A 20-month-old presented with fever, rash in the groin and trunk, swelling of hands and feet, and bilateral conjunctivitis. A diagnosis was made of Kawasaki Disease. The differential discussion raised the possibility of Staphylococcal Scalded Skin Syndrome. I did the following quick search in Ovid Medline to see if any articles discussed both problems:
1 Mucocutaneous Lymph Node Syndrome/ (3692)
2 Staphylococcal Scalded Skin Syndrome/ (241)
3 1 and 2 (3)
4 from 3 keep 1-3 (3)

Note that the official MeSH term for Kawasaki Disease is “mucocutaneous Lymph Node Syndrome. Of the 3 articles retrieved, a nice differential diagnosis discussion on fever and rash appeared in Pediatric Annals 36:1, 30-38, 2007.  Fever and Rash in a Child: When to Worry?

Excellent images of five key symptoms of Kawasaki Disease are available from the Children’s Hospital, Boston.

The case presented was a 6-year-old female admitted with painful red bumps in her mouth. Tongue was swollen and she had thick white plaque-like lesions in her mouth. A culture grew candida and a diagnosis of Crohn’s disease was made after endoscopy. Patient did not present with gastrointestinal symptoms.
Clinical question: Do studies show a relationship between candida and Crohn’s in a young patient?
The following general search was performed in Ovid Medline:
1 Crohn Disease/ (24359)
2 exp candida/ (28900)
3 1 and 2 (24)
4 exp Mouth/ (200349)
5 tongue/ (12614)
6 4 or 5 (212963)
7 3 and 6 (3)

Search Strategy: Using the MeSH (medical subject headings), I combined Crohn Disease (notice the official term is singular) with candida. I also “exploded” candida to include all of the more specific organisms. You can always see what exploding will include by clicking on the link for the term you are searching in Ovid. Exploding allows your search to cast a wider net. This combination only retrieved 24 articles. This review article from Current Opinion in Gastroenterology looked like it contained a good discussion:

Pathogenic agents in inflammatory bowel diseases

Adding the terms ‘mouth’ or tongue’ to our search narrowed the results down to just 3 articles, but none looked helpful. However, another study from the original 24 retrieved that focused on the immunological basis for developing candida in Crohn’s disease patients looked interesting:

Candida albicans Colonization and ASCA in Familial Crohn ’ s Disease

There was a question after this morning’s Morning Report session about whether or not prostatitis is associated with either MRSA or Fournier Gangrene. 

PubMed search strategy:

prostatitis and (mrsa or fournier)

Article: 

Methicillin-resistant Staphylcoccus aureus prostatitis. Urology. 2007 Apr;69(4):779.e1-3.   Authors:  Beckman TJ, Edson RS.

Abstract:

Clinical question:

In a 17 y/o male with a MRSA infection in his scrotum living in downtown Baltimore, MD, which antibiotic should be prescribed?

P: 17 y/o with MRSA

I: Bactrim

C: Clindamycin

O: Resolution of MRSA

PubMed Search strategy:

Sometimes PubMed works just like you wish it would everytime, this is one of those times.  I simply entered “bactrim clindamycin MRSA” into the main search box and was able to retrieve a reasonble amount of relevant articles without having to use any of the advanced PubMed tools.

Articles:

Trimethoprim-sulfamethoxazole or clindamycin for treatment of community-acquired methicillin-resistant Staphylococcus aureus skin and soft tissue infections.  Pediatr Infect Dis J. 2009 Jan;28(1):57-9.  Hyun DY, Mason EO, Forbes A, Kaplan SL.  (see page 5)

Using a drug information database, such as Micromedex can often be faster than PubMed when you want to compare two or more drugs.  In Micromedex, simply select “Compare Drug Summaries” and enter the drugs that you are interested in, then click “Compare Drugs” to get a side-by-side view of those drugs: