Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

Nontuberculous Mycobacterial Infections Obesity 1071

■Skin and Soft Tissue – M. marinum sensitive to clarithromycin,

ethambutol, doxycycline, minocycline, rifampin and trimethoprim-

sulfamethoxazole; two drugs used for at least 3 months; M. fortuitum

sensitive to amikacin, cefoxitin, trimethoprim-sulfamethoxazole,

erythromycin and ciprofloxacin; therapy based on sensitivity testing;

initial IV therapy for several weeks with two drugs intravenously, fol-

lowed by oral therapy with two drugs for 3 months after resolution

of lesions; surgical debridement may be needed

follow-up

■Pulmonary symptoms take months to improve, even with appropri-

ate therapy.

■Monthly sputum cultures until negative

■Periodic radiographic studies to ensure resolution

■Skin infections followed clinically

complications and prognosis

■Cure rate for pulmonary MAC 70–80%; progressive pulmonary insuf-

ficiency and death in those who fail to respond

■Cure of M. abscessus and M. chelonae pulmonary disease rare; inter-

mittent therapy for symptomatic recurrences long-term strategy

OBESITY

PATSY OBAYASHI, MS, RD, CNSD, CDE

history & physical

History

■Chronic excessive accumulation of body fat

■Calorie intake exceeds energy expenditure

Physical Signs

■Body mass index (BMI=weight in kg/height in m2)

➣BMI=25–30=overweight

➣BMI=≥^30 =obesity

➣BMI=≥^40 =extreme obesity

■Waist circumference >35 inches=risk for women

■Waist circumference >40 inches=risk for men

■Percent ideal body weight >120%