPONDENCE: Spread of a Novel Influenza A (H1N1) Virus via Global Airline Transportation

Thu, 09Â JulÂ 2009 00:00:00 -05:00

To the Editor: Throughout March and April 2009, international air travelers departing from Mexico were unknowingly transporting a novel influenza A (H1N1) virus1 to cities around the world. We analyzed...

PERSPECTIVE: Geographic Dependence, Surveillance, and Origins of the 2009 Influenza A (H1N1) Virus

Thu, 09Â JulÂ 2009 00:00:00 -05:00

In April 2009, a new strain of human H1N1 influenza A virus was identified in Mexico. According to the World Health Organization (www.who.int/csr/don/2009_05_25), as of May 25, 2009, the virus...

PERSPECTIVE: Managing and Reducing Uncertainty in an Emerging Influenza Pandemic

Thu, 09Â JulÂ 2009 00:00:00 -05:00

The early phases of an epidemic present decision makers with predictable challenges1 that have been evident as the current novel influenza A (H1N1) virus has spread. The scale of the...

EDITORIAL: Implications of the Emergence of a Novel H1 Influenza Virus

Robert B. Belshe, M.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

In this issue of the Journal, there are two reports of recent transmissions of swine influenza viruses in humans. One group of viruses, described by Shinde et al.,1 are triple...

EDITORIAL: H1N1 Influenza A Disease â Information for Health Professionals

Thu, 18Â JunÂ 2009 00:00:00 -05:00

In the first 2 weeks in April, cases of infection with an untypable influenza A virus began to be identified in Mexico and southern California.1 Although the exact sequence of...

ORIGINAL ARTICLE: Triple-Reassortant Swine Influenza A (H1) in Humans in the United States, 2005â2009

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Background: Triple-reassortant swine influenza A (H1) viruses â containing genes from avian, human, and swine influenza viruses â emerged and became enzootic among pig herds in North America during the...

ORIGINAL ARTICLE: Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team — Thu, 18Â JunÂ 2009 00:00:00 -05:00

Background: On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The...

PERSPECTIVE: The Signature Features of Influenza Pandemics â Implications for Policy

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Vast amounts of time and resources are being invested in planning for the next influenza pandemic, and one may indeed have already begun. Data from past pandemics can provide useful...

CORRESPONDENCE: Antibodies against H5 and H9 Avian Influenza among Poultry Workers in China

Ming Wang, M.D., Chuan-Xi Fu, Ph.D., and Bo-Jian Zheng, M.D., Ph.D. — Thu, 11Â JunÂ 2009 00:00:00 -05:00

To the Editor: Human infection with the H5N1 or H9N2 avian influenza virus has been reported in the city of Guangzhou in southern China.12 To assess the risk of avian...

CLINICAL PROBLEM-SOLVING: Kiss of Death

Thu, 11Â JunÂ 2009 00:00:00 -05:00

A 23-year-old South African man presented to an emergency department with a 2-day history of fever, mild dyspnea, headache, nausea, and myalgias. His symptoms had begun 5 days after he...

ORIGINAL ARTICLE: Zika Virus Outbreak on Yap Island, Federated States of Micronesia

Thu, 11Â JunÂ 2009 00:00:00 -05:00

Background: In 2007, physicians on Yap Island reported an outbreak of illness characterized by rash, conjunctivitis, and arthralgia. Although serum from some patients had IgM antibody against dengue virus, the...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Common Cold, Uncommon Variation

Gregory A. Poland, M.D., and Michael A. Barry, Ph.D. — Thu, 21Â MayÂ 2009 00:00:00 -05:00

The average person will spend about 5 years suffering from the common cold, and 1 year of that time will be spent with a cold that is severe enough to...

ORIGINAL ARTICLE: Fatal Case of Deer Tick Virus Encephalitis

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Deer tick virus is related to Powassan virus, a tickborne encephalitis virus. A 62-year-old man presented with a meningoencephalitis syndrome and eventually died. Analyses of tissue samples obtained during surgery...

CLINICAL DECISIONS: Management of Incidental Hepatitis C Virus Infection

Thu, 30Â AprÂ 2009 00:00:00 -05:00

A 25-year-old black woman is referred to your clinic for management of an incidental positive result on a hepatitis C virus (HCV) antibody test. She had decided to donate blood...

EDITORIAL: A Step Forward in Therapy for Hepatitis C

Jay H. Hoofnagle, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

The therapy of hepatitis C began almost 25 years ago with a small trial of recombinant human interferon alfa.1 The rationale for using interferon was its broad antiviral effects and...

ORIGINAL ARTICLE: Telaprevir and Peginterferon with or without Ribavirin for Chronic HCV Infection

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Background: In patients with chronic infection with hepatitis C virus (HCV) genotype 1, treatment with peginterferon alfa and ribavirin for 48 weeks results in rates of sustained virologic response of...

ORIGINAL ARTICLE: Telaprevir with Peginterferon and Ribavirin for Chronic HCV Genotype 1 Infection

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Background: Current therapy for chronic hepatitis C virus (HCV) infection is effective in less than 50% of patients infected with HCV genotype 1. Telaprevir, a protease inhibitor specific to the...

CORRESPONDENCE: Effectiveness of One Dose of SA 14-14-2 Vaccine against Japanese Encephalitis

Rashmi Kumar, M.D., Piyush Tripathi, M.Sc., and Anwar Rizvi, B.M.S. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

To the Editor: Japanese encephalitis remains a major cause of viral encephalitis in Asia, imposing a significant burden on poor rural families. Vaccination is an important element of disease control....

EDITORIAL: From India to the World â A Better Way to Prevent Cervical Cancer

Mark Schiffman, M.D., M.P.H., and Sholom Wacholder, Ph.D. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

In this issue of the Journal, Sankaranarayanan et al.1 report the results of a randomized clinical trial of screening for cervical cancer involving more than 130,000 women in India. The...

ORIGINAL ARTICLE: HPV Screening for Cervical Cancer in Rural India

Thu, 02Â AprÂ 2009 00:00:00 -05:00

Background: In October 1999, we began to measure the effect of a single round of screening by testing for human papillomavirus (HPV), cytologic testing, or visual inspection of the cervix...

EDITORIAL: Prevention of Viral Sexually Transmitted Infections â Foreskin at the Forefront

Matthew R. Golden, M.D., M.P.H., and Judith N. Wasserheit, M.D., M.P.H. — Thu, 26Â MarÂ 2009 00:00:00 -05:00

Three landmark randomized, controlled trials conducted in South Africa, Uganda, and Kenya from 2005 through 2007 demonstrated that adult male circumcision reduced the acquisition of human immunodeficiency virus (HIV) by...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 10-2009 â A 23-Year-Old Woman with an Abnormal Papanicolaou Smear

Thu, 26Â MarÂ 2009 00:00:00 -05:00

Dr. Naana Afua Jumah (Student, Harvard Medical School): A 23-year-old woman was seen in the gynecology clinic of this hospital because of a high-grade squamous intraepithelial lesion seen on pathological...

ORIGINAL ARTICLE: Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis

Thu, 26Â MarÂ 2009 00:00:00 -05:00

Background: Male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men in three clinical trials. We assessed the efficacy of male circumcision for the prevention of...

CORRESPONDENCE: Cytokine Induction after Laboratory-Acquired West Nile Virus Infection

Thu, 19Â MarÂ 2009 00:00:00 -05:00

To the Editor: We report a case of laboratory-acquired West Nile virus infection after a needlestick injury in a 29-year-old, immunocompetent female scientist in South Africa, who was not infected...

EDITORIAL: One Step Closer to a CMV Vaccine

Cornelia L. Dekker, M.D., and Ann M. Arvin, M.D. — Thu, 19Â MarÂ 2009 00:00:00 -05:00

In this issue of the Journal, Pass and colleagues describe the results of a phase 2 trial of a vaccine containing recombinant cytomegalovirus (CMV) glycoprotein B subunit antigen combined with...

ORIGINAL ARTICLE: Vaccine Prevention of Maternal Cytomegalovirus Infection

Thu, 19Â MarÂ 2009 00:00:00 -05:00

Background: Congenital infection with cytomegalovirus (CMV) is an important cause of hearing, cognitive, and motor impairments in newborns.

Methods: In this phase 2, placebo-controlled, randomized, double-blind trial, we evaluated a vaccine...

PERSPECTIVE: Global Transmission of Oseltamivir-Resistant Influenza

Thu, 05Â MarÂ 2009 00:00:00 -05:00

Seemingly from one influenza season to the next, we have lost the use of our leading antiviral influenza drug because of resistance. This winter, the circulating strain of seasonal influenza...

ORIGINAL ARTICLE: The Burden of Respiratory Syncytial Virus Infection in Young Children

Thu, 05Â FebÂ 2009 00:00:00 -05:00

Background: The primary role of respiratory syncytial virus (RSV) in causing infant hospitalizations is well recognized, but the total burden of RSV infection among young children remains poorly defined.

Methods: We...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2009 â A 39-Year-Old Pregnant Woman with Fever after a Trip to Africa

Patrick Duff, M.D., William H. Barth, Jr., M.D., and Miriam D. Post, M.D. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

A 39-year-old woman in the first trimester of her first pregnancy was seen in the obstetrics and gynecology clinic of this hospital at 14 weeks of gestation because of a...

EDITORIAL: Practice Imperfect â Treatment for Wheezing in Preschoolers

Andrew Bush, M.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

Nearly one third of preschool children (4 years of age or younger) have intermittent wheezing, a condition that many of them outgrow. The most common early trigger is a respiratory...

ORIGINAL ARTICLE: Preemptive Use of High-Dose Fluticasone for Virus-Induced Wheezing in Young Children

Thu, 22Â JanÂ 2009 00:00:00 -05:00

Background: Although virus-induced wheezing is common in preschool-age children, optimal management remains elusive. We examined the efficacy and safety of preemptive treatment with high-dose fluticasone in reducing the severity of...

ORIGINAL ARTICLE: Oral Prednisolone for Preschool Children with Acute Virus-Induced Wheezing

Thu, 22Â JanÂ 2009 00:00:00 -05:00

Background: Attacks of wheezing induced by upper respiratory viral infections are common in preschool children between the ages of 10 months and 6 years. A short course of oral prednisolone...

BOOK REVIEW:

Thu, 15Â JanÂ 2009 00:00:00 -05:00

Viruses are responsible for 20% of malignant conditions in humans, including some of the most common cancers worldwide, and are especially common in immunosuppressed patients. The identification of viruses associated...

ORIGINAL ARTICLE: Peginterferon Alfa-2a and Ribavirin in Latino and Non-Latino Whites with Hepatitis C

Thu, 15Â JanÂ 2009 00:00:00 -05:00

Background: Race has been shown to be a factor in the response to therapy for hepatitis C virus (HCV) infection, and limited data suggest that ethnic group may be as...

CLINICAL PRACTICE: Prevention and Treatment of Seasonal Influenza

W. Paul Glezen, M.D. — Thu, 11Â DecÂ 2008 00:00:00 -05:00

In February 2007, fever developed in a previously healthy 15-year-old girl, with a peak temperature of 102Â°F (38.9Â°C) and mild upper respiratory congestion. The next day she was seen by...

EDITORIAL: Chronic Hepatitis B â New Goals, New Treatment

Ching-Lung Lai, M.D., and Man-Fung Yuen, M.D. — Thu, 04Â DecÂ 2008 00:00:00 -05:00

The hepatitis B virus (HBV) causes chronic infection in approximately 400 million people in the world. Most carriers of chronic HBV, including Asians, Africans, and a proportion of persons in...

ORIGINAL ARTICLE: Tenofovir Disoproxil Fumarate versus Adefovir Dipivoxil for Chronic Hepatitis B

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Background: Tenofovir disoproxil fumarate (DF) is a nucleotide analogue and a potent inhibitor of human immunodeficiency virus type 1 reverse transcriptase and hepatitis B virus (HBV) polymerase.

Methods: In two double-blind,...

ORIGINAL ARTICLE: Prolonged Therapy of Advanced Chronic Hepatitis C with Low-Dose Peginterferon

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Background: In patients with chronic hepatitis C who do not have a response to antiviral treatment, the disease may progress to cirrhosis, liver failure, hepatocellular carcinoma, and death. Whether long-term...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Attenuation by a Thousand Cuts

John M. Coffin, Ph.D. — Thu, 20Â NovÂ 2008 00:00:00 -05:00

Vaccination with live attenuated virus can be highly effective for the induction of protective immunity and is critical in the prevention of once devastating epidemic diseases. Vaccines containing live attenuated...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Virus Infection, Asthma, and Chronic Obstructive Pulmonary Disease

Ratko DjukanoviÄ, M.D., and Stephan D. Gadola, M.D. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

Both asthma and chronic obstructive pulmonary disease (COPD) are characterized by chronic inflammation of the airways. This inflammation is accompanied by increased mucus production and an excessive propensity of the...

IMAGES IN CLINICAL MEDICINE: Corneal Dendritic Ulcer from Herpes Simplex Virus Infection

Christopher C. Teng, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

A 24-year-old man presented with a 2-day history of redness, photophobia, and blurry vision in the right eye. He reported no medical problems, similar previous episodes, fever, recent illnesses, or...

EDITORIAL: Monovalent Oral Poliovirus Vaccines â A Good Tool but Not a Total Solution

Ellie Ehrenfeld, Ph.D., and Konstantin Chumakov, Ph.D. — Thu, 16Â OctÂ 2008 00:00:00 -05:00

The polio eradication campaign initiated in 1988 by the World Health Organization (WHO) led to an impressive decline in cases of paralytic poliomyelitis around the world. The eradication strategy involved...

ORIGINAL ARTICLE: Effectiveness of Immunization against Paralytic Poliomyelitis in Nigeria

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Background: The number of cases of paralytic poliomyelitis has declined in Nigeria since the introduction of newly licensed monovalent oral poliovirus vaccines and new techniques of vaccine delivery. Understanding the...

ORIGINAL ARTICLE: Monovalent Type 1 Oral Poliovirus Vaccine in Newborns

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Background: In 1988, the World Health Assembly resolved to eradicate poliomyelitis. Although substantial progress toward this goal has been made, eradication remains elusive. In 2004, the World Health Organization called...

CORRESPONDENCE: Antigenically Distinct MF59-Adjuvanted Vaccine to Boost Immunity to H5N1

Thu, 09Â OctÂ 2008 00:00:00 -05:00

To the Editor: Antigenically distinct avian influenza A (H5N1) viruses are widely dispersed.1 Clade 1 H5N1 viruses previously predominated in Indochina. Indonesian, Eurasian, and African viruses are clustered in a...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Insights into Inflammation and Influenza

Cameron Simmons, Ph.D., and Jeremy Farrar, M.D., D.Phil. — Thu, 09Â OctÂ 2008 00:00:00 -05:00

The emergence of highly pathogenic avian influenza H5N1 viruses in Asia and their spread globally have delivered a timely reminder of the public health and clinical challenges an influenza pandemic...

REVIEW ARTICLE: Hepatitis B Virus Infection

Jules L. Dienstag, M.D. — Thu, 02Â OctÂ 2008 00:00:00 -05:00

Reports of successful antiviral therapy for chronic hepatitis B virus (HBV) infection appeared three decades ago,1 and during the past decade, progress has accelerated dramatically. Along with progress, however, has...

CORRESPONDENCE: Fatal Oseltamivir-Resistant Influenza Virus Infection

Thu, 04Â SepÂ 2008 00:00:00 -05:00

To the Editor: The incidence of influenza A (H1N1) viruses that carry the neuraminidase H274Y mutation has increased by 30% this year in the Netherlands.1 Influenza A (H1N1) viruses that...

CORRESPONDENCE: Human Papillomavirus Vaccine in Males

Mark A. Goldstein, M.D. — Thu, 21Â AugÂ 2008 00:00:00 -05:00

To the Editor: In 2006, the Food and Drug Administration (FDA) licensed the human papillomavirus (HPV) vaccine for use in females 9 to 26 years old. The vaccine helps prevent...

EDITORIAL: Human Papillomavirus Vaccination â Reasons for Caution

Charlotte J. Haug, M.D., Ph.D. — Thu, 21Â AugÂ 2008 00:00:00 -05:00

Despite great expectations and promising results of clinical trials, we still lack sufficient evidence of an effective vaccine against cervical cancer. Several strains of human papillomavirus (HPV) can cause cervical...

SPECIAL ARTICLE: Health and Economic Implications of HPV Vaccination in the United States

Jane J. Kim, Ph.D., and Sue J. Goldie, M.D., M.P.H. — Thu, 21Â AugÂ 2008 00:00:00 -05:00

Background: The cost-effectiveness of prophylactic vaccination against human papillomavirus types 16 (HPV-16) and 18 (HPV-18) is an important consideration for guidelines for immunization in the United States.

Methods: We synthesized epidemiologic...

ORIGINAL ARTICLE: HHV-6A in Syncytial Giant-Cell Hepatitis

Thu, 07Â AugÂ 2008 00:00:00 -05:00

Syncytial giant-cell hepatitis is a rare but severe form of hepatitis that is associated with autoimmune diseases, drug reactions, and viral infections. We used serologic, molecular, and immunohistochemical methods to...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2008 â A 52-Year-Old Woman with Fever and Confusion

Thu, 17Â JulÂ 2008 00:00:00 -05:00

Dr. Marylyn M. Addo (Infectious Disease): A 52-year-old woman was admitted to this hospital in late summer because of fever and confusion. The patient had been well until 9 days...

REVIEW ARTICLE: The Challenge of HIV-1 Subtype Diversity

Thu, 10Â AprÂ 2008 00:00:00 -05:00

Nearly 27 years after the first reported cases of the acquired immunodeficiency syndrome (AIDS) and 25 years after the discovery of the etiologic agent, effective control of the AIDS pandemic...

ORIGINAL ARTICLE: Effect of Herpes Simplex Suppression on Incidence of HIV among Women in Tanzania

Thu, 10Â AprÂ 2008 00:00:00 -05:00

Background: Infection with herpes simplex virus type 2 (HSV-2) is associated with an increased risk of acquiring infection with the human immunodeficiency virus (HIV). This study tested the hypothesis that...

PERSPECTIVE: Challenges to HIV Prevention â Seeking Effective Measures in the Absence of a Vaccine

Thu, 10Â AprÂ 2008 00:00:00 -05:00

In this issue of the Journal, Watson-Jones et al. (pages 1560â1571) report anxiously awaited findings about a strategy for preventing infection with the human immunodeficiency virus (HIV) by pharmacologically suppressing...

ORIGINAL ARTICLE: A New Arenavirus in a Cluster of Fatal Transplant-Associated Diseases

Thu, 06Â MarÂ 2008 00:00:00 -05:00

Background: Three patients who received visceral-organ transplants from a single donor on the same day died of a febrile illness 4 to 6 weeks after transplantation. Culture, polymerase-chain-reaction (PCR) and...

PERSPECTIVE: The New Age of Molecular Diagnostics for Microbial Agents

Thu, 06Â MarÂ 2008 00:00:00 -05:00

How, in this era of molecular diagnostic tests, can we best determine whether there is a causal relationship between the presence of a genetic signature of an infectious agent and...

ORIGINAL ARTICLE: Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Hepatitis E virus (HEV) is considered an agent responsible for acute hepatitis that does not progress to chronic hepatitis. We identified 14 cases of acute HEV infection in three patients...

ORIGINAL ARTICLE: Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

Thu, 24Â JanÂ 2008 00:00:00 -05:00

Complete hematopoietic chimerism and tolerance of a liver allograft from a deceased male donor developed in a 9-year-old girl, with no evidence of graft-versus-host disease 17 months after transplantation. The...

REVIEW ARTICLE: Update on Avian Influenza A (H5N1) Virus Infection in Humans

Thu, 17Â JanÂ 2008 00:00:00 -05:00

The unprecedented epizootic of avian influenza A (H5N1) viruses among birds continues to cause human disease with high mortality and to pose the threat of a pandemic. This review updates...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Small RNAs and Large DNA Viruses

Jay A. Nelson, Ph.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

Although most human cytomegalovirus (CMV) infections are asymptomatic, CMV is a significant pathogen in immunosuppressed patients such as patients with AIDS and those who receive immunosuppressive therapy after solid-organ or...

ORIGINAL ARTICLE: Telbivudine versus Lamivudine in Patients with Chronic Hepatitis B

Thu, 20Â DecÂ 2007 00:00:00 -05:00

Background: Reducing hepatitis B virus (HBV) replication to minimal levels is emerging as a key therapeutic goal for chronic hepatitis B.

Methods: In this double-blind, phase 3 trial, 1370 patients with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2007 â A 30-Year-Old Man with Inflammatory Bowel Disease and Recent Onset of Fever and Bloody Diarrhea

Thu, 15Â NovÂ 2007 00:00:00 -05:00

Dr. Patrick S. Yachimski (Gastroenterology): A 30-year-old Moroccan man was admitted to this hospital because of fever, abdominal pain, and bloody diarrhea.

The patient had a history of inflammatory bowel disease...

ORIGINAL ARTICLE: Duration of Humoral Immunity to Common Viral and Vaccine Antigens

Ian J. Amanna, Ph.D., Nichole E. Carlson, Ph.D., and Mark K. Slifka, Ph.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

Background: Maintenance of long-term antibody responses is critical for protective immunity against many pathogens. However, the duration of humoral immunity and the role played by memory B cells remain poorly...

CLINICAL PROBLEM-SOLVING: No Respecter of Age â A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier

Don R. Martin, M.D., D. William Schlott, M.D., and John A. Flynn, M.D., M.B.A. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier. She...

IMAGES IN CLINICAL MEDICINE: Herpes Labialis

Julian W. Tang, M.D. and Paul K.S. Chan, M.D. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

A 68-year-old man with a history of asthma and chronic obstructive pulmonary disease was admitted to our hospital with a 1-day history of dyspnea, fever, and epigastric and chest pain....

EDITORIAL: Another Success for Hepatitis A Vaccine

Carol J. Baker, M.D. — Thu, 25Â OctÂ 2007 00:00:00 -05:00

Before the licensure of the first inactivated hepatitis A vaccine in 1995, hepatitis A caused a substantial disease burden in the United States. Annual cases reported to the Centers for...

ORIGINAL ARTICLE: Hepatitis A Vaccine versus Immune Globulin for Postexposure Prophylaxis

Thu, 25Â OctÂ 2007 00:00:00 -05:00

Background: Hepatitis A vaccine administered to persons after exposure to the hepatitis A virus has not been compared directly with immune globulin, which is known to be highly effective in...

EDITORIAL: Bell's Palsy â Is Glucocorticoid Treatment Enough?

Donald H. Gilden, M.D., and Kenneth L. Tyler, M.D. — Thu, 18Â OctÂ 2007 00:00:00 -05:00

Approximately a third of cases of acute peripheral facial weakness are caused by trauma, diabetes mellitus, hypertension, eclampsia, the Ramsay Hunt syndrome (facial palsy with zoster oticus caused by varicellaâzoster...

EDITORIAL: Molecular Screening for Cervical Cancer â Time to Give up Pap Tests?

Carolyn D. Runowicz, M.D. — Thu, 18Â OctÂ 2007 00:00:00 -05:00

In 1943, Papanicolaou and Traut published their famous monograph on vaginal cytology as a screening method for uterine cancer.1 Since then, the Papanicolaou (Pap) smear has become the most commonly...

ORIGINAL ARTICLE: Early Treatment with Prednisolone or Acyclovir in Bell's Palsy

Thu, 18Â OctÂ 2007 00:00:00 -05:00

Background: Corticosteroids and antiviral agents are widely used to treat the early stages of idiopathic facial paralysis (i.e., Bell's palsy), but their effectiveness is uncertain.

Methods: We conducted a double-blind, placebo-controlled,...

ORIGINAL ARTICLE: Human Papillomavirus and Papanicolaou Tests to Screen for Cervical Cancer

Thu, 18Â OctÂ 2007 00:00:00 -05:00

Background: Screening for cervical cancer based on testing for human papillomavirus (HPV) increases the sensitivity of detection of high-grade (grade 2 or 3) cervical intraepithelial neoplasia, but whether this gain...

ORIGINAL ARTICLE: Human Papillomavirus DNA versus Papanicolaou Screening Tests for Cervical Cancer

Thu, 18Â OctÂ 2007 00:00:00 -05:00

Background: To determine whether testing for DNA of oncogenic human papillomaviruses (HPV) is superior to the Papanicolaou (Pap) test for cervical-cancer screening, we conducted a randomized trial comparing the two...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Viral Infections and Nonspecific Protection â Good or Bad?

Emil R. Unanue, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

Viruses, like many microbes, have complex and diverse relationships with the immune system. We need to kill or control viruses to survive as a species, but under special circumstances, we...

IMAGES IN CLINICAL MEDICINE: Herpetic Glossitis

Chih-Chieh Chan, M.D. and Hsien-Ching Chiu, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

A 75-year-old woman with more than a 10-year history of hypertension and diabetes mellitus reported a 3-day history of throat discomfort and white eruptions on the tongue. On examination, multiple...

PERSPECTIVE: Noroviruses â Challenges to Control

Thu, 13Â SepÂ 2007 00:00:00 -05:00

Acute infectious gastroenteritis is an extremely common illness, second in frequency only to acute respiratory illness among North American families. Although it had long been suspected that such illnesses were...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2007 â A 20-Year-Old Pregnant Woman with Altered Mental Status

Thu, 09Â AugÂ 2007 00:00:00 -05:00

A 20-year-old pregnant woman was admitted to this hospital at 26 weeks of gestation because of dizziness, confusion, and difficulty walking.

Ten weeks before admission, the patient had a positive result...

EDITORIAL: Shortened Therapy for Hepatitis C Virus Genotype 2 or 3 â Is Less More?

T. Jake Liang, M.D. — Thu, 12Â JulÂ 2007 00:00:00 -05:00

Infection with hepatitis C virus (HCV) is a major worldwide cause of chronic liver disease, cirrhosis, and liver cancer, which together represent a chief global public health burden. Therapy has...

ORIGINAL ARTICLE: Peginterferon Alfa-2a and Ribavirin for 16 or 24 Weeks in HCV Genotype 2 or 3

Thu, 12Â JulÂ 2007 00:00:00 -05:00

Background: Patients infected with hepatitis C virus (HCV) genotype 2 or 3 have sustained virologic response rates of approximately 80% after receiving treatment with peginterferon and ribavirin for 24 weeks....

EDITORIAL: Entecavir Surprise

Martin S. Hirsch, M.D. — Thu, 21Â JunÂ 2007 00:00:00 -05:00

The truly remarkable advances in the treatment of human immunodeficiency virus type 1 (HIV-1) infection have turned a once nearly uniform death sentence into a treatable condition. The survival benefits...

ORIGINAL ARTICLE: The HBV Drug Entecavir â Effects on HIV-1 Replication and Resistance

Thu, 21Â JunÂ 2007 00:00:00 -05:00

Entecavir, a drug approved by the Food and Drug Administration for the treatment of chronic hepatitis B virus (HBV) infection, is not believed to inhibit replication of human immunodeficiency virus...

EDITORIAL: Human Papillomaviruses in Head and Neck Carcinomas

Stina SyrjÃ¤nen, D.D.S., Ph.D. — Thu, 10Â MayÂ 2007 00:00:00 -05:00

Each year, almost 650,000 patients worldwide receive the diagnosis of head and neck cancer and some 350,000 die from this disease.1 Nearly 90% of these cancers are squamous-cell carcinomas. The...

EDITORIAL: HPV Vaccination â More Answers, More Questions

George F. Sawaya, M.D., and Karen Smith-McCune, M.D., Ph.D. — Thu, 10Â MayÂ 2007 00:00:00 -05:00

The availability of a âcancer vaccineâ has elicited enormous enthusiasm from the medical community and the public, culminating in advocacy for mandatory vaccination against human papillomavirus (HPV) and a recommendation...

EDITORIAL: Human Papillomavirus Vaccine â Opportunity and Challenge

Thu, 10Â MayÂ 2007 00:00:00 -05:00

In this issue of the Journal, we publish three Original Articles,123 two Perspective articles,45 two editorials,67 a letter to the editor,8 and an audio interview9 on the subject of human...

ORIGINAL ARTICLE: CaseâControl Study of Human Papillomavirus and Oropharyngeal Cancer

Thu, 10Â MayÂ 2007 00:00:00 -05:00

Background: Substantial molecular evidence suggests a role for human papillomavirus (HPV) in the pathogenesis of oropharyngeal squamous-cell carcinoma, but epidemiologic data have been inconsistent.

Methods: We performed a hospital-based, caseâcontrol study...

ORIGINAL ARTICLE: Quadrivalent Vaccine against Human Papillomavirus to Prevent Anogenital Diseases

Thu, 10Â MayÂ 2007 00:00:00 -05:00

Background: A phase 3 trial was conducted to evaluate the efficacy of a prophylactic quadrivalent vaccine in preventing anogenital diseases associated with human papillomavirus (HPV) types 6, 11, 16, and...

ORIGINAL ARTICLE: Quadrivalent Vaccine against Human Papillomavirus to Prevent High-Grade Cervical Lesions

The FUTURE II Study Group — Thu, 10Â MayÂ 2007 00:00:00 -05:00

Background: Human papillomavirus types 16 (HPV-16) and 18 (HPV-18) cause approximately 70% of cervical cancers worldwide. A phase 3 trial was conducted to evaluate a quadrivalent vaccine against HPV types...

PERSPECTIVE: Introducing HPV Vaccine in Developing Countries â Key Challenges and Issues

Thu, 10Â MayÂ 2007 00:00:00 -05:00

More than any other cancer, cervical cancer reflects striking global health inequity. It is the second most common cancer among women worldwide, with about 493,000 new cases diagnosed annually (see...

PERSPECTIVE: Politics, Parents, and Prophylaxis â Mandating HPV Vaccination in the United States

Thu, 10Â MayÂ 2007 00:00:00 -05:00

Cancer prevention has fallen victim to the culture wars. Throughout the United States, state legislatures are scrambling to respond to the availability of Merck's human papillomavirus (HPV) vaccine, Gardasil, and...

ORIGINAL ARTICLE: Randomized, Placebo-Controlled Trial of Inactivated Poliovirus Vaccine in Cuba

The Cuba IPV Study Collaborative Group — Thu, 12Â AprÂ 2007 00:00:00 -05:00

Background: After poliomyelitis has been eradicated, access to live polioviruses will be highly restricted and the use of oral poliovirus vaccine (OPV) will probably be discontinued. Countries using OPV must...

IMAGES IN CLINICAL MEDICINE: Conjunctival Viral Papilloma

Wasee Tulvatana, M.D. and Kittisak Kulvichit, M.D. — Thu, 29Â MarÂ 2007 00:00:00 -05:00

A healthy 9-year-old boy had a 1-year history of an itchy right eye with frequent tearing. Small masses that gradually developed in the right caruncula lacrimalis area were associated with...

CLINICAL THERAPEUTICS: VaricellaâZoster Vaccine for the Prevention of Herpes Zoster

David W. Kimberlin, M.D., and Richard J. Whitley, M.D. — Thu, 29Â MarÂ 2007 00:00:00 -05:00

A 64-year-old man presents to his internist for his annual examination. He has been in good general health, although he received a diagnosis of pneumonia 8 months ago, for which...

ORIGINAL ARTICLE: Neurodevelopment and Cognition in Children after Enterovirus 71 Infection

Thu, 22Â MarÂ 2007 00:00:00 -05:00

Background: Enterovirus 71 is a common cause of hand, foot, and mouth disease and encephalitis in Asia and elsewhere. The long-term neurologic and psychiatric effects of this viral infection on...

PERSPECTIVE: Enterovirus DÃ©jÃ Vu

Thu, 22Â MarÂ 2007 00:00:00 -05:00

More than 90 human enterovirus serotypes have now been identified in three distinct waves of discovery. The three poliovirus serotypes were first isolated from nonhuman primates in the course of...

ORIGINAL ARTICLE: Loss of Vaccine-Induced Immunity to Varicella over Time

Thu, 15Â MarÂ 2007 00:00:00 -05:00

Background: The introduction of universal varicella vaccination in 1995 has substantially reduced varicella-related morbidity and mortality in the United States. However, it remains unclear whether vaccine-induced immunity wanes over time,...

EDITORIAL: Hepatitis E Vaccine â Ready for Prime Time?

Krzysztof Krawczynski, M.D., Ph.D. — Thu, 01Â MarÂ 2007 00:00:00 -05:00

Large outbreaks of hepatitis E virus (HEV) infection were first recognized as a distinct clinical entity in the early 1980s.12 Outbreaks continue and involve thousands of patients in certain geographic...

ORIGINAL ARTICLE: Safety and Efficacy of a Recombinant Hepatitis E Vaccine

Thu, 01Â MarÂ 2007 00:00:00 -05:00

Background: Hepatitis E virus (HEV) is an important cause of viral hepatitis. We evaluated the safety and efficacy of an HEV recombinant protein (rHEV) vaccine in a phase 2, randomized,...

EDITORIAL: Synergistic Copathogens â HIV-1 and HSV-2

Lawrence Corey, M.D. — Thu, 22Â FebÂ 2007 00:00:00 -05:00

The variability in both the clinical progression and transmission of human immunodeficiency virus (HIV) infection has prompted a search for cofactors influencing replication of the virus. Although it is clear...

ORIGINAL ARTICLE: Reduction of HIV-1 RNA Levels with Therapy to Suppress Herpes Simplex Virus

Thu, 22Â FebÂ 2007 00:00:00 -05:00

Background: Epidemiologic data suggest that infection with herpes simplex virus type 2 (HSV-2) is associated with increased genital shedding of human immunodeficiency virus type 1 (HIV-1) RNA and HIV-1 transmissibility.

Methods:...

EDITORIAL: Different Approaches to Influenza Vaccination

Keiji Fukuda, M.D., M.P.H., and Marie Paule Kieny, Ph.D. — Thu, 14Â DecÂ 2006 00:00:00 -05:00

In this issue of the Journal, two important and timely studies address basic questions related to the use and performance of influenza vaccines.12 The findings are also informative because both...

ORIGINAL ARTICLE: Effectiveness of School-Based Influenza Vaccination

Thu, 14Â DecÂ 2006 00:00:00 -05:00

Background: Vaccination of children in school is one strategy to reduce the spread of influenza in households and communities.

Methods: We identified 11 demographically similar clusters of elementary schools in four...

ORIGINAL ARTICLE: Prevention of Antigenically Drifted Influenza by Inactivated and Live Attenuated Vaccines

Thu, 14Â DecÂ 2006 00:00:00 -05:00

Background: The efficacy of influenza vaccines may decline during years when the circulating viruses have antigenically drifted from those included in the vaccine.

Methods: We carried out a randomized, double-blind, placebo-controlled...

PERSPECTIVE: The Eradication of Polio â Progress and Challenges

Thu, 14Â DecÂ 2006 00:00:00 -05:00

Six years after the original 2000 target date for the global eradication of polio, public health workers are encountering several stumbling blocks. Poliovirus circulation persists in countries where the virus...

EDITORIAL: Thiazolidinediones for Nonalcoholic Steatohepatitis â Promising but Not Ready for Prime Time

Arthur J. McCullough, M.D. — Thu, 30Â NovÂ 2006 00:00:00 -05:00

Mostly unrecognized before 1980, nonalcoholic fatty liver disease now affects all fields of clinical medicine and is the most common form of chronic liver disease in the United States.1 The...

ORIGINAL ARTICLE: A Placebo-Controlled Trial of Pioglitazone in Subjects with Nonalcoholic Steatohepatitis

Thu, 30Â NovÂ 2006 00:00:00 -05:00

Background: No pharmacologic therapy has conclusively proved to be effective for the treatment of nonalcoholic steatohepatitis, which is characterized by insulin resistance, steatosis, and necroinflammation with or without centrilobular fibrosis....

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Key Role for a Viral Lytic Gene in Kaposi's Sarcoma

Robert Yarchoan, M.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

Several types of cancer, including the majority of those typically associated with AIDS, are caused by gammaherpesviruses. Herpesviruses undergo both latent and lytic infection; most research on herpesvirus-induced tumors has...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2006 â A 41-Year-Old Man with Dyspnea, Fever, and Lymphadenopathy

David T. Scadden, M.D., Victorine V. Muse, M.D., and Robert P. Hasserjian, M.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

A 41-year-old man was admitted to the hospital because of shortness of breath and fever. He had been well until 7 months earlier, when a rash and wheezing developed after...

ORIGINAL ARTICLE: Transmission of Human Herpesvirus 8 by Blood Transfusion

Thu, 28Â SepÂ 2006 00:00:00 -05:00

Background: Whether human herpesvirus 8 (HHV-8) is transmissible by blood transfusion remains undetermined. We evaluated the risk of HHV-8 transmission by blood transfusion in Uganda, where HHV-8 is endemic.

Methods: We...

IMAGES IN CLINICAL MEDICINE: Regression of Optociliary Shunt Vessels

Adrienne Ruth, M.D. and Nancy J. Newman, M.D. — Thu, 21Â SepÂ 2006 00:00:00 -05:00

A previously healthy 53-year-old man presented with headache, blurred vision, and pulsatile tinnitus. A lumbar puncture demonstrated meningitis with increased intracranial pressure (opening pressure, 37 cm H2O), with a white-cell...

ORIGINAL ARTICLE: Marburg Hemorrhagic Fever Associated with Multiple Genetic Lineages of Virus

Thu, 31Â AugÂ 2006 00:00:00 -05:00

Background: An outbreak of Marburg hemorrhagic fever was first observed in a gold-mining village in northeastern Democratic Republic of the Congo in October 1998.

Methods: We investigated the outbreak of Marburg...

PERSPECTIVE: Marburg Hemorrhagic Fever â The Forgotten Cousin Strikes

Thu, 31Â AugÂ 2006 00:00:00 -05:00

More than 30 years after the discovery of Marburg virus as the causative agent of an outbreak of severe viral hemorrhagic fever in Germany and the former Yugoslavia in 1967,...

IMAGES IN CLINICAL MEDICINE: Salt-and-Pepper Retinopathy of Rubella

Rahul N. Khurana, M.D. and Srinivas R. Sadda, M.D. — Thu, 03Â AugÂ 2006 00:00:00 -05:00

A 39-year-old woman presented at a clinic for a second opinion regarding a diagnosis of age-related macular degeneration, which had been noted on routine ophthalmologic examination. She reported having no...

IMAGES IN CLINICAL MEDICINE: Abdominal Pseudohernia Due to Herpes Zoster

N. Troy Tagg, M.D. and Jack W. Tsao, M.D., D.Phil. — Thu, 06Â JulÂ 2006 00:00:00 -05:00

A vesicular rash of the right T11âT12 dermatomes developed in a 75-year-old man. Four weeks later, as the rash was resolving (Panel A), he noticed a protrusion of the right...

ORIGINAL ARTICLE: Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women

Thu, 22Â JunÂ 2006 00:00:00 -05:00

Background: To evaluate whether the use of male condoms reduces the risk of male-to-female transmission of human papillomavirus (HPV) infection, longitudinal studies explicitly designed to evaluate the temporal relationship between...

ORIGINAL ARTICLE: Transmission of Lymphocytic Choriomeningitis Virus by Organ Transplantation

Thu, 25Â MayÂ 2006 00:00:00 -05:00

Background: In December 2003 and April 2005, signs and symptoms suggestive of infection developed in two groups of recipients of solid-organ transplants. Each cluster was investigated because diagnostic evaluations were...

PERSPECTIVE: Lymphocytic Choriomeningitis Virus â An Old Enemy up to New Tricks

Thu, 25Â MayÂ 2006 00:00:00 -05:00

Lymphocytic choriomeningitis virus (LCMV) was among the first human pathogenic viruses to be isolated. In the mid-1930s, Armstrong and Lillie obtained a filterable agent thought to be from the brain...

CLINICAL PROBLEM-SOLVING: A Jaundiced Eye

Thu, 06Â AprÂ 2006 00:00:00 -05:00

A previously healthy 27-year-old man presented to his primary care physician six days after the onset of a nonproductive cough, sore throat, and a feeling of being ârun down.â During...

PERSPECTIVE: Preventing Cervical Cancer in the Developing World

Thu, 16Â MarÂ 2006 00:00:00 -05:00

The Pap smear has transformed cervical cancer from a leading killer to a rare disease in the United States. But few countries have the resources and infrastructure necessary to run...

PERSPECTIVE: The Potential of Human Papillomavirus Vaccines

Thu, 16Â MarÂ 2006 00:00:00 -05:00

The anticipated licensure within the next three months of a vaccine against human papillomavirus (HPV) would represent a major public health advance against cervical cancer and other, less common cancers,...

EDITORIAL: Hepatitis B â Preventable and Now Treatable

Jay H. Hoofnagle, M.D. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

Chronic infection with hepatitis B virus (HBV) accounts for an enormous burden of disease worldwide, including up to half of all cases of cirrhosis, end-stage liver disease, and hepatocellular carcinoma.1...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Silencing Herpes Simplex Virus with a Vaginal Microbicide

David C. Johnson, Ph.D. — Thu, 02Â MarÂ 2006 00:00:00 -05:00

The use of RNA interference (RNAi) as an experimental tool to analyze mammalian gene function has increased dramatically over the past five years. Its application to animal models of human...

PERSPECTIVE: Antiviral Resistance in Influenza Viruses â Implications for Management and Pandemic Response

Thu, 23Â FebÂ 2006 00:00:00 -05:00

The Centers for Disease Control and Prevention (CDC) recently issued an alert instructing clinicians to avoid using M2 ion-channel inhibitors (amantadine and rimantadine) during the current influenza season because amantadine...

ORIGINAL ARTICLE: Oseltamivir Resistance during Treatment of Influenza A (H5N1) Infection

Thu, 22Â DecÂ 2005 00:00:00 -05:00

Influenza A (H5N1) virus with an amino acid substitution in neuraminidase conferring high-level resistance to oseltamivir was isolated from two of eight Vietnamese patients during oseltamivir treatment. Both patients died...

PERSPECTIVE: The Run on Tamiflu â Should Physicians Prescribe on Demand?

Thu, 22Â DecÂ 2005 00:00:00 -05:00

âDoctor, I need a prescription for that bird flu drug.â If recent newspaper headlines are any indication,1 this request has been repeated tens of thousands of times around the country...

PERSPECTIVE: Oseltamivir Resistance â Disabling Our Influenza Defenses

Thu, 22Â DecÂ 2005 00:00:00 -05:00

As the potential for an influenza pandemic has galvanized the medical community and the public into action, physicians and patients alike have been heartened by the availability of effective antiviral...

ORIGINAL ARTICLE: Influenza-Associated Deaths among Children in the United States, 2003â2004

Thu, 15Â DecÂ 2005 00:00:00 -05:00

Background: Although influenza is common among children, pediatric mortality related to laboratory-confirmed influenza has not been assessed nationally.

Methods: During the 2003â2004 influenza season, we requested that state health departments report...

PERSPECTIVE: Influenza â Interpandemic as Well as Pandemic Disease

Thu, 15Â DecÂ 2005 00:00:00 -05:00

Influenza occurs in both pandemic and interpandemic forms. Fortunately, pandemics, defined as worldwide outbreaks of severe disease, occur infrequently. Interpandemic influenza, although less extensive in its impact, occurs virtually every...

PERSPECTIVE: The Origins of Pandemic Influenza â Lessons from the 1918 Virus

Thu, 24Â NovÂ 2005 00:00:00 -05:00

The completion of the genetic sequencing of the 1918 influenza A virus by Taubenberger et al.1 and the subsequent recovery of the virus by Tumpey et al.2 using reverse genetic...

EDITORIAL: Pertussis â A Disease and Vaccine for All Ages

Scott A. Halperin, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

There is increasing evidence and awareness that pertussis is not just a disease of children. Although most severe disease and almost all mortality occur in young infants, the overall disease...

ORIGINAL ARTICLE: Efficacy of an Acellular Pertussis Vaccine among Adolescents and Adults

Thu, 13Â OctÂ 2005 00:00:00 -05:00

Background: Pertussis immunization of adults may be necessary to improve the control of a rising burden of disease and infection. This trial of an acellular pertussis vaccine among adolescents and...

EDITORIAL: Immunotherapy for Congenital Cytomegalovirus Infection

Patrick Duff, M.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

Cytomegalovirus (CMV) is an extremely important perinatal pathogen. Each year, approximately 1 percent of susceptible women seroconvert during pregnancy. Although sexual transmission of CMV can occur, most pregnant women acquire...

REVIEW ARTICLE: Avian Influenza A (H5N1) Infection in Humans

Thu, 29Â SepÂ 2005 00:00:00 -05:00

An unprecedented epizootic avian influenza A (H5N1) virus that is highly pathogenic has crossed the species barrier in Asia to cause many human fatalities and poses an increasing pandemic threat....

REVIEW ARTICLE: Neuraminidase Inhibitors for Influenza

Anne Moscona, M.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

The impact of influenza infection is felt globally each year when the disease develops in approximately 20 percent of the world's population. In the United States, influenza infections occur in...

ORIGINAL ARTICLE: Passive Immunization during Pregnancy for Congenital Cytomegalovirus Infection

Thu, 29Â SepÂ 2005 00:00:00 -05:00

Background: Currently, there is no effective intervention for a primary cytomegalovirus (CMV) infection during pregnancy.

Methods: We studied pregnant women with a primary CMV infection. The therapy group comprised women whose...

EDITORIAL: Hepatitis A â The Price of Progress

Loriana Di Giammarino, M.D., and Jules L. Dienstag, M.D. — Thu, 01Â SepÂ 2005 00:00:00 -05:00

Hepatitis A tends to be a self-limited disease without serious sequelae and with a low case fatality rate1; unlike hepatitis B and hepatitis C, hepatitis A is not a cause...

EDITORIAL: Intravenous Fluids â Getting the Balance Right

Thu, 01Â SepÂ 2005 00:00:00 -05:00

Acute infections are a major cause of illness and death in children worldwide. In Africa, 50 percent of in-hospital deaths of children occur within 24 hours of admission, and shock...

REVIEW ARTICLE: Dengue in Travelers

Annelies Wilder-Smith, M.D., Ph.D., and Eli Schwartz, M.D. — Thu, 01Â SepÂ 2005 00:00:00 -05:00

Dengue virus infection is increasingly recognized as one of the world's major emerging infectious diseases.123 Dengue is endemic in most tropical and subtropical countries, many of which are popular tourist...

ORIGINAL ARTICLE: An Outbreak of Hepatitis A Associated with Green Onions

Thu, 01Â SepÂ 2005 00:00:00 -05:00

Background: In November 2003, a large hepatitis A outbreak was identified among patrons of a single Pennsylvania restaurant. We investigated the cause of the outbreak and factors that contributed to...

ORIGINAL ARTICLE: Comparison of Three Fluid Solutions for Resuscitation in Dengue Shock Syndrome

Thu, 01Â SepÂ 2005 00:00:00 -05:00

Background: Dengue shock syndrome is characterized by severe vascular leakage and disordered hemostasis and progresses to death in 1 to 5 percent of cases. Although volume replacement is recognized as...

EDITORIAL: Problem Solved? West Nile Virus and Transfusion Safety

Lyle R. Petersen, M.D., M.P.H., and Jay S. Epstein, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

In 2002, just three years after its appearance in the Western Hemisphere, West Nile virus caused the largest outbreak of arboviral encephalitis ever recorded in the United States.1 Epidemiologic investigations...

ORIGINAL ARTICLE: Screening the Blood Supply for West Nile Virus RNA by Nucleic Acid Amplification Testing

Thu, 04Â AugÂ 2005 00:00:00 -05:00

Background: The use of nucleic acid amplification tests of âminipoolsâ of 16 samples to screen blood donors for West Nile virus RNA began in July 2003. We report the yield...

ORIGINAL ARTICLE: West Nile Virus among Blood Donors in the United States, 2003 and 2004

Thu, 04Â AugÂ 2005 00:00:00 -05:00

Background: 05080428.xml West Nile virus first appeared in the United States in 1999 and has since spread throughout the contiguous states, resulting in thousands of cases of disease. By 2002,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2005 â An 81-Year-Old Man with Cough, Fever, and Altered Mental Status

Harry Hollander, M.D., Pamela W. Schaefer, M.D., and E. Tessa Hedley-Whyte, M.D. — Thu, 21Â JulÂ 2005 00:00:00 -05:00

Dr. Sherry Chou (Neurology): An 81-year-old man was admitted to the Massachusetts General Hospital in September because of fever, chills, productive cough, and diffuse weakness.

Two weeks before admission, a cough...

ORIGINAL ARTICLE: A Relapsing Inflammatory Syndrome and Active Human Herpesvirus 8 Infection

Thu, 14Â JulÂ 2005 00:00:00 -05:00

We describe an immunocompetent 61-year-old woman who was negative for human immunodeficiency virus and who had recurrent human herpesvirus 8 (HHV-8) infection associated with a relapsing systemic inflammatory syndrome characterized...

EDITORIAL: The Maze of Treatments for Hepatitis B

Anna Suk-Fong Lok, M.D. — Thu, 30Â JunÂ 2005 00:00:00 -05:00

Worldwide, there are approximately 350 million carriers of hepatitis B virus (HBV), of whom half a million to 1 million die from liver disease each year. The goal of treatment...

ORIGINAL ARTICLE: Peginterferon Alfa-2a, Lamivudine, and the Combination for HBeAg-Positive Chronic Hepatitis B

Thu, 30Â JunÂ 2005 00:00:00 -05:00

Background: Current treatments for chronic hepatitis B are suboptimal. In the search for improved therapies, we compared the efficacy and safety of pegylated interferon alfa plus lamivudine, pegylated interferon alfa...

ORIGINAL ARTICLE: Long-Term Therapy with Adefovir Dipivoxil for HBeAg-Negative Chronic Hepatitis B

Thu, 30Â JunÂ 2005 00:00:00 -05:00

Background: Treatment with adefovir dipivoxil for 48 weeks resulted in histologic, virologic, and biochemical improvement in patients with hepatitis B e antigen (HBeAg)ânegative chronic hepatitis B. We evaluated the effect...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: How Ebola Virus Infects Cells

Yoshihiro Kawaoka, D.V.M., Ph.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

Despite its isolation three decades ago, Ebola virus continues to cause periodic outbreaks of severe hemorrhagic fever in humans, and the closely related Marburg virus is responsible for a recent...

IMAGES IN CLINICAL MEDICINE: Mixed Cryoglobulinemia

Gary Josephsen, M.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

A 38-year-old woman presented with increasing abdominal fullness and a new rash on the lower extremities. She had a history of chronic hepatitis C infection, for which she had been...

ORIGINAL ARTICLE: Peginterferon Alfa-2b and Ribavirin for 12 vs. 24 Weeks in HCV Genotype 2 or 3

Thu, 23Â JunÂ 2005 00:00:00 -05:00

Background: We hypothesized that in patients with hepatitis C virus (HCV) genotype 2 or 3 in whom HCV RNA is not detectable after 4 weeks of therapy, 12 weeks of...

PERSPECTIVE: Marburg and Ebola â Arming Ourselves against the Deadly Filoviruses

C.J. Peters, M.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

As of May 26, 2005, the Angolan Ministry of Health had reported 399 cases of Marburg hemorrhagic fever, 335 of which were fatal. Even as this unprecedented spread of filovirus...

IMAGES IN CLINICAL MEDICINE: Recurrent Respiratory Papillomatosis with Lung Involvement

Daniel Glikman, M.D. and Fuad M. Baroody, M.D. — Thu, 16Â JunÂ 2005 00:00:00 -05:00

A five-year-old girl received the diagnosis of respiratory papillomatosis after an episode of respiratory distress in which the collapse of the right lung required intubation. During bronchoscopy, a single laryngeal...

PERSPECTIVE: Preparing for the Next Pandemic

Michael T. Osterholm, Ph.D., M.P.H. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

Annual influenza epidemics are like Minnesota winters â all are challenges, but some are worse than others. No matter how well we prepare, some blizzards take quite a toll. Each...

EDITORIAL: Immunosuppressive Drugs and the Risk of Cancer after Organ Transplantation

Jacques Dantal, M.D., Ph.D., and Jean-Paul Soulillou, M.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

Improvements in immunosuppressive therapy during the past decade have brought us closer to the day when long-term acceptance of organ allografts will be routine. These achievements, however, have run up...

ORIGINAL ARTICLE: Morphine, Gabapentin, or Their Combination for Neuropathic Pain

Thu, 31Â MarÂ 2005 00:00:00 -05:00

Background: The available drugs to treat neuropathic pain have incomplete efficacy and dose-limiting adverse effects. We compared the efficacy of a combination of gabapentin and morphine with that of each...

ORIGINAL ARTICLE: Transmission of Rabies Virus from an Organ Donor to Four Transplant Recipients

Thu, 17Â MarÂ 2005 00:00:00 -05:00

Background: In 2004, four recipients of kidneys, a liver, and an arterial segment from a common organ donor died of encephalitis of an unknown cause.

Methods: We reviewed the medical records...

ORIGINAL ARTICLE: A Population-Based Study of Primary Human Herpesvirus 6 Infection

Thu, 24Â FebÂ 2005 00:00:00 -05:00

Background: Serologic studies indicate that human herpesvirus 6 (HHV-6) infects 90 percent of children by two years of age. Little is known about the acquisition, virologic course, and clinical manifestations...

PERSPECTIVE: Sixth Disease and the Ubiquity of Human Herpesviruses

Charles Prober, M.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

Human herpesvirus 6 (HHV-6) is the cause of the sixth clinically distinct exanthematous disease of childhood. Measles virus, erythrogenic group A streptococci, and rubella virus are the causes of the...

ORIGINAL ARTICLE: Fatal Avian Influenza A (H5N1) in a Child Presenting with Diarrhea Followed by Coma

Thu, 17Â FebÂ 2005 00:00:00 -05:00

In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. The cerebrospinal fluid contained 1 white cell per cubic millimeter, normal glucose levels, and...

EDITORIAL: Avian Influenza and Pandemics â Research Needs and Opportunities

Klaus StÃ¶hr, Ph.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

As the year 2004 progressed, so did conditions favoring the start of an influenza pandemic. The first warning came in January, when Thailand and Vietnam reported fatal human cases of...

ORIGINAL ARTICLE: Probable Person-to-Person Transmission of Avian Influenza A (H5N1)

Thu, 27Â JanÂ 2005 00:00:00 -05:00

Background: During 2004, a highly pathogenic avian influenza A (H5N1) virus caused poultry disease in eight Asian countries and infected at least 44 persons, killing 32; most of these persons...

PERSPECTIVE: The Threat of an Avian Influenza Pandemic

Arnold S. Monto, M.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

There have been three influenza pandemics during the past century â in 1918, 1957, and 1968. Although the severity of the epidemics and the primary age groups affected varied, each...

CLINICAL PRACTICE: Prevention of Hepatitis B with the Hepatitis B Vaccine

Gregory A. Poland, M.D., and Robert M. Jacobson, M.D. — Thu, 30Â DecÂ 2004 00:00:00 -05:00

A 25-year-old registered nurse comes for a visit to initiate prenatal care after receiving a positive result on a pregnancy test. On review of her vaccination status, she reports that...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2004 â A 52-Year-Old Woman with Recurrent Episodes of Atypical Pneumonia

Thu, 23Â DecÂ 2004 00:00:00 -05:00

A 52-year-old woman was admitted to the hospital because of cough and dyspnea.

She had smoked two to three packs of cigarettes daily for 35 years. During the two decades before...

CLINICAL PRACTICE: Prophylaxis against Rabies

Charles E. Rupprecht, V.M.D., M.S., Ph.D., and Robert V. Gibbons, M.D., M.P.H. — Thu, 16Â DecÂ 2004 00:00:00 -05:00

A six-month-old girl presents for a âwell-babyâ appointment in New Jersey. The mother is concerned about a dead bat she found in the child's bedroom. A Virginia businessman relaxing on...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Genetic Archaeology of Influenza

Daniel F. Hoft, M.D., Ph.D., and Robert B. Belshe, M.D. — Thu, 09Â DecÂ 2004 00:00:00 -05:00

Over the past century, three influenza pandemics occurred because of the emergence of novel influenzaviruses to which little or no immunity existed. In 1918 and 1919, the âSpanishâ influenza pandemic...

PERSPECTIVE: Running Like Water â The Omnipresence of Hepatitis E

Suzanne U. Emerson, Ph.D., and Robert H. Purcell, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

Hepatitis E virus (HEV), originally identified as the culprit in massive waterborne epidemics of acute hepatitis in Asia, is now commanding attention in regions of Sudan and Iraq. And once...

PERSPECTIVE: Avian Influenza â A Challenge to Global Health Care Structures

Thu, 02Â DecÂ 2004 00:00:00 -05:00

The largest, most devastating outbreak of an infectious disease in modern history occurred in 1918, when a highly virulent influenza A (H1N1) virus spread throughout the world and killed between...

PERSPECTIVE: Westward Ho? â The Spread of West Nile Virus

Lyle R. Petersen, M.D., M.P.H., and Edward B. Hayes, M.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

West Nile virus, a mosquito-borne flavivirus, was first isolated from a febrile patient in the West Nile region of Uganda in 1937. For the next 60 years, it remained a...

PERSPECTIVE: From Culture to Vaccine â Salk and Sabin

Samuel L. Katz, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

The Nobel Prizeâwinning demonstration by John Enders, Frederick Robbins, and Thomas Weller that polioviruses could be propagated successfully in nonneural cell cultures paved the way for two brilliant, ambitious scientists...

PERSPECTIVE: Advances in Virology â Weller and Robbins

Martha L. Lepow, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

Book Review: This article reviews the book Growing Pathogens in Tissue Culture: Fifty Years in Academic Tropical Medicine, Pediatrics, and Virology, by Thomas H. Weller, published by Science History Publishers,...

PERSPECTIVE: Isolation of Poliovirus â John Enders and the Nobel Prize

Fred S. Rosen, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

When John Enders was informed, 50 years ago this month, that he was the sole recipient of the Nobel Prize in Medicine or Physiology for 1954, he declined the honor....

EDITORIAL: The Safety and Availability of Blood and Tissues â Progress and Challenges

Jesse L. Goodman, M.D., M.P.H. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

The availability of a safe blood supply is critical for both medical progress and national security. Safety has been increased by nucleic acidâamplification testing, as documented by Stramer et al....

ORIGINAL ARTICLE: Detection of HIV-1 and HCV Infections among Antibody-Negative Blood Donors by Nucleic AcidâAmplification Testing

Thu, 19Â AugÂ 2004 00:00:00 -05:00

Background: Testing of blood donors for human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) RNA by means of nucleic acid amplification was introduced in the United States...

ORIGINAL ARTICLE: Probability of Viremia with HBV, HCV, HIV, and HTLV among Tissue Donors in the United States

Thu, 19Â AugÂ 2004 00:00:00 -05:00

Background: Tissue-banking organizations in the United States have introduced various review and testing procedures to reduce the risk of the transmission of viral infections from tissue grafts. We estimated the...

PERSPECTIVE: Viral Entry Denied

Robert W. Doms, M.D., Ph.D. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

Until recently, antiviral drugs were both uncommon and not terribly potent. This has changed: during the past decade, more than 30 antiviral drugs have been licensed, and many of them...

ORIGINAL ARTICLE: Peginterferon Alfa-2a plus Ribavirin versus Interferon Alfa-2a plus Ribavirin for Chronic Hepatitis C in HIV-Coinfected Persons

Thu, 29Â JulÂ 2004 00:00:00 -05:00

Background: Chronic hepatitis C virus (HCV) infection is a cause of major complications in persons who are also infected with the human immunodeficiency virus (HIV). However, the treatment of HCV...

ORIGINAL ARTICLE: Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis C Virus Infection in HIV-Infected Patients

Thu, 29Â JulÂ 2004 00:00:00 -05:00

Background: Hepatitis C virus (HCV) infection is highly prevalent and is associated with substantial morbidity and mortality among persons infected with the human immunodeficiency virus (HIV). We compared the efficacy...

PERSPECTIVE: Treating Hepatitis C in âDifficult-to-Treatâ Patients

Jean-Michel Pawlotsky, M.D., Ph.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

The current standard treatment for chronic hepatitis C is the combination of pegylated interferon alfa and ribavirin, a synthetic guanosine analogue. In the pegylated form of interferon, the interferon alfa...

REVIEW ARTICLE: Flavivirus Encephalitis

Tom Solomon, M.D., Ph.D. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

During the summers of 2002 and 2003, North America was affected by its largest-ever outbreaks of arboviral encephalitis. West Nile virus caused 2942 cases of meningitis or encephalitis in 2002,...

PERSPECTIVE: Vestibular Neuritis, or Driving Dizzily through Donegal

Richard T. Johnson, M.D. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

Ten years ago, while touring the west coast of Ireland, I had a sudden onset of vertigo without hearing loss, tinnitus, or fullness in an ear. As a neurologist, I...

PERSPECTIVE: Milk of Human Kindness? â HAMLET, Human Papillomavirus, and Warts

Jan N. Bouwes Bavinck, M.D., Ph.D., and Mariet C.W. Feltkamp, M.D., Ph.D. — Thu, 24Â JunÂ 2004 00:00:00 -05:00

Cutaneous viral warts are common, benign, usually self-limited papillomas with a preference for the hands and feet. A wide range of local therapies based on destruction, keratolysis, immunostimulation, or antimitotic...

REVIEW ARTICLE: Pneumocystis Pneumonia

Charles F. Thomas, Jr., M.D., and Andrew H. Limper, M.D. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

Pneumocystis pneumonia remains the most prevalent opportunistic infection in patients infected with the human immunodeficiency virus (HIV).12 First identified as a protozoan nearly 100 years ago and reclassified as a...

ORIGINAL ARTICLE: Quantification of Plasma EpsteinâBarr Virus DNA in Patients with Advanced Nasopharyngeal Carcinoma

Thu, 10Â JunÂ 2004 00:00:00 -05:00

Background: We investigated the clinical significance of plasma concentrations of EpsteinâBarr virus (EBV) DNA in patients with advanced nasopharyngeal carcinoma.

Methods: Ninety-nine patients with biopsy-proven stage III or IV nasopharyngeal carcinoma...

ORIGINAL ARTICLE: Peginterferon Alfa-2b and Ribavirin for the Treatment of Chronic Hepatitis C in Blacks and Non-Hispanic Whites

Thu, 27Â MayÂ 2004 00:00:00 -05:00

Background: Several small studies have reported a lower response rate to interferon alfa among black patients with chronic hepatitis C infection than among white patients. The increased prevalence of infection...

CLINICAL PRACTICE: Genital Herpes

David W. Kimberlin, M.D., and Dwight J. Rouse, M.D., M.S.P.H. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

A 22-year-old woman presents to her gynecologist with genital lesions. Examination reveals bilateral labial ulcerations (Figure 1), cervical ulcerations, and mildly tender inguinal lymphadenopathy. To her knowledge, neither she nor...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2004 â A 66-Year-Old Man with Progressive Neurologic Deficits

Thu, 29Â AprÂ 2004 00:00:00 -05:00

A 66-year-old, right-handed man was admitted to the hospital because of progressive left-sided weakness.

Nineteen years before admission, the patient had received a renal transplant from a living related donor because...

REVIEW ARTICLE: Persistence of the EpsteinâBarr Virus and the Origins of Associated Lymphomas

David A. Thorley-Lawson, Ph.D., and Andrew Gross, M.D. — Thu, 25Â MarÂ 2004 00:00:00 -05:00

EpsteinâBarr virus (EBV) is perhaps best known for its ability to immortalize human B lymphocytes in culture.1 This property makes it a candidate for causing human disease, particularly cancer and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2004 â An 18-Year-Old Man with Respiratory Symptoms and Shock

Thu, 18Â MarÂ 2004 00:00:00 -05:00

Dr. I. David Todres (Pediatric Intensive Care): An eighteen-year-old man was admitted to the hospital in shock after a five-day illness.

The patient had been in good health until five...

ORIGINAL ARTICLE: Avian Influenza A (H5N1) in 10 Patients in Vietnam

Thu, 18Â MarÂ 2004 00:00:00 -05:00

Background: Recent outbreaks of avian influenza A (H5N1) in poultry throughout Asia have had major economic and health repercussions. Human infections with this virus were identified in Vietnam in January...

PERSPECTIVE: Crossing the Species Barrier â One Small Step to Man, One Giant Leap to Mankind

Mark S. Klempner, M.D., and Daniel S. Shapiro, M.D. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

On first setting foot on the moon, Neil Armstrong famously proclaimed that he had taken âOne small step for man, one giant leap for mankind.â With minor adjustments, he could...

REVIEW ARTICLE: Hepatitis B Virus Infection â Natural History and Clinical Consequences

Don Ganem, M.D., and Alfred M. Prince, M.D. — Thu, 11Â MarÂ 2004 00:00:00 -05:00

In the past 10 years, remarkable strides have been made in the understanding of the natural history and pathogenesis of hepatitis B virus (HBV) infection. In this article we will...

ORIGINAL ARTICLE: Persistent GB Virus C Infection and Survival in HIV-Infected Men

Thu, 04Â MarÂ 2004 00:00:00 -05:00

Background: GB virus C (GBV-C), which is not known to be pathogenic in humans, replicates in lymphocytes, inhibits the replication of human immunodeficiency virus (HIV) in vitro, and has been...

PERSPECTIVE: HIV and GB Virus C â Can Two Viruses Be Better Than One?

Roger J. Pomerantz, M.D., and Giuseppe Nunnari, M.D. — Thu, 04Â MarÂ 2004 00:00:00 -05:00

GB virus C (GBV-C), an RNA virus in the Flaviviridae family, is a close relative of the hepatitis C virus. Although it has been shown that many people worldwide are...

ORIGINAL ARTICLE: Use of the Inactivated Intranasal Influenza Vaccine and the Risk of Bell's Palsy in Switzerland

Thu, 26Â FebÂ 2004 00:00:00 -05:00

Background: After the introduction of an inactivated intranasal influenza vaccine that was used only in Switzerland, 46 cases of Bell's palsy were reported.

Methods: We conducted a matched caseâcontrol study and...

PERSPECTIVE: Nasal Vaccination, Enterotoxin, and Bell's Palsy

Robert B. Couch, M.D. — Thu, 26Â FebÂ 2004 00:00:00 -05:00

In 1997, a Swiss Company (Berna Biotech) received approval to market an inactivated influenza vaccine for parenteral administration that consists of the hemagglutinin and neuraminidase surface antigens of influenzavirus incorporated...

IMAGES IN CLINICAL MEDICINE: Use of Multinucleated Giant Cells to Diagnose a Viral Eruption

Frank C. Koranda, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

Part of the differential diagnosis of a vesicular eruption must include smallpox. The characteristic smallpox lesions â papulovesicular pustules â develop two to four days after an influenza-like prodrome. The...

PERSPECTIVE: Getting Polio Eradication Back on Track in Nigeria

Ebrahim Samba, M.D., Francis Nkrumah, M.D., M.P.H., and Rose Leke, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

The recent cancellation of polio-vaccination campaigns in several key northern Nigerian states where poliomyelitis is endemic1 has focused attention on this African country, which reported more cases of the disease...

IMAGES IN CLINICAL MEDICINE: Parvovirus B19 Infection

Shirley Chen, M.D. and Orion Howard, M.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

A 77-year-old man was admitted to the hospital with a three-week history of nausea, vomiting, pain in the right upper quadrant, and fever with chills. Laboratory studies showed that the...

REVIEW ARTICLE: Parvovirus B19

Neal S. Young, M.D., and Kevin E. Brown, M.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

Yvonne Cossart, an Australian virologist working in London in the mid-1970s, noted an anomalous reaction of a normal blood donor's serum (occupying position 19 in plate B) in an assay...

IMAGES IN CLINICAL MEDICINE: Hypoglossal-Nerve Palsy

Dimitrios I. Zafeiriou,, M.D., Ph.D. and Evangelos Pavlou, M.D. — Thu, 29Â JanÂ 2004 00:00:00 -05:00

A six-year-old boy was brought to the emergency department because of acute speech difficulties. Five days previously, a low-grade fever, sore throat, and malaise had developed. The day before presentation,...

CLINICAL PRACTICE: Prevention of Hepatitis A with the Hepatitis A Vaccine

Allen S. Craig, M.D., and William Schaffner, M.D. — Thu, 29Â JanÂ 2004 00:00:00 -05:00

A 34-year-old man presented to the emergency department two weeks after returning from a trip to India, reporting a six-day history of anorexia, vomiting, malaise, fatigue, and dark urine. His...

ORIGINAL ARTICLE: Human Metapneumovirus and Lower Respiratory Tract Disease in Otherwise Healthy Infants and Children

Thu, 29Â JanÂ 2004 00:00:00 -05:00

Background: We sought to determine the role of human metapneumovirus in lower respiratory tract illness in previously healthy infants and children.

Methods: We tested nasal-wash specimens, obtained over a 25-year period...

PERSPECTIVE: Human Metapneumovirus â An Important New Respiratory Virus

Kenneth McIntosh, M.D., and Alexander J. McAdam, M.D., Ph.D. — Thu, 29Â JanÂ 2004 00:00:00 -05:00

Physicians who have an interest in infectious diseases know well that many infections cannot be assigned a microbial cause. This gap between what we observe and what we can explain...

ORIGINAL ARTICLE: Tanapox Infection in a College Student

Thu, 22Â JanÂ 2004 00:00:00 -05:00

Tanapox infection is a poxvirus infection that is endemic to equatorial Africa. It begins with a febrile prodrome that is soon followed by the eruption of one or more large,...

ORIGINAL ARTICLE: The Detection of Monkeypox in Humans in the Western Hemisphere

Thu, 22Â JanÂ 2004 00:00:00 -05:00

Background: During May and June 2003, an outbreak of febrile illness with vesiculopustular eruptions occurred among persons in the midwestern United States who had had contact with ill pet prairie...

PERSPECTIVE: Poxvirus Zoonoses â Putting Pocks into Context

Sharon E. Frey, M.D., and Robert B. Belshe, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

Naturally occurring poxvirus infections affect humans and many species of animals and insects. Smallpox, the dreaded disease caused by the only human-specific orthopoxvirus pathogen, variola, was successfully eradicated in the...

PERSPECTIVE: Influenza Vaccine â Outmaneuvering Antigenic Shift and Drift

John Treanor, M.D. — Thu, 15Â JanÂ 2004 00:00:00 -05:00

The winter of 2003â2004 will be remembered as a year in which stories about influenza dominated the news and patients young and old clamored for influenza vaccination. This intense interest...

EDITORIAL: Use of Antiviral Drugs to Prevent Herpesvirus Transmission

Clyde S. Crumpacker, M.D. — Thu, 01Â JanÂ 2004 00:00:00 -05:00

One of the main lessons of antiviral-drug therapy is that the drugs that inhibit viral replication are frequently more effective at preventing viral disease than they are at treating established...

ORIGINAL ARTICLE: Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes

Thu, 01Â JanÂ 2004 00:00:00 -05:00

Background: Nucleoside analogues against herpes simplex virus (HSV) have been shown to suppress shedding of HSV type 2 (HSV-2) on genital mucosal surfaces and may prevent sexual transmission of HSV.

Methods:...

REVIEW ARTICLE: The Severe Acute Respiratory Syndrome

Thu, 18Â DecÂ 2003 00:00:00 -05:00

The severe acute respiratory syndrome (SARS) is responsible for the first pandemic of the 21st century. Within months after its emergence in Guangdong Province in mainland China, it had affected...

ORIGINAL ARTICLE: Transmission of the Severe Acute Respiratory Syndrome on Aircraft

Thu, 18Â DecÂ 2003 00:00:00 -05:00

Background: The severe acute respiratory syndrome (SARS) spread rapidly around the world, largely because persons infected with the SARS-associated coronavirus (SARS-CoV) traveled on aircraft to distant cities. Although many infected...

PERSPECTIVE: SARS â One Year Later

Donald E. Low, M.D., and Allison McGeer, M.D. — Thu, 18Â DecÂ 2003 00:00:00 -05:00

It was just over a year ago, in November 2002, that the first case of what was to become known as the severe acute respiratory syndrome (SARS) was identified in...

ORIGINAL ARTICLE: Characteristics of Hodgkin's Lymphoma after Infectious Mononucleosis

Thu, 02Â OctÂ 2003 00:00:00 -05:00

Background: Infectious mononucleosisârelated EpsteinâBarr virus (EBV) infection has been associated with an increased risk of Hodgkin's lymphoma in young adults. Whether the association is causal remains unclear.

Methods: We compared the...

PERSPECTIVE: Infection and Lymphoma

Richard Ambinder, M.D., Ph.D. — Thu, 02Â OctÂ 2003 00:00:00 -05:00

The persistence of the eponyms âHodgkinâ and âReedâSternbergâ and the noncommittal descriptor âdiseaseâ underscores the uncertainties long associated with the multinucleated giant cells that Sternberg believed to be a manifestation...

ORIGINAL ARTICLE: Transmission of West Nile Virus through Blood Transfusion in the United States in 2002

Thu, 25Â SepÂ 2003 00:00:00 -05:00

Background: During the 2002 West Nile virus epidemic in the United States, patients were identified whose West Nile virus illness was temporally associated with the receipt of transfused blood and...

PERSPECTIVE: Emerging Infections, Transfusion Safety, and Epidemiology

Roger Y. Dodd, Ph.D. — Thu, 25Â SepÂ 2003 00:00:00 -05:00

Over the past few decades, our optimism â or perhaps hubris â that infectious disease had been conquered has been overturned so completely that emerging infections are now a new...

ORIGINAL ARTICLE: Expression of Human Herpesvirus 8 in Primary Pulmonary Hypertension

Thu, 18Â SepÂ 2003 00:00:00 -05:00

Background: Severe pulmonary hypertension constitutes a group of diseases characterized by complex, lumen-occluding vascular lesions that develop in genetically susceptible persons. The only viral infection associated with severe pulmonary hypertension...

PERSPECTIVE: Kaposi's SarcomaâAssociated Herpesvirus â The High Cost of Viral Survival

Ethel Cesarman, M.D., Ph.D. — Thu, 18Â SepÂ 2003 00:00:00 -05:00

It has been almost 10 years and 2000 articles since the publication of the article identifying the etiologic agent of Kaposi's sarcoma, a virus appropriately called Kaposi's sarcomaâassociated herpesvirus (KSHV)...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2003 â A 50-Year-Old Colombian Man with Fever and Seizures

Thu, 21Â AugÂ 2003 00:00:00 -05:00

A 50-year-old man was admitted to the hospital because of fever, a seizure, and confusion.

The patient was a native of Colombia who had traveled to the United States six weeks...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2003 â A 38-Year-Old Woman with Fever, Headache, and Confusion

Martin S. Hirsch, M.D., and Barbara Werner, Ph.D. — Thu, 29Â MayÂ 2003 00:00:00 -05:00

A 38-year-old woman was admitted to the hospital in early August 2002 because of fever and confusion.

The patient had been well until four days earlier, when a headache gradually developed...

ORIGINAL ARTICLE: Transmission of West Nile Virus from an Organ Donor to Four Transplant Recipients

Thu, 29Â MayÂ 2003 00:00:00 -05:00

Background: In August 2002, fever and mental-status changes developed in recipients of organs from a common donor. Transmission of West Nile virus through organ transplantation was suspected.

Methods: We reviewed medical...

EDITORIAL: Case Clusters of the Severe Acute Respiratory Syndrome

Jeffrey M. Drazen, M.D. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

Just over three weeks ago, the World Health Organization (WHO) issued a worldwide notice about the severe acute respiratory syndrome (SARS). It described a rapidly progressive, sometimes fatal pneumonia that...

EDITORIAL: Faster . . . but Fast Enough? Responding to the Epidemic of Severe Acute Respiratory Syndrome

Julie Louise Gerberding, M.D., M.P.H. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

Severe acute respiratory syndrome (SARS) was diagnosed in more than 1800 patients in 17 countries (including the United States and Canada) between February 1 and March 31, 2003. During this...

IMAGES IN CLINICAL MEDICINE: Radiologic Manifestations of Severe Acute Respiratory Syndrome