Severe infections

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  • Adverse Reactions Adverse drug reactions are frequently classified by mechanism as either dose-related ("toxic") or unpredictable. Unpredictable reactions are either idiosyncratic or allergic. Dose-related reactions include aminoglycoside-induced nephrotoxicity, linezolid-induced thrombocytopenia, penicillin-induced seizures, and vancomycin-induced anaphylactoid reactions. Many of these reactions can be avoided by reducing dosage in patients with impaired renal function, limiting the duration of therapy, or reducing the rate of administration.

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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:Rates of, and risk factors for, severe infections in patients with systemic autoimmune diseases receiving biological agents off-label...

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  • Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: First evidence of a pro-inflammatory response to severe infection with influenza virus H1N1...

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  • Streptococcal disease caused by Streptococcus iniae is without doubt one of the major bacterial diseases in fish. It has been reported to cause significant mortality in more than 12 different aquaculture species. Its distribution is worldwide in both freshwater and marine environments. The annual impact to aquaculture has been estimated to be over US$100 million. However, in the past, very few reports have described its presence in Asia.

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  • Meningitis L. monocytogenes causes ~5–10% of all cases of community-acquired bacterial meningitis in adults in the United States. Case-fatality rates are reported to be 15–26% and do not appear to have changed over time. This diagnosis should be considered in all older or chronically ill adults with "aseptic" meningitis. The presentation is more frequently subacute (with illness developing over several days) than in meningitis of other bacterial etiologies, and nuchal rigidity and meningeal signs are less common. Photophobia is infrequent.

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  • Harrison's Internal Medicine Chapter 138. Moraxella Infections Moraxella catarrhalis The gram-negative coccus Moraxella catarrhalis is a component of the normal bacterial flora of the upper airways and has been increasingly recognized as a cause of otitis media, sinusitis, and bronchopulmonary infection. Over the past several decades, this organism has been variously designated as Micrococcus catarrhalis, Neisseria catarrhalis, and Branhamella catarrhalis. Bacteriology and Immunity On Gram's staining, M.

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  • Candida species are opportunistic fungal pathogens which cause severe infections in immunocompromised patients. Due to the profound developments in medical care, the number of immunocompromised patients has increased, and so has the number of life-threatening Candida infections1. At present, Candida is the 4th most common bloodstream pathogen in North America and ranks 8th in Europe13,19.

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  • Nontypable H. influenzae Nontypable H. influenzae is a common cause of community-acquired bacterial pneumonia in adults. Nontypable H. influenzae pneumonia is especially common among patients with COPD or AIDS. The clinical features of H. influenzae pneumonia are similar to those of other types of bacterial pneumonia (including pneumococcal pneumonia). Patients present with fever, cough, and purulent sputum, usually of several days' duration. Chest radiography reveals alveolar infiltrates in a patchy or lobar distribution.

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  • Other Nondiphtherial Corynebacteria C. xerosis is a human commensal found in the conjunctiva, nasopharynx, and skin. This nontoxigenic organism is occasionally identified as a source of invasive infection in immunocompromised or postoperative patients and prosthetic joint recipients. C. striatum is found in the anterior nares and on the skin, face, and upper torso of normal individuals. Also nontoxigenic, this organism has been associated with invasive opportunistic infections in severely ill or immunocompromised patients. C.

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  • Other Syndromes Local extension causing empyema is very uncommon, and—as might be inferred from the low rate of bacteremia—metastatic complications of M. catarrhalis pneumonia, such as septic arthritis, are exceedingly rare. As of 1995, 58 cases of bacteremic infection due to M. catarrhalis had been reported, mainly in children 60 years old; most of these patients had severe underlying lung disease and/or were immunocompromised. The syndromes reported have included bacteremia with no apparent focus, pneumonia, endocarditis, and meningitis.

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  • Harrison's Internal Medicine Chapter 130. Streptococcal and Enterococcal Infections Streptococcal and Enterococcal Infections: Introduction Many varieties of streptococci are found as part of the normal flora colonizing the human respiratory, gastrointestinal, and genitourinary tracts. Several species are important causes of human disease. Group A Streptococcus (GAS, S.

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  • Enterococci may be resistant to penicillins via two distinct mechanisms. The first is β-lactamase production (mediating resistance to penicillin and ampicillin), which has been reported for E. faecalis isolates from several locations in the United States and other countries. Because the amount of β-lactamase produced may be insufficient for detection by routine antibiotic susceptibility testing, isolates from serious infections should be screened specifically for βlactamase production with a chromogenic cephalosporin or another method.

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  • Infection of the submandibular and/or sublingual space typically originates from an infected or recently extracted lower tooth. The result is the severe, lifethreatening infection referred to as Ludwig's angina (see "Oral Infections," above). Infection of the lateral pharyngeal (or parapharyngeal) space is most often a complication of common infections of the oral cavity and upper respiratory tract, including tonsillitis, peritonsillar abscess, pharyngitis, mastoiditis, or periodontal infection.

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  • Adjunctive treatments may reduce morbidity and mortality and include dexamethasone for bacterial meningitis; intravenous immunoglobulin (IVIg) for TSS and necrotizing fasciitis caused by group A Streptococcus; low-dose hydrocortisone and fludrocortisone for septic shock; and drotrecogin alfa (activated), also known as recombinant human activated protein C, for meningococcemia and severe sepsis.

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  • Table 118-5 Indications for Cardiac Surgical Intervention in Patients with Endocarditis Surgery required for optimal outcome Moderate to severe congestive heart failure due to valve dysfunction Partially dehisced unstable prosthetic valve Persistent bacteremia despite optimal antimicrobial therapy Lack of effective microbicidal therapy (e.g., fungal or Brucella endocarditis) S.

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  • Intracardiac Surgical Indications Most surgical interventions are warranted by intracardiac findings, detected most reliably by TEE. Because of the highly invasive nature of prosthetic valve endocarditis, as many as 40% of affected patients merit surgical treatment. In many patients, coincident rather than single intracardiac events necessitate surgery. Congestive Heart Failure Moderate to severe refractory congestive heart failure caused by new or worsening valve dysfunction is the major indication for cardiac surgical treatment of endocarditis.

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  • Antibiotic prophylaxis, if 100% effective, likely prevents only a small number of cases of endocarditis; nevertheless, it is possible that rare cases are prevented. Weighing the potential benefits, potential adverse events, and costs associated with antibiotic prophylaxis, the expert committee of the American Heart Association has dramatically restricted the recommendations for antibiotic prophylaxis. Prophylactic antibiotics (Table 118-7) are advised only for those patients at highest risk for severe morbidity or death from endocarditis (Table 1188).

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  • Pelvic Inflammatory Disease: Treatment The 2006 CDC guidelines recommend initiation of empirical treatment for PID in sexually active young women and other women at risk for PID if they are experiencing pelvic or lower abdominal pain, if no other cause for the pain can be identified, and if pelvic examination reveals one or more of the following criteria for PID: cervical motion tenderness, uterine tenderness, or adnexal tenderness. Women with suspected PID can be treated as either outpatients or inpatients.

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  • Microbiology and Laboratory Diagnosis These organisms are non-acid-fast, catalase-positive, aerobic or facultatively anaerobic bacilli. Their colonial morphologies vary widely; some species are small and α-hemolytic (similar to lactobacilli), whereas others form large white colonies (similar to yeasts). Many nondiphtherial coryneforms require special medium (e.g., Löffler's, Tinsdale's, or telluride medium) for growth. Epidemiology Humans are the natural reservoirs for several nondiphtherial coryneforms, including C. xerosis, C. pseudodiphtheriticum, C. striatum, C.

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  • Patients with fulminant meningococcemia often experience diffuse leakage of fluid into extravascular spaces, shock, and multiple-organ dysfunction (Chaps. 264 and 265). Myocardial depression may be prominent. Supportive therapy, although never studied in randomized, placebo-controlled trials, is recommended. Standard measures include vigorous fluid resuscitation (often requiring several liters over the first 24 h), elective ventilation, and pressors. Some authorities recommend early hemodialysis or hemofiltration.

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