Immunosuppressed patients

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  • Renal and Ureteral Infections Infections of the urinary tract are common among patients whose ureteral excretion is compromised (Table 82-1). Candida, which has a predilection for the kidney, can invade either from the bloodstream or in a retrograde manner (via the ureters or bladder) in immunocompromised patients. The presence of "fungus balls" or persistent candiduria suggests invasive disease. Persistent funguria (with Aspergillus as well as Candida) should prompt a search for a nidus of infection in the kidney. Certain viruses are typically seen only in immunosuppressed patients.

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  • Typhlitis Typhlitis (also referred to as necrotizing colitis, neutropenic colitis, necrotizing enteropathy, ileocecal syndrome, and cecitis) is a clinical syndrome of fever and right-lower-quadrant tenderness in an immunosuppressed host. This syndrome is classically seen in neutropenic patients after chemotherapy with cytotoxic drugs.

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  • Neoplastic disease In most cases, the cause of cancer is multifactorial. About 75% of cancers are due to environmental factors, some of which are within the control of the individual, e.g. tobacco smoking, exposure to sunlight. Growing understanding of cancer genetics and inherited disease suggests that fewer than 10% of cancers are familial.The different systemic modalities used to treat cancer patients are discussed. Immunosuppressive drugs are described here as they share many characteristics with cytotoxics. ...

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  • Endophthalmitis This occurs from bacterial, viral, fungal, or parasitic infection of the internal structures of the eye. It is usually acquired by hematogenous seeding from a remote site. Chronically ill, diabetic, or immunosuppressed patients, especially those with a history of indwelling IV catheters or positive blood cultures, are at greatest risk for endogenous endophthalmitis. Although most patients have ocular pain and injection, visual loss is sometimes the only symptom.

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  • Candidiasis: Treatment Treatment involves removing any predisposing factors such as antibiotic therapy or chronic wetness and the use of appropriate topical or systemic antifungal agents. Effective topicals include nystatin or azoles (miconazole, clotrimazole, econazole, or ketoconazole). The associated inflammatory response accompanying candidal infection on glabrous skin can be treated with a mild glucocorticoid lotion or cream (2.5% hydrocortisone).

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  • To identify differences in the clinical, radiologic, and microbiologic features of pulmonary tuberculosis (TB) in the young (factors after initiation of anti-TB medication. Most importantly, the severe immunosuppression that characterizes the post-HSCTperiod may have a deleterious e¡ect on response to anti-TB treatment. In this study, we report on 2 childrenwho showed a di¡ering clinical course after treatment for pulmonaryTB diagnosed after allogeneic HSCT for acute lymphoblastic leukemia (ALL)....

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  • Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: High frequency of corticosteroid and immunosuppressive therapy in patients with systemic sclerosis despite limited evidence for efficacy...

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  • Our aim was to evaluate the effect of human immunodeficiency virus (HIV) disease stage on chest radiographic (CXR) findings among patients with HIV-related pulmonary tuberculosis (TB). Data are from a prospective multicenter treatment trial for HIV-related TB. Baseline CXR findings and CD4/ lymphocyte counts were compared among patients with HIV-related TB. Data from published studies describing CXR findings in HIV-infected patients were reviewed and a pooleddata analysis was conducted. Of 135 patients with culture-confirmed HIV-related TB, 128 had both CXR and CD4/ lymphocyte data.

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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Progressive multifocal leukoencephalopathy in a patient without apparent immunosuppression

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  • This book reflects a major medical problem which is still under thorough studies. There is a number of clinical cases corresponding directly or indirectly to a certain alteration of the immune system, thus leading to various pathologic conditions. The unique defense, what humans have with their immunity, is rather often affected by infections, tumor processes, organ, tissue and cell transplantation, allergy, autoimmune processes, as well as different influences by the environment.

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  • Immunosuppression significantly decreases the ability of young poultry to respond effectively to standard vaccinations, and also predisposes them to infection by other specific pathogens. How- ever, sub-clinical immunosuppression is often not readily appar- ent to the farmer, and therefore a common “silent” cause of significant economic losses. Pathogens causing such infectious disease conditions are termed “erosive” for site productivity (Shane, 2004).

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  • Adenoviruses have been recognized as opportunistic and significant viral pathogens in immunocompromised patients such as recipients of hematopoietic stem cells or other solid organs treated with immunosuppressive agents, and among patients with acquired immunodeficiency syndrome. These patients are incapable of developing a normal immune response. Reactivation of adenoviruses in the impaired immunological response leads to acute or persistent infections with high morbidity or even mortality in these patients.

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  • Hospitals, by their very nature, are dangerous places. Sick and infected patients are clustered together in one institution, often in close proximity to those who are immunosuppressed due to recent surgery, chemotherapy or transplantation. Contact between these various patient groups is easily achieved via the hands of healthcare workers (HCWs), use of shared equipment or the hospital’s air handling system.

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  • Encephalitis and Encephalomyelitis: Treatment Most types of paraneoplastic encephalitis and encephalomyelitis respond poorly to treatment. Stabilization of symptoms or partial neurologic improvement may occasionally occur, particularly if there is a satisfactory response of the tumor to treatment. The roles of plasma exchange, IVIg, and immunosuppression have not been established. Approximately 30% of patients with anti-Ma2-associated encephalitis respond to treatment of the tumor (usually a germ-cell neoplasm of the testis) and immunotherapy.

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  • Outcomes following both transplant and immunosuppression have improved with time. High doses of cyclophosphamide, without stem cell rescue, have been reported to produce durable hematologic recovery, without relapse or evolution to MDS, but this treatment can produce sustained severe fatal neutropenia and response is often delayed. New immunosuppressive drugs in clinical trial may further improve outcome.

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  • Pneumocystis jiroveci pneumonia, once seen in 5–10% of patients, can be prevented by treating patients with oral trimethoprim-sulfamethoxazole for 1 week pretransplant and resuming the treatment once patients have engrafted. The risk of infection diminishes considerably beyond 3 months after transplant unless chronic Most GVHD transplant develops, centers requiring recommend continuous continuing immunosuppression. trimethoprim-sulfamethoxazole prophylaxis while patients are receiving any immunosuppressive drugs and also recommend careful monitoring for late CMV reactivation.

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  • Middle-Period Infections Because of continuing immunosuppression, kidney transplant recipients are predisposed to lung infections characteristic of those in patients with T cell deficiency (i.e., infections with intracellular bacteria, mycobacteria, nocardiae, fungi, viruses, and parasites). The high mortality rates associated with Legionella pneumophila infection (Chap. 141) led to the closing of renal transplant units in hospitals with endemic legionellosis.

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  • Chryseobacterium Species (Formerly Flavobacterium) C. meningosepticum is an important cause of nosocomial infections, including outbreaks due to contaminated fluids (e.g., disinfectants and aerosolized antibiotics) and sporadic infections due to indwelling devices, feeding tubes, and other fluid-associated apparatuses. Patients with nosocomial C. meningosepticum infection usually have underlying immunosuppression (e.g., related to malignancy). C.

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  • The field of solid organ transplantation has developed enormously in the last three decades andwhat was pioneering surgery has now become routine. Outcomes are no longer considered in terms of 1-year survival, but clinicians and patients are looking to 20 years and beyond. The current success of transplantation is based on many different factors: developments in surgical technique, better immunosuppression, improved anesthetic and intensive care, improved microbiology, and close collaboration between – all those involved in the transplant pathway have contributed....

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  • The Transplant Preparative Regimen The treatment regimen administered to patients immediately preceding transplantation is designed to eradicate the patient's underlying disease and, in the setting of allogeneic transplantation, immunosuppress the patient adequately to prevent rejection of the transplanted marrow. The appropriate regimen therefore depends on the disease setting and source of marrow.

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