Có 20+ tài liệu thuộc chủ đề "Harrisons Internal Medicine"
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Sexually Transmitted Infections:. Clinicians should order a rapid serologic test for syphilis in all cases of genital ulcer and a dark-field or direct immunofluorescence test (or PCR test, where available) for T. pallidum in all lesions except those highly characteristic of infection with HSV (i.e., those with herpetic vesicles). Table 124-7 Clinical Features of Genital Ulcers. 3 days–6 weeks. Usua...
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Table 124-8 Initial Management of Genital or Perianal Ulcer. Herpes simplex virus (HSV). Dark-field exam, direct FA, or PCR for T. RPR or VDRL test for syphilis (if negative but primary syphilis suspected, repeat in 1 week). direct FA, ELISA, or PCR for HSV. In chancroid-endemic area: PCR or culture for H. Herpes confirmed or suspected (history or sign of...
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Sexually Transmitted Infections:. Ulcerative Genital or Perianal Lesions: Treatment. Immediate syndrome-based treatment for acute genital ulcerations (after collection of all necessary hdiagnostic specimens at the first visit) is often appropriate before all test results become available, because patients with typical initial or recurrent episodes of genital or anorectal herpes can benefit from prompt oral antiviral therapy (Chap. because early treatment...
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Sexually Transmitted Infections:. Overview and Clinical Approach. Such patients should undergo anoscopy to detect rectal ulcers or vesicles and petechiae after swabbing of the rectal mucosa;. and to obtain rectal swab specimens for testing for rectal gonorrhea, chlamydial infection, herpes, and syphilis. Pending test results, patients with proctitis should receive empirical syndromic treatment—e.g., with ceftriaxone (a single IM dose of...
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Sexually Transmitted Infections:. Treatment of the source contact (often a casual contact) benefits the community by preventing further transmission. treatment of the recently exposed secondary contact (typically a spouse or another steady sexual partner) prevents both the development of serious complications (such as PID) in the partner and reinfection of the index patient. Centers for Disease Control and Prevention: Sexually...
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Health Care–. Health Care–Associated Infections. Health Care–Associated Infections: Introduction. http://www.jcaho.org. http://www.cap.org. OSH Regu Workers http://www.osha.gov. http://www.cms.hhs.gov. Health care facilities and personnel. http://www.cdc.gov/ncidod/dhq p/index.html. http://www.cdc.gov/ncidod/dhq p/hicpac_charter.html. Workers http://www.cdc.gov/niosh/. Broad (e.g., health care. http://www.ahrq.org. Broad (e.g., health care personnel). http://www.qualityforum.org. http://www.iom.edu. http://www.idsociety.org. http://www.shea-online.org. http://www.apic.org. http://www.medqic.org. http://www.ihi.org
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Health Care–. Organization, Responsibilities, and Increasing Scrutiny of Infection- Control Programs. The standards of the Joint Commission on Accreditation of Healthcare Organizations require all accredited hospitals to have an active program for surveillance, prevention, and control of nosocomial infections. Education of physicians in infection control and health care epidemiology is required in infectious disease fellowship programs and is available by...
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Health Care–. Associated Infections (Part 3). The fact that 25–50% or more of nosocomial infections are due to the combined effect of the patient's own flora and invasive devices highlights the importance of improvements in the use and design of such devices. of evidence-based interventions (Table 125-2) can reduce infection rates through improved asepsis in handling and earlier removal of...
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Urinary Tract Infections. Urinary tract infections (UTIs) account for as many as 40–45% of nosocomial infections. Although UTIs contribute only 10–15% to prolongation of hospital stay and to extra costs, these infections are important reservoirs and sources for spread of antibiotic-resistant bacteria in hospitals. Almost all nosocomial UTIs are associated with preceding instrumentation or indwelling bladder catheters, which create a...
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Control measures for pneumonia (Table 125-2) are aimed at the remediation of risk factors in general patient care (e.g., minimizing aspiration- prone supine positioning) and at meticulous aseptic care of respirator equipment (e.g., disinfecting or sterilizing all inline reusable components such as nebulizers, replacing tubing circuits at intervals of >48 h—rather than more frequently—to lessen the number of breaks in...
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The epidemic of mad cow disease, centered in the United Kingdom, and associated human cases of variant Creutzfeldt-Jakob disease (Chap. 378) caused by disinfection-resistant prion agents have led to revised recommendations for decontaminating surgical instruments, especially those used for operations on the central nervous system or in patients with dementing illness of unknown etiology.. The process of diagnosing and treating...
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Vascular device–related infection is suspected on the basis of the appearance of the catheter site or the presence of fever or bacteremia without another source in patients with vascular catheters. The diagnosis is confirmed by the recovery of the same species of microorganism from peripheral-blood cultures (preferably two cultures drawn from peripheral veins by separate venipunctures) and from semiquantitative or...
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Health Care–. Epidemic and Emerging Problems. Outbreaks and emerging pathogens are always big news but probably account for <5% of nosocomial infections. Concern about emerging pathogens often prompts authorities to require hospitals to develop contingency and response plans. The investigation and control of nosocomial epidemics require that infection-control personnel develop a case definition, confirm that an outbreak really exists (since...
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Health Care–. Important measures for the control of tuberculosis (Chap. use of negative- pressure, 100% exhaust, private isolation rooms with closed doors and 6–12 or more air changes per hour. use of N95 "respirators". (approved by the National Institute for Occupational Safety and Health) by caregivers entering isolation rooms. possible use of high-efficiency particulate air filter units and/or ultraviolet lights...
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Health Care–. Table 125-3 Controlling Antibiotic Resistance: Approaches to Consider. Conduct surveillance for antibiotic resistance.. For clonal expansion (e.g., single-strain outbreaks): Stress hand hygiene (alcohol hand rub and universal gloving). monitor adherence and give feedback.. For polyclonal expansion (e.g., multistrain outbreaks): Stress antibiotic prudence (consider antibiotic rotation for ICUs). monitor adherence and give. see also www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf.. Currently, several antibiotic resistance...
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Health Care–. Employee Health Service Issues. An institution's employee health service is a critical component of its infection-control efforts. New employees should be processed through the service, where a contagious-disease history can be taken. evidence of immunity to a variety of diseases, such as hepatitis B, chickenpox, measles, mumps, and rubella, can be sought. immunizations for hepatitis B, measles, mumps,...
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Infections in Transplant Recipients. Infections in Transplant Recipients: Introduction. The evaluation of infections in transplant recipients involves consideration of both the donor and the recipient of the transplanted organ. Infections following transplantation are complicated by the use of drugs that are necessary to enhance the likelihood of survival of the transplanted organ but that also cause the host to be...
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Infections in Transplant Recipients. In many transplantation centers, transmission of infections that may be latent or clinically inapparent in the donor organ has resulted in the development of specific donor-screening protocols. examine chest radiographs for evidence of granulomatous disease, and should perform purified protein derivative (PPD) skin testing or obtain blood for immune cell–based assays that detect active or latent...
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Infections in Transplant Recipients. Bacterial Infections. In the first month after hematopoietic stem cell transplantation, infectious complications are similar to those in granulocytopenic patients receiving chemotherapy for acute leukemia (Chap. Because of the anticipated 1- to 3- week duration of neutropenia and the high rate of bacterial infection in this population, many centers give prophylactic antibiotics to patients upon initiation...
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Within the first 2 weeks after transplantation, most patients who are seropositive for HSV-1 excrete the virus from the oropharynx. Administration of prophylactic acyclovir (or valacyclovir) to seropositive HSCT recipients has been shown to reduce mucositis and prevent HSV pneumonia (a rare condition reported almost exclusively in allogeneic HSCT recipients). Both esophagitis (usually due to HSV-1) and anogenital disease (commonly...